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MedEvac cost effective with modest use improvements

By Trevor Stokes

NEW YORK (Reuters Health) - Emergency helicopter transport is expensive, but could become cost effective if it's used mainly for cases where it will make a measurable difference in trauma patients' survival or long-term disabilities, according to a new analysis.

"For the routine use of helicopter emergency medical services to be considered good value for our health care dollars, there needs to be a modest reduction in mortality or some reduction in disability among patients who are flown out with serious injuries," said study author Dr. Kit Delgado, an instructor of emergency medicine at Stanford University Medical School.

But he noted to Reuters Health, "there's relatively little guidance based on the data how to best use helicopter EMS for trauma."

The analysis comes at a time when the healthcare industry is looking for cost savings, and weighing the evidence supporting heroic and expensive measures.

Ground ambulances typically cost nearly seven times less than the average $6,500 helicopter transport - although air transport has the advantage of speed and the ability to take patients across difficult terrain.

The debate is not merely academic: Close to 25 percent of U.S. trauma patients are uninsured and can get stuck with large medical bills after a helicopter transport.

The big question, experts said, is how to avoid transporting patients with minor injuries via resource-intense helicopters yet make sure that critically-injured patients don't get left behind, figuratively speaking.

To better understand long-term financial costs of using helicopters to transport trauma patients, Delgado and colleagues did a cost-benefit analysis of helicopter versus ground transport.

The researchers modeled cost estimates and the risks of dying in a group of nearly 161,000 patients who went to U.S. trauma centers by helicopter or by ambulance.

In addition to those modes of transport, the researchers modeled costs such as potential transportation accidents, hospital expenses, patients' loss of work (to disability) and lifetime medical costs.

In a hypothetical trauma center that accepts 400 patients per year, Delgado and his colleagues found that about half would have minor injuries more appropriate for ground transport but that might not be apparent to EMS crews. Of the remaining 200 severely-injured patients requiring trauma care, on average, 20 would die.

If 17 died instead, however - that is, if an additional three patients survived - the extra cost of helicopter transport would be good value for the money, the team reports in the Annals of Emergency Medicine.

"Helicopter EMS becomes a much better value if we figure out who are the right patients to be transported," Delgado told Reuters Health.

"One way to improve the system is to have greater physician involvement," said Sam Galvagno Jr., assistant professor at the R. Adams Cowley Shock Trauma Center at the University of Maryland, who was not involved in the new study.

Maryland recently halved the number of helicopter flights by linking EMS workers directly with trauma physicians who can request additional medical information and help judge whether air transport is appropriate, Galvagno told Reuters Health.

Ongoing research shows that patient mortality doesn't seem to have increased, suggesting that large reductions in air transport are possible without harming patients, according to Galvagno.

Dr. Eileen Bulger, chief of trauma at Harborview Medical Center in Seattle, which serves five states, said an integrated system wherein EMS, trauma doctors and transportation services work in coordination works best.

Some places have competing air medical services that aren't integrated with the trauma system, "an area we could improve on," said Bulger, who also was not involved in the current study.

The public may not be directly involved in the debate over trauma transport costs, but if asked many people would be glad to have helicopter transport available should they ever need it, regardless of the cost, one expert noted.

"Helicopter transport does not have a particularly favorable cost effectiveness profile in relation to other interventions like drugs or medical services," said Colman Taylor, a health economist with the George Institute for International Health in Sydney who researched the cost-benefit of helicopter services in Australia.

Still, Taylor told Reuters Health, "The public may be willing to pay a higher cost effectiveness profile for helicopter transport because for whatever reason they value the option."

SOURCE: bit.ly/Zrh8jZ Annals of Emergency Medicine, online April 11, 2013.

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