Re: Medical helicopter bill is 'a tough pill to swallow'

[Guest guest]

What Dave Lieber don't know is that this is all too uncommon, not only in places

like Benbrook, but even in small rural places like Eastland County. Like Doc B

has said, there is an abuse of the system. Please don't anyone get me wrong,

they (air medical) are a vital assest to the pre-hospital setting and do save

lives, when they are used the right way.

It seems that here, the provider for 75% of the county can't make a call without

asking for air medical support. In the case of an active STEMI or Stroke,

that's understandable. But when you start flying out the diabetic pt that you

run on a routine bases, that's an abuse of the system. It seem that the only

time they are not asking for Southwest is on return calls from the hospital to

the local nursing home.

Had this call happened here, there would have been a 98% chance that the local

EMS would have been calling for air medical to transport. The last time that I

checked, those on the ambulance here were certified as EMTs and Paramedics,

meaning they should have the training to handle just about any call that they go

on and should be able to ground pound it to the hospital. One of the biggest

things you see here, is EMS will drive to the hospital and sit on the pad

waiting for air-medical to arrive. I was always taught that if you have to wait

30 minutes for air-medical, that you should take them into the hospital, even if

it is a level 4, that is better than waiting.

As Doc B said, this is not only an EMS problem, but also a hospital problem.

Had a family member that was sent to Ft.Worth for a possible MI and at no time

were they notified that they were being sent by helicopter. They were stable,

no changes in 12 lead, labs were off, which was later determined to be a false

positive. So, they were flown for nothing and had a bill for about $8,000 that

was not warranted. So, where do we start with the education on where and when

to call for air-medical?

The article also talks about something else that I have a problem with, and that

is calling for air-medical support that is not closer to the call or scene. For

this area, it would be like someone calling for STAT Air when CareFlite or

Air-Evac maybe closer to the scene. This is something that local EMS will do.

If SWA is not available, they refuse to call for the next closer provider, but

will call another one further away. Again, I was always taught that you call

the one closer to the scene. But, when the local EMS has members that either

work or have worked for their favorite one, they tend to call only that one. I

have a membership with both of the providers in this area that sell memberships,

and if needed, will call them direct before calling for local EMS.

I know that its up to the EMS crew on scene when they decide to call for

air-medical support and they have to do so with the best interest of the pt in

mind. Last time that I flew out a pt, it was warranted. 4-5 stab wounds to the

left side, with a knife of unknown length. But, it didn't take 30 minutes for

the helicopter to arrive, so no sitting on the pad and the helicopter with the

shortest time to the scene was called.

If I need air-medical support, then call the one that is closer to me at the

time, and not the one that provides you with the free meals. I have nothing

against any air medical program, because as I said, they are vital to pt care,

but we should not be calling them just because we don't want to provide pt care

and pass that off to someone else. If you don't feel comfortable in providing

pt care at the paramedic level, then take a critical care paramedic class, go

give you that extra training so that you will be able to handle those calls. I

think that one thing is that EMS needs to go back and think what they would be

doing before all of the air-medical programs started popping up? EMS provided

care and transported, and did not sit on scene waiting for a helicopter. Some

might say this part of EMS is just load and go. It might be, but in your EMS

training, you are taught to do as much as you can while going to the ER.

and other docs are right, there is an abuse of the system, but EMS is the

reason why. We need to stop and think, does this pt really need to go by air?

For those that took the classes at the conference given by y with AirLife

you would have the extra knowledge to know, fly or no fly? We should also

consider the cost to the pt, if they are not " sick " enough to go by air-medical.

Can they pay that $17,000 bill we just gave them? They may have to pay this

bill themselves, and have no insurance, or if so, they may do like the one in

the article and pay only part, because it was NOT warranted.

Just my thoughts.

Wayne

> To: texasems-l

> From: phillipsdo@...

> Date: Fri, 4 Dec 2009 23:38:10 +0000

> Subject: Medical helicopter bill is 'a tough pill to swallow'

>

> Sorry the original didn't post right

>

> Medical helicopter bill is 'a tough pill to swallow'

>

> Posted Thursday, Dec. 03, 2009

>

> By DAVE LIEBER

>

> watchdog@...

>

> lieber Dana Strittmatter was boiling water in her kitchen in July when it

spilled on her leg. After paramedics from Benbrook's Emergency Medical Services

arrived, they called for a medical helicopter from PHI Air Medical, a for-profit

company that operates in Dallas-Fort Worth and elsewhere.

>

> PHI Air Medical flew her to Parkland Memorial Hospital in Dallas. She was

treated and released in an hour, according to her husband, Larry. She had

second-degree burns.

>

> But at the hospital, a doctor and others were angry that she had been

transported by helicopter, Larry Strittmatter said.

>

> One doctor told him that abuse of medical helicopters is a growing problem.

The hospital expected her to arrive by ambulance.

>

> " They were shocked when the helicopter pilot radioed in announcing his

arrival, " he said.

>

> The final bill was $17,500.

>

> The couple's insurance company, UniCare, paid $3,500, saying the situation did

not warrant a helicopter ride because the injury was not life-threatening, Larry

Strittmatter said.

>

> PHI Air Medical sent them a bill for $14,000 with a cheerful " Thank you for

allowing us to be of service! "

>

> " A tough pill to swallow, " Larry Strittmatter said.

>

> On my suggestion, he complained to the Texas Department of Insurance, but that

wasn't right. The agency doesn't regulate pricing. Nor does any other part of

state government — or the federal government, either.

>

> There are no rules about when a helicopter should be dispatched and which

service should get the call. There's no regional dispatch system, either.

>

> With three competing services — PHI, CareFlite and Air Evac Lifeteam — the

region has more medical helicopters than most cities.

>

> Yet abuse of medical helicopters " goes on every day in this country, " said Dr.

Bledsoe, an emergency room physician in Midlothian and a vocal critic of

the air ambulance industry.

