Saving Time, Lives: Emergency Medical Copters Parked Atop Metro Hospitals Might Look Cool, but Basing the Air Ambulances in Rural Areas With the Greatest Needs Can Mean Faster Flights and the Difference Between Life and Death.
Posted on: Saturday, 26 August 2006, 06:00 CDT
By Jeremy Olson, Pioneer Press, St. Paul, Minn.
Aug. 26--The pilot picked the landing pad of the Grantsburg hospital out of the tree-lined horizon of western Wisconsin and dipped a LifeLink III helicopter to the ground.
The helicopter, code-named Seven Alpha Mike, had jetted from New Richmond with sketchy details -- elderly woman, heart attack, transport to Minneapolis.
Turbulence rattled the cabin as the rotors pounded air to the ground, but soon the helicopter touched down. Nurse Candy Stover and medic Mark Cusick rushed a gurney into the hospital.
Seven Alpha Mike on scene: 3:11 p.m.
Metro hospitals used to keep helicopters atop their roofs because -- as one rescue official says -- it "looked cool," but have tried in recent years to cut response times by moving their bases to the rural locations that generate most flights. While the race to these hot spots has intensified competition, which can disrupt emergency service and create costly redundancies, executives for Minnesota's air ambulance services said the only outcome has been faster flights.
LifeLink used to send helicopters from downtown St. Paul, which is 18 miles farther from Grantsburg. By starting at the New Richmond airport on Aug. 14, Seven Alpha Mike had a nine-minute head start.
"If we can cut those minutes, it saves lives, bottom line," said Kristin Brand, a spokeswoman for LifeLink, which is affiliated with six Minnesota hospital groups.
Last year, LifeLink placed helicopters in New Richmond, Wis., and Hutchinson, Minn. This summer, a base opened in Eden Prairie. North Memorial Air Care opened bases in Princeton, Minn., and Lakeville within the last year. The Mayo Clinic added a helicopter in Mankato, Minn., in late 2004.
Executives with these hospital-affiliated helicopter services said they opened bases in areas of need -- even if competitors were nearby. This explains why North's Princeton base is so close to LifeLink's St. Cloud, Minn., base, and why its bases in Lakeville and Eden Prairie are seven minutes from one another.
No central 911 dispatch exists for helicopters. The strategy is to open bases in prime locations and then woo neighboring hospitals to call them first.
While the state licenses air ambulance services, it does not regulate their boundaries.
Minnesota, however, limits the number of ground ambulances that can serve in any one community in order to prevent competitive conflicts, such as distant ambulances taking calls even though competitors are closer.
Having more than one helicopter in one area can be a good thing, said Andrew Kirchoff, LifeLink's executive director. North, LifeLink and Mayo all rely on one another for backup. Any helicopter services that get greedy and hoard calls will end up with long response times and angry hospitals.
"We have customers with stopwatches," Kirchoff said. "They hold us accountable for our time."
Myrtle Fahland didn't want to be at Burnett Medical Center in Grantsburg, and she certainly didn't want a helicopter ride. She had left her dentist in pain and collapsed at home, but barely wanted her husband to call an ambulance.
"I'm 83 years old," she said. "I don't need this. I don't want to go."
Tests showed signs of a major heart attack. She needed intensive cardiac care within 90 minutes, but it wasn't available at Burnett.
A nurse called North Memorial, but its closest helicopter was fighting 20-knot winds back to Princeton. LifeLink's New Richmond crew took the call instead, and was airborne in four minutes.
Fahland tensed up as the medics lifted her onto a gurney. It felt so thin. "I'm on the edge," she moaned. But soon the crew slid her into the helicopter and latched the door.
Seven Alpha Mike to Minneapolis: 3:24 p.m.
THE "GOLDEN HOUR"
Helicopter crews have tried all sorts of time-savers to keep their flights within the "golden hour," an unscientific term for getting patients to hospitals within an hour. When accident victims need breathing tubes, for example, medics insert them in flight instead of on the ground.
The opening of rural bases has made an immediate difference, air ambulance executives said. By shortening the distances to hospitals or accidents scenes, the moves have also bought extra time for medics to ensure patients are stable before they take off.
