|
In This Issue...
|
|
|
|
|
|
|
|
More Accident Victims Taking Costly Flights to Trauma Centers
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
More Accident Victims Taking Costly Flights to Trauma Centers
Summer Traffic Soars for Air Ambulance Transports
By Michael Thomas
Over the past five years, the number of local accident victims flown by helicopter to Santa Clara County trauma centers has more than doubled. In 2005, the County’s EMS agency tracked the outcomes of 234 patients flown over the Santa Cruz Mountains, though the real number of flights may be higher.
By comparison, only about a hundred patients were flown out in 2000 and only 161 in 2004, according to an annual assessment released in June. Of the 234 accident victims in 2005, 63 people, or 28 percent, were later found to have only minor trauma not requiring critical care.
Recently, a citizen complained to the Board of Supervisors that helicopter transfers are creating huge bills for the public health system. County supervisors are expecting a report explaining the apparent increase at their meeting on Tuesday, Aug. 22.
“All of us have noticed that it seems like everything is getting on those [helicopters,]” said County Supervisor Ellen Pirie. “It looks like it will be even more this year.”
EMS Medical Director Kent Benedict, a former emergency room physician and proponent of the current system under which transports have increased, says the evaluation system that field paramedics follow hasn’t recently changed. He added that some unnecessary transfers are inevitable.
“We have frequently only minutes to make those decisions,” he said. “As a result, we will have patients that go to expensive trauma centers that don’t need it. But we need to do it to get the patients there that need it.”
Santa Cruz County does not have a trauma center, and must refer extremely critical cases to one of three facilities in Santa Clara County.
Benedict said there’s always variation in the number of flights annually, but he recognizes that there’s been an increase.
“Indeed, the hospitals have been busier and there have been more times of ‘code red’, but in our assessment that has not been a factor in which patients get transferred,” he said.
Code red is the term used when a local hospital’s emergency room is full and unable to accept incoming patients. Dominican Hospital spokespersons, contacted earlier this summer about the uptick in air ambulance traffic, were unable to say if the facility had reached code red and if so, how frequently.
Summer Busier Than Ever
During a two-day period in July, dispatch reports showed a total of 14 calls for helicopter transport. In some cases, the helicopter may have been recalled if first responders determined that a transfer was not required. But in some recent incidents, accident victims have reportedly been flown out, only to walk out of the hospital with minor injuries shortly thereafter.
In such cases, insurance companies may refuse to pay for the flight. Stanford’s LifeFlight charges an average of $11,207.
Benedict believes a variety of factors are responsible for the increased use of helicopters.
“We were probably keeping too many patients in Santa Cruz County previously,” he said. Since car crashes account for almost half of all trauma incidents, increasing congestion on local roads could also play a role.
“Summertime is typically one of the busiest times of the year because we have so many vehicles on our highways,” Benedict added.
County Staff Stands by Evaluation Procedure
EMS Manager Celia Barry believes the triage system is working well.
“I am quite proud of the system that we have where the patients that need trauma care most can get it,” she said.
Emergency personnel responding to an accident scene in Santa Cruz County use the MAP Score system, which stands for Mechanism, Anatomy and Physiology. Obvious complications in any of those categories earn a patient a point, with a maximum score of three. A score of two means a field paramedic, and in some cases a fire captain, can call for air transport.
“Somebody who’s been in a motor vehicle accident and medics see that there was a rollover or the person was ejected, that person would get one point for mechanism,” Benedict explained. “If there’s evidence of penetrating or blunt injury that would be another point.”
In about 20 percent of cases a helicopter is not available, often due to foggy coastal weather. That could change soon. Barry said a weather sensor is being installed at Dominican to help pilots on instrument controlled landings. This reduces the visibility required for a helicopter to land.
Barry said the application has been submitted and approval could come within a year.
As to the considerable number of transfers that turn out to be unnecessary, Benedict said some counties have an “over-triage” rate of between 35 percent and 50 percent. He believes the rate here, which dropped from 32 percent in 2004 to 28 percent in 2005, is relatively low.
Barry pointed out that, “A patient can always refuse transportation if they believe it’s not necessary.”
|