>

> Recently, Bledsoe said, a patient was brought by helicopter to his emergency

room with a sore throat.

>

> " The doctor thought it was an abscess, but it wasn't, " he said. " We treated

the patient and sent her home. "

>

> Without regulation, the only hope for the Strittmatters is that PHI won't

aggressively collect the entire amount.

>

> " Some operators are very aggressive about filing lawsuits and using liens to

collect payments, " Bledsoe said.

>

> The air ambulance companies court the paramedics who make the decisions about

whether to use a helicopter. Some companies, he said, offer paramedics small

gifts such as pizza dinners, baseball caps or coffee mugs.

>

> But some patients are getting wise, Bledsoe said.

>

> " We're hearing more stories about people refusing helicopter service, " he

said.

>

> It's one more piece of the health insurance puzzle that people should pay

attention to, according to the Texas Department of Insurance.

>

> Larry Strittmatter said he doesn't recall being asked to give consent for the

helicopter ride. His wife, he said, " was drugged and could not have answered

coherently. "

>

> A spokeswoman for UniCare, the insurance company that would pay only part of

the cost, told me: " You're doing a good story because we see cases like this

quite a bit. "

>

> Benbrook Fire Chief Tommy said his paramedics contact a hospital and

give a patient report. Paramedics decide what kind of transportation is needed.

>

> " We assess the patient and determine the best care and expedient method of

transportation, " he told me.

>

> " I understand the situation with the bill. Insurance companies call a lot of

EMS expenses unnecessary and do not dictate patient care. They just decide what

they will and will not pay. "

>

> An executive with PHI Air Medical, based in Phoenix, who asked not to be named

because he wasn't authorized to speak publicly, told me: " It's easy to look at

the case after the fact. The reality is the paramedic is on the scene and must

make a split-second decision. They're driven by what's in the patient's best

interest. "

>

> Dr. Roy Yamada is the North Texas medical director for PHI Air Medical. At the

same time, he has served as medical director for several North Texas cities,

including Bedford, Euless, Hurst, Keller, Mansfield, North Richland Hills,

Pantego and Richland Hills, as well as Dallas/Fort Worth Airport.

>

> In 2007, the Star-Telegram reported that many cities where Yamada trained the

EMS crews also called PHI Air Medical for emergency transports.

>

> The newspaper also reported that, in 2007, a man was flown by PHI Air Medical

to Parkland, even though PHI was not the closest air ambulance.

>

> The PHI Air Medical executive said Yamada had nothing to do with the

Strittmatter case and has no relationship with Benbrook.

>

> When I called Yamada, he said: " I'm over here at one of the fire departments

now giving an exam. So I won't be able to talk to you. Call corporate on that. "

>

> The PHI executive told me that the Strittmatters can still seek a negotiated

settlement with the company.

>

> " PHI is more than willing to talk directly with the patient, " he told me.

>

> Larry Strittmatter sent a certified letter to the company last month asking

for help.

>

> Online extras

>

> Find more Watchdog columns, investigative reports and product recalls at

star-telegram.com/watchdog

>

> THE WATCHDOG COLUMN APPEARS FRIDAYS AND SUNDAYS. DAVE LIEBER,

TWITTER @DAVELIEBER

>

> Looking for comments?

>

>

>

> ------------------------------------

>

>

[Guest guest]

A couple things come to mind when I read this article and Wayne's comments.

1. Odd, on sunny days, we have to wait for air medical support but on foggy,

rainy or windy days, we can take them to the hospital by ground ambulance...I am

curious if EMS patients fare worse on bad weather days???

2. Ground EMS agencies talk a lot about not having enough revenue...imagine if

insurance paid this much on a patient that didn't need to fly, wondering if the

ground agency gave up their full fare by putting this patient on a helicopter.

3. The idea of " patient consent " intrigues me. Did this patient consent for

" transport " ? A better question, if your patient is AAOX4 and you are going to

fly them, do you get their consent to fly them? Is it INFORMED consent

explaining all risks and benefits?

4. It seems to me our air medical providers are focusing their PR on the wrong

people. The patient is not their customer...because the patient does not place

the call for their services...we do. Not only does this mean we have all the

power (too often we forget this and place absolutely NO demands on our " vendor "

because we are too awestruck at the presence of the 'great god of wind and

noise' and we may not be able to get our ACLS or other free classes needed for

CE if we make them mad) but we also have tremendous responsibility to make sure

we are calling the best resources for our patients. We need to take this

seriously because not only are we going to continue to be asked about why we

flew who we flew when the whirly bird crashes...but we are very likely going to

be asked what process we used to make sure we were calling the absolute best

whirly bird to put our patient on if we had a choice...

Like all things in our profession, as we get better and smarter...our level of

accountability rises...and the days are quickly fading where we call the

helicopter and stand around high fiving each other because we " saved another

one " ...

Dudley

Medical helicopter bill is 'a tough pill to swallow'

Sorry the original didn't post right

Medical helicopter bill is 'a tough pill to swallow'

Posted Thursday, Dec. 03, 2009

By DAVE LIEBER

watchdog@...

lieber Dana Strittmatter was boiling water in her kitchen in July when it

pilled on her leg. After paramedics from Benbrook's Emergency Medical Services

rrived, they called for a medical helicopter from PHI Air Medical, a for-profit

ompany that operates in Dallas-Fort Worth and elsewhere.

PHI Air Medical flew her to Parkland Memorial Hospital in Dallas. She was

reated and released in an hour, according to her husband, Larry. She had

econd-degree burns.

But at the hospital, a doctor and others were angry that she had been

ransported by helicopter, Larry Strittmatter said.

One doctor told him that abuse of medical helicopters is a growing problem.

he hospital expected her to arrive by ambulance.

" They were shocked when the helicopter pilot radioed in announcing his

rrival, " he said.

The final bill was $17,500.

The couple's insurance company, UniCare, paid $3,500, saying the situation did

ot warrant a helicopter ride because the injury was not life-threatening, Larry

trittmatter said.

