The Ethics of Air Ambulances

[HemeOncHopeful19]

As someone not in EM, is there any medicolegal aspect to deciding on ground vs air? I think I read through the whole thread and didn’t see it come up. Could it be that some inappropriate transfers using air ambulance are done playing defensive medicine for instance?

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[cyanide12345678]

Hmmmm... Are we talking about Life Flight for transfers?
I sometimes use this service on critical care patients when I am working at the rural critical access site. Is there something wrong with doing that?
The Life Flight crew is just way better and more skilled than the ground crews.

They are. But the patient eventually gets a 20-50k bill, which insurance may or may not cover.

 

[cyanide12345678]

As someone not in EM, is there any medicolegal aspect to deciding on ground vs air? I think I read through the whole thread and didn’t see it come up. Could it be that some inappropriate transfers using air ambulance are done playing defensive medicine for instance?

I don't think as a physician you can ever get into trouble for being too safe.

Patients can also refuse certain things too.

 

[cyanide12345678]

Same here. I work at a critical access hospital 45 minutes from my main metro area. The nurses prompt to activate air transport on stable things like DKA. I push back as much as I can, but sometimes it's not worth fighting them.

Had one of the air-ambulance nurses trying to intubate my 34 yo GCS 15 hemi-plegic ICH patient, cuz "You know doc the aircraft is small and it's a nightmare to intubate in the dark up there if she loses her airway". Fortunately I put a stop to it.

Having been a flight doc in residency, it is a nightmare to manage airway mid flight. Though, they always have supraglottic devices with them, and can easily insert them mid flight without any issue. So you can always remind them that they have supraglottic devices for the exact reason if airway deteriorated in flight.

 

[FLTDOC1]

Quantity and quality of medical care in HEMS is basically left up to the individual programs . Incredible disparity from one program to another depending on financial structure. It is highly unregulated. Without specific knowledge about a given program Never assume a "higher level of care".

 

[aafisahar]

They are. But the patient eventually gets a 20-50k bill, which insurance may or may not cover.

i had a family member who needed a flight and insurance paid a maximum of 10k; total bill was like 60k just for the flight. the flight med company didn't negotiate down and they are paying like 1g/month after arbitration.

 

[WheezyBaby]

What's a typical cost for something like a 3 hour ground critical care transport? Is there any homogeneity with insurance companies capping reimbursement for air transport but not for ground transport or does that tend to be an across the board "emergency transport" cap

 

[southerndoc]

Usually an SCT (specialty care transport) bills a base rate ($1000-2000 on average) plus mileage ($7-12/mile). Most counties set the rates for ambulance providers. I do not recall what our rate is off hand, but we contract with two private ambulance services for transport. They bill at the rate we have listed in the contract. CMS and insurers usually reimburse less. We do not regulate SCT as this is usually only for interfacility transports.

 

[cyanide12345678]

What's a typical cost for something like a 3 hour ground critical care transport? Is there any homogeneity with insurance companies capping reimbursement for air transport but not for ground transport or does that tend to be an across the board "emergency transport" cap

Significantly less issues with insurance company paying for an ambulance ride vs a helicopter ride.

Most of the time when we get a helicopter, there is a chance we're bankrupting that person, assuming they are one of those people that pay bills, many of our ER customers however aren't as we all know.

Unless i personally had a STEMI, dissection, or AAA, or something truly that's going to drop me dead and time matters, i personally wouldn't want to fly.

 

[RoyBasch]

As someone not in EM, is there any medicolegal aspect to deciding on ground vs air? I think I read through the whole thread and didn’t see it come up. Could it be that some inappropriate transfers using air ambulance are done playing defensive medicine for instance?

Obviously this is a fairly unusual hypothetical situation, but what if you flew a patient for a thin indication (say not too truly emergent) rather than ground, and the helicopter crashes and the patient dies. Can they allege malpractice (standard of care would have been "safer" ground transportation)? As Cyanide noted above, I would assume from a purely medical perspective (financial not considered) getting a helicopter is the "safest" option in terms of highest level of care available for EMS transport, so as he said, you can't be sued for being "too safe." But I don't know.

 

[turkeyjerky]

Obviously this is a fairly unusual hypothetical situation, but what if you flew a patient for a thin indication (say not too truly emergent) rather than ground, and the helicopter crashes and the patient dies. Can they allege malpractice (standard of care would have been "safer" ground transportation)? As Cyanide noted above, I would assume from a purely medical perspective (financial not considered) getting a helicopter is the "safest" option in terms of highest level of care available for EMS transport, so as he said, you can't be sued for being "too safe." But I don't know.

Frankly, I think there’s a better malpractice case there than a lot of the BS out there. I seem to recall a case published in one of the malpractice newsletters where one if the claims was related to a delay in transport when they waited 4 hrs for a helicopter, but were only an hour or so away from the receiving facility.