"Twenty-one years ago, the business model was you had the helicopter at the hospital, because it looked cool," said Mike Parrish, director of North Memorial's ambulance service, which also placed helicopters in Redwood Falls and Brainerd, Minn., in 2000. "We knew that we needed to start putting our ships closer to where the patients were."
It took 62 minutes, on average, for medical helicopters to fly to trauma scenes and then transfer patients to their destination hospitals from July 2005 through June 2006, according to flight data from the state's Emergency Medical Services Regulatory Board.
It's too early to tell whether that time is significantly better than it was when the helicopters flew from Twin Cities rooftops.
One in three calls involve accidents or trauma. More and more flights are for victims of heart attacks or stroke, whose chances of survival are better if they are moved quickly to metro hospitals that specialize in cardiac or neurological care. LifeLink also transports babies born prematurely in rural hospitals to intensive neonatal care in the Twin Cities.
Fahland's blood pressure increased as the helicopter rose. Nerves probably, but Stover, the nurse, calmly increased her intravenous medication.
"Keep talking," the medic, Cusick, said as he squeezed Fahland's hand to ensure she was alert. Fahland squeezed back.
The scream of the helicopter's twin jet engines drowned any other noise inside, so Fahland raised her hand to talk. Stover removed the headphones from one ear and leaned cheek to cheek so she could hear.
"Where are we?" Fahland asked.
Seven Alpha Mike 10 minutes out: 3:42 p.m.
COMPETITIVE CONCERNS
Six helicopter services carry out most of the ambulance runs in Minnesota. All are affiliated with hospitals, which the executives said takes away some of the financial motives when compared with for-profit outfits elsewhere in the country. Leaders of the six groups meet regularly to discuss safety and efficiency.
However, a U.S. Institute of Medicine report on emergency response noted that hospital-based services have potential conflicts. Helicopters might bypass competitors' hospitals, for example, even if they are closest.
The issue surfaced in Pennsylvania in 2001, when a helicopter crew bypassed a trauma hospital to take a child to an affiliated pediatric hospital. The boy died during the ride. State officials later upheld the crew's decision, but created strict new guidelines governing when medical helicopters could bypass the nearest trauma centers.
State data suggest this isn't an issue in Minnesota. Only one of four North Memorial flights drops patients at North Memorial Medical Center in Robbinsdale. Patients or their families pick the destination hospital more than half the time, according to the state database.
When Dakota County switched its primary helicopter service because LifeLink moved too far away after leaving St. Paul, it made North Memorial promise to take patients to the closest hospitals, and not bypass them en route to Robbinsdale.
"We've made it clear it is unacceptable to do otherwise," said Dakota County EMS coordinator Kevin Miller.
A HAPPY ENDING
Standing on the roof of Abbott Northwestern Hospital, Barb Unger was anxious. She checked her watch. It had been nearly an hour.
She created Abbott's Level I heart attack program, by which patients are transported from rural hospitals to get immediate intensive cardiac care. The goal is to carry out angioplasties that open up clogged arteries within 90 minutes of attacks.
At 3:52 p.m., Seven Alpha Mike cut through the strong easterly gusts to land atop Abbott's helipad. Cusick and Stover turned the gurney out of the helicopter and down the ramp toward a waiting elevator, which was preprogrammed to bypass all other floors on the way down to the cardiology lab.
Drugs had kept Fahland's heart beating, but one artery was almost completely shut. Doctors inserted a stent to open it, and inserted four others to treat partial blockages. Fahland would go home two days later, laughing at her reluctance to take the flight.
The crew of Seven Alpha Mike climbed back into the helicopter to return to New Richmond, refuel and get ready for the next call.
Seven Alpha Mike en route to New Richmond.
Staff photographer Richard Marshall contributed to this report.
Jeremy Olson can be reached at jolson@pioneerpress.com or 651-228-5583.
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Copyright (c) 2006, Pioneer Press, St. Paul, Minn.
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Source: Saint Paul Pioneer Press (St. Paul, Minn.)
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