PHI Air Medical sent them a bill for $14,000 with a cheerful " Thank you for

llowing us to be of service! "

" A tough pill to swallow, " Larry Strittmatter said.

On my suggestion, he complained to the Texas Department of Insurance, but that

asn't right. The agency doesn't regulate pricing. Nor does any other part of

tate government — or the federal government, either.

There are no rules about when a helicopter should be dispatched and which

ervice should get the call. There's no regional dispatch system, either.

With three competing services — PHI, CareFlite and Air Evac Lifeteam — the

egion has more medical helicopters than most cities.

Yet abuse of medical helicopters " goes on every day in this country, " said Dr.

ryan Bledsoe, an emergency room physician in Midlothian and a vocal critic of

he air ambulance industry.

Recently, Bledsoe said, a patient was brought by helicopter to his emergency

oom with a sore throat.

" The doctor thought it was an abscess, but it wasn't, " he said. " We treated

he patient and sent her home. "

Without regulation, the only hope for the Strittmatters is that PHI won't

ggressively collect the entire amount.

" Some operators are very aggressive about filing lawsuits and using liens to

ollect payments, " Bledsoe said.

The air ambulance companies court the paramedics who make the decisions about

hether to use a helicopter. Some companies, he said, offer paramedics small

ifts such as pizza dinners, baseball caps or coffee mugs.

But some patients are getting wise, Bledsoe said.

" We're hearing more stories about people refusing helicopter service, " he

aid.

It's one more piece of the health insurance puzzle that people should pay

ttention to, according to the Texas Department of Insurance.

Larry Strittmatter said he doesn't recall being asked to give consent for the

elicopter ride. His wife, he said, " was drugged and could not have answered

oherently. "

A spokeswoman for UniCare, the insurance company that would pay only part of

he cost, told me: " You're doing a good story because we see cases like this

uite a bit. "

Benbrook Fire Chief Tommy said his paramedics contact a hospital and

ive a patient report. Paramedics decide what kind of transportation is needed.

" We assess the patient and determine the best care and expedient method of

ransportation, " he told me.

" I understand the situation with the bill. Insurance companies call a lot of

MS expenses unnecessary and do not dictate patient care. They just decide what

hey will and will not pay. "

An executive with PHI Air Medical, based in Phoenix, who asked not to be named

ecause he wasn't authorized to speak publicly, told me: " It's easy to look at

he case after the fact. The reality is the paramedic is on the scene and must

ake a split-second decision. They're driven by what's in the patient's best

nterest. "

Dr. Roy Yamada is the North Texas medical director for PHI Air Medical. At the

ame time, he has served as medical director for several North Texas cities,

ncluding Bedford, Euless, Hurst, Keller, Mansfield, North Richland Hills,

antego and Richland Hills, as well as Dallas/Fort Worth Airport.

In 2007, the Star-Telegram reported that many cities where Yamada trained the

MS crews also called PHI Air Medical for emergency transports.

The newspaper also reported that, in 2007, a man was flown by PHI Air Medical

o Parkland, even though PHI was not the closest air ambulance.

The PHI Air Medical executive said Yamada had nothing to do with the

trittmatter case and has no relationship with Benbrook.

When I called Yamada, he said: " I'm over here at one of the fire departments

ow giving an exam. So I won't be able to talk to you. Call corporate on that. "

The PHI executive told me that the Strittmatters can still seek a negotiated

ettlement with the company.

" PHI is more than willing to talk directly with the patient, " he told me.

Larry Strittmatter sent a certified letter to the company last month asking

or help.

Online extras

Find more Watchdog columns, investigative reports and product recalls at

tar-telegram.com/watchdog

THE WATCHDOG COLUMN APPEARS FRIDAYS AND SUNDAYS. DAVE LIEBER,

WITTER @DAVELIEBER

Looking for comments?

------------------------------------

[Guest guest]

Great post Dudley. In answer to your first question. I think the

skills of the ground crews improve on bad weather days.

Rick

>

> A couple things come to mind when I read this article and Wayne's comments.

>

> 1. Odd, on sunny days, we have to wait for air medical support but on

> foggy, rainy or windy days, we can take them to the hospital by ground

> ambulance...I am curious if EMS patients fare worse on bad weather days???

>

> 2. Ground EMS agencies talk a lot about not having enough revenue...imagine

> if insurance paid this much on a patient that didn't need to fly, wondering

> if the ground agency gave up their full fare by putting this patient on a

> helicopter.

>

> 3. The idea of " patient consent " intrigues me. Did this patient consent

> for " transport " ? A better question, if your patient is AAOX4 and you are

> going to fly them, do you get their consent to fly them? Is it INFORMED

> consent explaining all risks and benefits?

>

> 4. It seems to me our air medical providers are focusing their PR on the

> wrong people. The patient is not their customer...because the patient does

> not place the call for their services...we do. Not only does this mean we

> have all the power (too often we forget this and place absolutely NO demands

> on our " vendor " because we are too awestruck at the presence of the 'great

> god of wind and noise' and we may not be able to get our ACLS or other free

> classes needed for CE if we make them mad) but we also have tremendous

> responsibility to make sure we are calling the best resources for our

> patients. We need to take this seriously because not only are we going to

> continue to be asked about why we flew who we flew when the whirly bird

> crashes...but we are very likely going to be asked what process we used to

> make sure we were calling the absolute best whirly bird to put our patient

> on if we had a choice...

>

> Like all things in our profession, as we get better and smarter...our level

> of accountability rises...and the days are quickly fading where we call the

> helicopter and stand around high fiving each other because we " saved another

> one " ...

>

> Dudley

>

>

>

> Medical helicopter bill is 'a tough pill to swallow'

>

> Sorry the original didn't post right

>

> Medical helicopter bill is 'a tough pill to swallow'

>

> Posted Thursday, Dec. 03, 2009

>

> By DAVE LIEBER

>

> watchdog@...

