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Flights a Necessary Risk?

June 24, 2008

By Holly Huffman, The Eagle, Bryan, Texas

Jun. 22–When three 18-wheelers and a truck collided and burst into flames nearly two weeks ago in Robertson County, it took 35 minutes for a medical helicopter to arrive on the scene.

Normally, it would have taken just 15 minutes for a PHI Air Medical air ambulance to fly from its base at Coulter Field in Bryan to rural Robertson County, emergency medical officials said.

But June 10 wasn’t normal.

Just days earlier, the Bryan-based Med 12 helicopter had crashed while en route to Houston from Huntsville, killing its three-person flight crew and the patient whose life it was trying to save. As a result, service from the Bryan base was temporarily suspended and surrounding PHI bases — as well as helicopters from other companies offering air ambulance service — have been covering the Brazos Valley.

So when Robertson County emergency responders sought help that afternoon, helicopter response time more than doubled, said Brenda Putz, trauma coordinator at St. Joseph Regional Health Center and president of the Brazos Valley Regional Advisory Council, which governs regional trauma and acute care.

“Twenty minutes may not sound like much to the layperson,” Putz said, discussing the importance of local air ambulance service during a recent interview. “But for me, I know that 20 minutes may mean the difference in life and death for someone. It’s huge for our community and for our trauma patients.”

Putz and fellow area emergency medical officials say its hard to quantify the impact made by PHI since the Bryan base opened in 2005. Neither St. Joseph nor College Station Medical Center keeps data on the number of patients brought in by Med 12 or their mortality rate.

PHI Air Medical doesn’t keep specific statistics either, though company spokesman Jonathan Collier said the Bryan base averaged one to three transports each day. In just three years, that’s at least 1,000 patients — and possibly closer to 3,000.

But despite the lack of hard evidence, many emergency responders have said they feel sure the service has made a life-saving difference.

Rick Moore, trauma coordinator for the College Station Medical Center, said he believes patients who are transported by air have a lower mortality rate — he just can’t prove it.

One of the biggest benefits of air ambulance service is the speed of travel, Moore said, adding that a helicopter can reduce travel time by as much as 30 minutes depending on the time of day, traffic and the location of the accident. The type of care provided by flight paramedics also is more advanced than what a patient would receive in a ground ambulance, he said.

Medical helicopters are mobile intensive care units, Moore said. Flight paramedics often can perform procedures their road-based counterparts can’t, and the helicopter generally is equipped with O negative blood for emergency transfusions, he said.

“The addition of air ambulance service to the Brazos Valley in 2005 is an absolute godsend,” Moore said in an e-mail to The Eagle last week.

Critics of air ambulances contend that the service is simply too dangerous. Some argue that traveling by helicopter isn’t that much faster than by ground ambulance, considering the time a patient has to wait for a chopper to arrive.

That may be true in larger cities, Putz said. But helicopter service can mean the difference between life and death for trauma patients — those who have been in a major car accident or suffered from a heart attack or stroke — in rural areas, she said.

Both St. Joseph and The Med are designated level III trauma centers, which means they can provide basic care for trauma patients. However, severely injured patients needing a higher level of care must be transferred to level I or level II facilities. Level I and II facilities offer nearly the same services, Putz said, explaining that the top-tier hospitals also engage in extensive research.

University Medical Center at Brackenridge in Austin is designated a level II trauma center, she said. Scott & White Hospital in Temple and Memorial Hermann and Ben Taub General hospitals in Houston are designated level I.

While St. Joseph can handle many of the patients brought in, Putz said, many others must be shipped out. Pediatric patients with major trauma, burn victims and those in need of limb salvage all are transferred to higher-level trauma centers.

In Houston, ground ambulances and hospital facilities are spread throughout the city, providing quick access. But Putz said that isn’t the case in rural places such as Robertson, Leon and Burleson counties. It could take half an hour just to get an ambulance to a rural accident site and then another hour to drive a victim to the Bryan-College Station area, she said.

Add another 100 miles to that trip if the patient is severely injured and needs to go to a level I trauma facility, she said.

“By air, it’s 14 minutes,” Putz said of travel time from the Bryan-College Station area to Houston. “By ground — even with lights and sirens — if you can do it in 45 minutes … I’m not sure that’s safe.”

Moore said the Brazos Valley Regional Advisory Council authorizes air ambulances to take a severely injured patient directly to a level I trauma center if it is deemed necessary. Patients transported by ground ambulance must be taken first to a local facility, where federal law requires a medical evaluation before they can be transferred.

Some injuries — such as unstable pelvic fractures and spinal injuries — can be exacerbated in a ground ambulance because of the jostling that happens when traveling by road, he said.

Moore argued that statistics prove that air ambulances aren’t more dangerous than those that travel by ground.

More than 32 emergency medical service professionals die each year as a result of ground ambulance crashes, Moore said, citing a study quoted in the April 2007 edition of the Journal of Emergency Medical Services. That figure is three times the number of professionals who die as a result of air ambulance crashes, the study states.

“Is the PHI crash a tragedy? Yes, it is, as is any crash and/or line of duty death or injury of an emergency responder. Did I lose three friends the morning of June 8? Yes, I did,” Moore wrote in his e-mail. “Will I hesitate to call an air ambulance if I feel the patient’s best interest will be served by air transport? Absolutely not!”

PHI spokesman Collier noted that any member of the PHI flight crew can terminate a mission that doesn’t seem safe.

“Any member of the crew has the ability at any time and without recrimination to decide they do not want to go on the flight and it is canceled,” Collier said last week by e-mail. “For any reason: weather, maintenance, rest, not feeling good, gut feeling, etc. Our saying is ‘Three to go, one to say no.’”

Officials with the Bryan base are expected to meet Monday to decide when to resume service. Until then, other air ambulance services can be called upon when Brazos Valley emergency responders need help. Copters from neighboring PHI bases can be in the Bryan-College Station area within a half-hour, Putz said, and those stationed in Killeen and La Grange can arrive within 35 minutes to an hour.

But all of that cuts into what emergency medical responders call the “golden hour,” Putz said. Chances of survival are greatest if a seriously injured patient can receive definitive care within 60 minutes of being injured.

The disruption of Bryan-based air ambulance service could have deadly consequences for some Brazos Valley residents, Putz said.

“They get the worst of the worst [patients],” Putz said, noting that her son is a member of the PHI flight crew. “It’s truly an intensive-care unit in the air. When we turn that patient over to them, we know we’re turning them over to the best. That’s what’s important to all of us.”

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