>

> lieber Dana Strittmatter was boiling water in her kitchen in July when it

> pilled on her leg. After paramedics from Benbrook's Emergency Medical

> Services

> rrived, they called for a medical helicopter from PHI Air Medical, a

> for-profit

> ompany that operates in Dallas-Fort Worth and elsewhere.

>

> PHI Air Medical flew her to Parkland Memorial Hospital in Dallas. She was

> reated and released in an hour, according to her husband, Larry. She had

> econd-degree burns.

>

> But at the hospital, a doctor and others were angry that she had been

> ransported by helicopter, Larry Strittmatter said.

>

> One doctor told him that abuse of medical helicopters is a growing problem.

> he hospital expected her to arrive by ambulance.

>

> " They were shocked when the helicopter pilot radioed in announcing his

> rrival, " he said.

>

> The final bill was $17,500.

>

> The couple's insurance company, UniCare, paid $3,500, saying the situation

> did

> ot warrant a helicopter ride because the injury was not life-threatening,

> Larry

> trittmatter said.

>

> PHI Air Medical sent them a bill for $14,000 with a cheerful " Thank you for

> llowing us to be of service! "

>

> " A tough pill to swallow, " Larry Strittmatter said.

>

> On my suggestion, he complained to the Texas Department of Insurance, but

> that

> asn't right. The agency doesn't regulate pricing. Nor does any other part of

> tate government — or the federal government, either.

>

> There are no rules about when a helicopter should be dispatched and which

> ervice should get the call. There's no regional dispatch system, either.

>

> With three competing services — PHI, CareFlite and Air Evac Lifeteam — the

> egion has more medical helicopters than most cities.

>

> Yet abuse of medical helicopters " goes on every day in this country, " said

> Dr.

> ryan Bledsoe, an emergency room physician in Midlothian and a vocal critic

> of

> he air ambulance industry.

>

> Recently, Bledsoe said, a patient was brought by helicopter to his

> emergency

> oom with a sore throat.

>

> " The doctor thought it was an abscess, but it wasn't, " he said. " We treated

> he patient and sent her home. "

>

> Without regulation, the only hope for the Strittmatters is that PHI won't

> ggressively collect the entire amount.

>

> " Some operators are very aggressive about filing lawsuits and using liens

> to

> ollect payments, " Bledsoe said.

>

> The air ambulance companies court the paramedics who make the decisions

> about

> hether to use a helicopter. Some companies, he said, offer paramedics small

> ifts such as pizza dinners, baseball caps or coffee mugs.

>

> But some patients are getting wise, Bledsoe said.

>

> " We're hearing more stories about people refusing helicopter service, " he

> aid.

>

> It's one more piece of the health insurance puzzle that people should pay

> ttention to, according to the Texas Department of Insurance.

>

> Larry Strittmatter said he doesn't recall being asked to give consent for

> the

> elicopter ride. His wife, he said, " was drugged and could not have answered

> oherently. "

>

> A spokeswoman for UniCare, the insurance company that would pay only part

> of

> he cost, told me: " You're doing a good story because we see cases like this

> uite a bit. "

>

> Benbrook Fire Chief Tommy said his paramedics contact a hospital and

> ive a patient report. Paramedics decide what kind of transportation is

> needed.

>

> " We assess the patient and determine the best care and expedient method of

> ransportation, " he told me.

>

> " I understand the situation with the bill. Insurance companies call a lot

> of

> MS expenses unnecessary and do not dictate patient care. They just decide

> what

> hey will and will not pay. "

>

> An executive with PHI Air Medical, based in Phoenix, who asked not to be

> named

> ecause he wasn't authorized to speak publicly, told me: " It's easy to look

> at

> he case after the fact. The reality is the paramedic is on the scene and

> must

> ake a split-second decision. They're driven by what's in the patient's best

> nterest. "

>

> Dr. Roy Yamada is the North Texas medical director for PHI Air Medical. At

> the

> ame time, he has served as medical director for several North Texas cities,

> ncluding Bedford, Euless, Hurst, Keller, Mansfield, North Richland Hills,

> antego and Richland Hills, as well as Dallas/Fort Worth Airport.

>

> In 2007, the Star-Telegram reported that many cities where Yamada trained

> the

> MS crews also called PHI Air Medical for emergency transports.

>

> The newspaper also reported that, in 2007, a man was flown by PHI Air

> Medical

> o Parkland, even though PHI was not the closest air ambulance.

>

> The PHI Air Medical executive said Yamada had nothing to do with the

> trittmatter case and has no relationship with Benbrook.

>

> When I called Yamada, he said: " I'm over here at one of the fire

> departments

> ow giving an exam. So I won't be able to talk to you. Call corporate on

> that. "

>

> The PHI executive told me that the Strittmatters can still seek a

> negotiated

> ettlement with the company.

>

> " PHI is more than willing to talk directly with the patient, " he told me.

>

> Larry Strittmatter sent a certified letter to the company last month asking

> or help.

>

> Online extras

>

> Find more Watchdog columns, investigative reports and product recalls at

> tar-telegram.com/watchdog

>

> THE WATCHDOG COLUMN APPEARS FRIDAYS AND SUNDAYS. DAVE LIEBER,

> WITTER @DAVELIEBER

>

> Looking for comments?

>

>

>

> ------------------------------------

>

>

[Guest guest]

or the docs with the training to order, interpret and utilize the

information that might be obtained from those diagnostic and therapeutic

modalities.

ck

In a message dated 12/10/2009 09:21:05 Central Standard Time,

ExLngHrn@... writes:

Let me throw in my $0.05 (adjusted for inflation)..Le

We are overutilizing helicopters for trauma and I'd suspect that we're

UNDERutilizing them for medical emergencies in rural areas. Science is telling

us that there are definitely advantages to taking CVA and MI patients to

facilities where they can be reperfused. Unfortunately, most rural hospitals

don't fit into that category. Yet, time and time again, I see EMS

providers taking MI and CVA patients to rural hospitals that don't have CT

scans,

thrombolytics, and cath labs.

-Wes Ogilvie

-----Original Message-----

From: Henry Barber _hbarber@..._ (mailto:hbarber@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, Dec 10, 2009 8:44 am

Subject: Re: Medical helicopter bill is 'a tough pill to

swallow'

Once again Dudley you are the man. I have a few thoughts about using a

elicopter service I would like to share.

1. I am not dead set against using them.

.. We would not use them if we can get the patient to the appropriate

acility faster. Key here is appropriate.

.. We mostly use the helio for trauma actually that's all we use it for.

.. We have limited neuro coverage at our closest two level III hospitals so

ead injuries or suspected head injuries are a fly for us. If weather is

bad

e take to closest level III and they fly later.

.. I think the idea of a helicopter being exciting was true when it was

new.

owever, we owe it to our patients to attempt to keep the cost down for

them

nd their families. We are their advocates.

.. I think helicopters are a very useful tool for our tool bag and we

should

ever be intimidated into not using them. Lets use them appropriately.

.. We should be able to justify everything we do, every treatment not just

hen we use a bird.

Henry Barber

---- Original Message -----

rom: " Rick " <_aggietrauma@aggietrau_ (mailto:aggietrauma@...) >

o: <_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) >

ent: Tuesday, December 08, 2009 7:40 AM

ubject: Re: Medical helicopter bill is 'a tough pill to

wallow'

reat post Dudley. In answer to your first question. I think the

kills of the ground crews improve on bad weather days.

ick

On 12/7/09, _THEDUDMAN@..._ (mailto:THEDUDMAN@...)

_THEDUDMAN@..._ (mailto:THEDUDMAN@...) > wrote:

A couple things come to mind when I read this article and Wayne's

comments.

1. Odd, on sunny days, we have to wait for air medical support but on

foggy, rainy or windy days, we can take them to the hospital by ground

ambulance...ambulance... I am curious if EMS patients fare worse on ba

2. Ground EMS agencies talk a lot about not having enough

revenue...imagine

if insurance paid this much on a patient that didn't need to fly,

wondering

if the ground agency gave up their full fare by putting this patient on a

helicopter.

3. The idea of " patient consent " intrigues me. Did this patient consent

for " transport " ? A better question, if your patient is AAOX4 and you are

going to fly them, do you get their consent to fly them? Is it INFORMED

consent explaining all risks and benefits?

4. It seems to me our air medical providers are focusing their PR on the

wrong people. The patient is not their customer...because the patient

does

not place the call for their services...we do. Not only does this mean we

have all the power (too often we forget this and place absolutely NO

demands

on our " vendor " because we are too awestruck at the presence of the 'great

god of wind and noise' and we may not be able to get our ACLS or other

free

classes needed for CE if we make them mad) but we also have tremendous

responsibility to make sure we are calling the best resources for our

patients. We need to take this seriously because not only are we going to

continue to be asked about why we flew who we flew when the whirly bird

crashes...but we are very likely going to be asked what process we used to

make sure we were calling the absolute best whirly bird to put our patient

on if we had a choice...

Like all things in our profession, as we get better and smarter...our

level

of accountability rises...and the days are quickly fading where we call

the

helicopter and stand around high fiving each other because we " saved

another

one " ...

Dudley

-----Original Message-----

From: Wayne Dennis _rxmd911@..._ (mailto:rxmd911@...) >

To: Texas EMS List <_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) >

Sent: Sun, Dec 6, 2009 4:53 pm

Subject: RE: Medical helicopter bill is 'a tough pill to

swallow'

hat Dave Lieber don't know is that this is all too uncommon, not only in

places

ike Benbrook, but even in small rural places like Eastland County. Like

Doc

B

as said, there is an abuse of the system. Please don't anyone get me

wrong,

hey (air medical) are a vital assest to the pre-hospital setting and do

save

ives, when they are used the right way.

It seems that here, the provider for 75% of the county can't make a call

without

sking for air medical support. In the case of an active STEMI or Stroke,

hat's understandable. But when you start flying out the diabetic pt that

you

un on a routine bases, that's an abuse of the system. It seem that the

only

ime they are not asking for Southwest is on return calls from the hospital

to

he local nursing home.

Had this call happened here, there would have been a 98% chance that the

local

MS would have been calling for air medical to transport. The last time

that

I

hecked, those on the ambulance here were certified as EMTs and Paramedics,

eaning they should have the training to handle just about any call that

they

go

n and should be able to ground pound it to the hospital. One of the

biggest

hings you see here, is EMS will drive to the hospital and sit on the pad

aiting for air-medical to arrive. I was always taught that if you have to

wait

0 minutes for air-medical, that you should take them into the hospital,

even

if

t is a level 4, that is better than waiting.

As Doc B said, this is not only an EMS problem, but also a hospital

problem.

ad a family member that was sent to Ft.Worth for a possible MI and at no

time

ere they notified that they were being sent by helicopter. They were

stable,

o changes in 12 lead, labs were off, which was later determined to be a

false

ositive. So, they were flown for nothing and had a bill for about $8,000

that

as not warranted. So, where do we start with the education on where and

when

o call for air-medical?

The article also talks about something else that I have a problem with,

and

that

s calling for air-medical support that is not closer to the call or scene.

For

his area, it would be like someone calling for STAT Air when CareFlite or

ir-Evac maybe closer to the scene. This is something that local EMS will

do.

f SWA is not available, they refuse to call for the next closer provider,

but

ill call another one further away. Again, I was always taught that you

call

he one closer to the scene. But, when the local EMS has members that

either

ork or have worked for their favorite one, they tend to call only that

one.

I

ave a membership with both of the providers in this area that sell

memberships,

nd if needed, will call them direct before calling for local EMS.

I know that its up to the EMS crew on scene when they decide to call for

ir-medical support and they have to do so with the best interest of the pt

in

ind. Last time that I flew out a pt, it was warranted. 4-5 stab wounds

to

the

eft side, with a knife of unknown length. But, it didn't take 30 minutes

for

he helicopter to arrive, so no sitting on the pad and the helicopter with

the

hortest time to the scene was called.

If I need air-medical support, then call the one that is closer to me at

the

ime, and not the one that provides you with the free meals. I have

nothing

gainst any air medical program, because as I said, they are vital to pt

care,

ut we should not be calling them just because we don't want to provide pt

care

nd pass that off to someone else. If you don't feel comfortable in

providing

t care at the paramedic level, then take a critical care paramedic class,

go

ive you that extra training so that you will be able to handle those

calls.

I

hink that one thing is that EMS needs to go back and think what they would

be

oing before all of the air-medical programs started popping up? EMS

provided

are and transported, and did not sit on scene waiting for a helicopter.

Some

ight say this part of EMS is just load and go. It might be, but in your

EMS

raining, you are taught to do as much as you can while going to the ER.

and other docs are right, there is an abuse of the system, but EMS

is

the

eason why. We need to stop and think, does this pt really need to go by

air?

or those that took the classes at the conference given by y with

AirLife

ou would have the extra knowledge to know, fly or no fly? We should also

onsider the cost to the pt, if they are not " sick " enough to go by

air-medical.

an they pay that $17,000 bill we just gave them? They may have to pay

this

ill themselves, and have no insurance, or if so, they may do like the one

in

he article and pay only part, because it was NOT warranted.

Just my thoughts.

Wayne

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

From: _phillipsdo@..._ (mailto:phillipsdo@...)

Date: Fri, 4 Dec 2009 23:38:10 +0000

Subject: Medical helicopter bill is 'a tough pill to

swallow'

Sorry the original didn't post right

Medical helicopter bill is 'a tough pill to swallow'

Posted Thursday, Dec. 03, 2009

By DAVE LIEBER

_watchdog@star-watchdog@wat_ (mailto:watchdog@...)

lieber Dana Strittmatter was boiling water in her kitchen in July when it

pilled on her leg. After paramedics from Benbrook's Emergency Medical

Services

rrived, they called for a medical helicopter from PHI Air Medical, a

for-profit

ompany that operates in Dallas-Fort Worth and elsewhere.

PHI Air Medical flew her to Parkland Memorial Hospital in Dallas. She was

reated and released in an hour, according to her husband, Larry. She had

econd-degree burns.

But at the hospital, a doctor and others were angry that she had been

ransported by helicopter, Larry Strittmatter said.

One doctor told him that abuse of medical helicopters is a growing

problem.

he hospital expected her to arrive by ambulance.

" They were shocked when the helicopter pilot radioed in announcing his

rrival, " he said.

The final bill was $17,500.

The couple's insurance company, UniCare, paid $3,500, saying the

situation

did

ot warrant a helicopter ride because the injury was not life-threatening,

Larry

trittmatter said.

PHI Air Medical sent them a bill for $14,000 with a cheerful " Thank you

for

llowing us to be of service! "

" A tough pill to swallow, " Larry Strittmatter said.

On my suggestion, he complained to the Texas Department of Insurance, but

that

asn't right. The agency doesn't regulate pricing. Nor does any other part

of

tate government — or the federal government, either.

There are no rules about when a helicopter should be dispatched and which

ervice should get the call. There's no regional dispatch system, either.

With three competing services — PHI, CareFlite and Air Evac Lifeteam —

the

egion has more medical helicopters than most cities.

Yet abuse of medical helicopters " goes on every day in this country, "

said

Dr.

ryan Bledsoe, an emergency room physician in Midlothian and a vocal critic

of

he air ambulance industry.

Recently, Bledsoe said, a patient was brought by helicopter to his

emergency

oom with a sore throat.

" The doctor thought it was an abscess, but it wasn't, " he said. " We

treated

he patient and sent her home. "

Without regulation, the only hope for the Strittmatters is that PHI won't

ggressively collect the entire amount.

" Some operators are very aggressive about filing lawsuits and using liens

to

ollect payments, " Bledsoe said.

The air ambulance companies court the paramedics who make the decisions

about

hether to use a helicopter. Some companies, he said, offer paramedics

small

ifts such as pizza dinners, baseball caps or coffee mugs.

But some patients are getting wise, Bledsoe said.

" We're hearing more stories about people refusing helicopter service, " he

aid.

It's one more piece of the health insurance puzzle that people should pay

ttention to, according to the Texas Department of Insurance.

Larry Strittmatter said he doesn't recall being asked to give consent for

the

elicopter ride. His wife, he said, " was drugged and could not have

answered

oherently. "

A spokeswoman for UniCare, the insurance company that would pay only part

of

he cost, told me: " You're doing a good story because we see cases like

this

uite a bit. "

Benbrook Fire Chief Tommy said his paramedics contact a hospital

and

ive a patient report. Paramedics decide what kind of transportation is

needed.

" We assess the patient and determine the best care and expedient method

of

ransportation,ransportation

" I understand the situation with the bill. Insurance companies call a lot

of

MS expenses unnecessary and do not dictate patient care. They just decide

what

hey will and will not pay. "

An executive with PHI Air Medical, based in Phoenix, who asked not to be

named

ecause he wasn't authorized to speak publicly, told me: " It's easy to look

at

he case after the fact. The reality is the paramedic is on the scene and

must

ake a split-second decision. They're driven by what's in the patient's

best

nterest. "

Dr. Roy Yamada is the North Texas medical director for PHI Air Medical.

At

the

ame time, he has served as medical director for several North Texas

cities,

ncluding Bedford, Euless, Hurst, Keller, Mansfield, North Richland Hills,

antego and Richland Hills, as well as Dallas/Fort Worth Airport.

In 2007, the Star-Telegram reported that many cities where Yamada trained

the

MS crews also called PHI Air Medical for emergency transports.

The newspaper also reported that, in 2007, a man was flown by PHI Air

Medical

o Parkland, even though PHI was not the closest air ambulance.

The PHI Air Medical executive said Yamada had nothing to do with the

trittmatter case and has no relationship with Benbrook.

When I called Yamada, he said: " I'm over here at one of the fire

departments

ow giving an exam. So I won't be able to talk to you. Call corporate on

that. "

The PHI executive told me that the Strittmatters can still seek a

negotiated

ettlement with the company.

" PHI is more than willing to talk directly with the patient, " he told me.

Larry Strittmatter sent a certified letter to the company last month

asking

or help.

Online extras

Find more Watchdog columns, investigative reports and product recalls at

tar-telegram.tar-telegram

THE WATCHDOG COLUMN APPEARS FRIDAYS AND SUNDAYS. DAVE LIEBER,

WITTER @DAVELIEBER

Looking for comments?

------------------------------------

Yahoo! Groups Links

__________________________________________________________

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[Guest guest]

or the docs with the training to order, interpret and utilize the

information that might be obtained from those diagnostic and therapeutic

modalities.

ck

In a message dated 12/10/2009 09:21:05 Central Standard Time,

ExLngHrn@... writes:

Let me throw in my $0.05 (adjusted for inflation)..Le

We are overutilizing helicopters for trauma and I'd suspect that we're

UNDERutilizing them for medical emergencies in rural areas. Science is telling

us that there are definitely advantages to taking CVA and MI patients to

facilities where they can be reperfused. Unfortunately, most rural hospitals

don't fit into that category. Yet, time and time again, I see EMS

providers taking MI and CVA patients to rural hospitals that don't have CT

scans,

thrombolytics, and cath labs.

-Wes Ogilvie

-----Original Message-----

From: Henry Barber _hbarber@..._ (mailto:hbarber@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, Dec 10, 2009 8:44 am

Subject: Re: Medical helicopter bill is 'a tough pill to

swallow'

Once again Dudley you are the man. I have a few thoughts about using a

elicopter service I would like to share.

1. I am not dead set against using them.

.. We would not use them if we can get the patient to the appropriate

acility faster. Key here is appropriate.

.. We mostly use the helio for trauma actually that's all we use it for.

.. We have limited neuro coverage at our closest two level III hospitals so

ead injuries or suspected head injuries are a fly for us. If weather is

bad

e take to closest level III and they fly later.

.. I think the idea of a helicopter being exciting was true when it was

new.

owever, we owe it to our patients to attempt to keep the cost down for

them

nd their families. We are their advocates.

.. I think helicopters are a very useful tool for our tool bag and we

should

ever be intimidated into not using them. Lets use them appropriately.

.. We should be able to justify everything we do, every treatment not just

hen we use a bird.

Henry Barber

---- Original Message -----

rom: " Rick " <_aggietrauma@aggietrau_ (mailto:aggietrauma@...) >

o: <_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) >

ent: Tuesday, December 08, 2009 7:40 AM

ubject: Re: Medical helicopter bill is 'a tough pill to

wallow'

reat post Dudley. In answer to your first question. I think the

kills of the ground crews improve on bad weather days.

ick

On 12/7/09, _THEDUDMAN@..._ (mailto:THEDUDMAN@...)

_THEDUDMAN@..._ (mailto:THEDUDMAN@...) > wrote:

A couple things come to mind when I read this article and Wayne's

comments.

1. Odd, on sunny days, we have to wait for air medical support but on

foggy, rainy or windy days, we can take them to the hospital by ground

ambulance...ambulance... I am curious if EMS patients fare worse on ba

2. Ground EMS agencies talk a lot about not having enough

revenue...imagine

if insurance paid this much on a patient that didn't need to fly,

wondering

if the ground agency gave up their full fare by putting this patient on a

helicopter.

3. The idea of " patient consent " intrigues me. Did this patient consent

for " transport " ? A better question, if your patient is AAOX4 and you are

going to fly them, do you get their consent to fly them? Is it INFORMED

consent explaining all risks and benefits?

4. It seems to me our air medical providers are focusing their PR on the

wrong people. The patient is not their customer...because the patient

does

not place the call for their services...we do. Not only does this mean we

have all the power (too often we forget this and place absolutely NO

demands

on our " vendor " because we are too awestruck at the presence of the 'great

god of wind and noise' and we may not be able to get our ACLS or other

free

classes needed for CE if we make them mad) but we also have tremendous

responsibility to make sure we are calling the best resources for our

patients. We need to take this seriously because not only are we going to

continue to be asked about why we flew who we flew when the whirly bird

crashes...but we are very likely going to be asked what process we used to

make sure we were calling the absolute best whirly bird to put our patient

on if we had a choice...

Like all things in our profession, as we get better and smarter...our

level

of accountability rises...and the days are quickly fading where we call

the

helicopter and stand around high fiving each other because we " saved

another

one " ...

Dudley

-----Original Message-----

From: Wayne Dennis _rxmd911@..._ (mailto:rxmd911@...) >

To: Texas EMS List <_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) >

Sent: Sun, Dec 6, 2009 4:53 pm

Subject: RE: Medical helicopter bill is 'a tough pill to

swallow'

hat Dave Lieber don't know is that this is all too uncommon, not only in

places

ike Benbrook, but even in small rural places like Eastland County. Like

Doc

B

as said, there is an abuse of the system. Please don't anyone get me

wrong,

hey (air medical) are a vital assest to the pre-hospital setting and do

save

ives, when they are used the right way.

It seems that here, the provider for 75% of the county can't make a call

without

sking for air medical support. In the case of an active STEMI or Stroke,

hat's understandable. But when you start flying out the diabetic pt that

you

un on a routine bases, that's an abuse of the system. It seem that the

only

ime they are not asking for Southwest is on return calls from the hospital

to

he local nursing home.

Had this call happened here, there would have been a 98% chance that the

local

MS would have been calling for air medical to transport. The last time

that

I

hecked, those on the ambulance here were certified as EMTs and Paramedics,

eaning they should have the training to handle just about any call that

they

go

n and should be able to ground pound it to the hospital. One of the

biggest

hings you see here, is EMS will drive to the hospital and sit on the pad

aiting for air-medical to arrive. I was always taught that if you have to

wait

0 minutes for air-medical, that you should take them into the hospital,

even

if

t is a level 4, that is better than waiting.

As Doc B said, this is not only an EMS problem, but also a hospital

problem.

ad a family member that was sent to Ft.Worth for a possible MI and at no

time

ere they notified that they were being sent by helicopter. They were

stable,

o changes in 12 lead, labs were off, which was later determined to be a

false

ositive. So, they were flown for nothing and had a bill for about $8,000

that

as not warranted. So, where do we start with the education on where and

when

o call for air-medical?

The article also talks about something else that I have a problem with,

and

that

s calling for air-medical support that is not closer to the call or scene.

For

his area, it would be like someone calling for STAT Air when CareFlite or

ir-Evac maybe closer to the scene. This is something that local EMS will

do.

f SWA is not available, they refuse to call for the next closer provider,

but

ill call another one further away. Again, I was always taught that you

call

he one closer to the scene. But, when the local EMS has members that

either

ork or have worked for their favorite one, they tend to call only that

one.

I

ave a membership with both of the providers in this area that sell

memberships,

nd if needed, will call them direct before calling for local EMS.

I know that its up to the EMS crew on scene when they decide to call for

ir-medical support and they have to do so with the best interest of the pt

in

ind. Last time that I flew out a pt, it was warranted. 4-5 stab wounds

to

the

eft side, with a knife of unknown length. But, it didn't take 30 minutes

for

he helicopter to arrive, so no sitting on the pad and the helicopter with

the

hortest time to the scene was called.

If I need air-medical support, then call the one that is closer to me at

the

ime, and not the one that provides you with the free meals. I have

nothing

gainst any air medical program, because as I said, they are vital to pt

care,

ut we should not be calling them just because we don't want to provide pt

care

nd pass that off to someone else. If you don't feel comfortable in

providing

t care at the paramedic level, then take a critical care paramedic class,

go

ive you that extra training so that you will be able to handle those

calls.

I

hink that one thing is that EMS needs to go back and think what they would

be

oing before all of the air-medical programs started popping up? EMS

provided

are and transported, and did not sit on scene waiting for a helicopter.

Some

ight say this part of EMS is just load and go. It might be, but in your

EMS

raining, you are taught to do as much as you can while going to the ER.

and other docs are right, there is an abuse of the system, but EMS

is

the

eason why. We need to stop and think, does this pt really need to go by

air?

or those that took the classes at the conference given by y with

AirLife

ou would have the extra knowledge to know, fly or no fly? We should also

onsider the cost to the pt, if they are not " sick " enough to go by

air-medical.

an they pay that $17,000 bill we just gave them? They may have to pay

this

ill themselves, and have no insurance, or if so, they may do like the one

in

he article and pay only part, because it was NOT warranted.

Just my thoughts.

Wayne

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

From: _phillipsdo@..._ (mailto:phillipsdo@...)

Date: Fri, 4 Dec 2009 23:38:10 +0000

Subject: Medical helicopter bill is 'a tough pill to

swallow'

Sorry the original didn't post right

Medical helicopter bill is 'a tough pill to swallow'

Posted Thursday, Dec. 03, 2009

By DAVE LIEBER

_watchdog@star-watchdog@wat_ (mailto:watchdog@...)

lieber Dana Strittmatter was boiling water in her kitchen in July when it

pilled on her leg. After paramedics from Benbrook's Emergency Medical

Services

rrived, they called for a medical helicopter from PHI Air Medical, a

for-profit

ompany that operates in Dallas-Fort Worth and elsewhere.

PHI Air Medical flew her to Parkland Memorial Hospital in Dallas. She was

reated and released in an hour, according to her husband, Larry. She had

econd-degree burns.

But at the hospital, a doctor and others were angry that she had been

ransported by helicopter, Larry Strittmatter said.

One doctor told him that abuse of medical helicopters is a growing

problem.

he hospital expected her to arrive by ambulance.

" They were shocked when the helicopter pilot radioed in announcing his

rrival, " he said.

The final bill was $17,500.

The couple's insurance company, UniCare, paid $3,500, saying the

situation

did

ot warrant a helicopter ride because the injury was not life-threatening,

Larry

trittmatter said.

PHI Air Medical sent them a bill for $14,000 with a cheerful " Thank you

for

llowing us to be of service! "

" A tough pill to swallow, " Larry Strittmatter said.

On my suggestion, he complained to the Texas Department of Insurance, but

that

asn't right. The agency doesn't regulate pricing. Nor does any other part

of

tate government — or the federal government, either.

There are no rules about when a helicopter should be dispatched and which

ervice should get the call. There's no regional dispatch system, either.

With three competing services — PHI, CareFlite and Air Evac Lifeteam —

the

egion has more medical helicopters than most cities.

Yet abuse of medical helicopters " goes on every day in this country, "

said

Dr.

ryan Bledsoe, an emergency room physician in Midlothian and a vocal critic

of

he air ambulance industry.

Recently, Bledsoe said, a patient was brought by helicopter to his

emergency

oom with a sore throat.

" The doctor thought it was an abscess, but it wasn't, " he said. " We

treated

he patient and sent her home. "

Without regulation, the only hope for the Strittmatters is that PHI won't

ggressively collect the entire amount.

" Some operators are very aggressive about filing lawsuits and using liens

to

ollect payments, " Bledsoe said.

The air ambulance companies court the paramedics who make the decisions

about

hether to use a helicopter. Some companies, he said, offer paramedics

small

ifts such as pizza dinners, baseball caps or coffee mugs.

But some patients are getting wise, Bledsoe said.

" We're hearing more stories about people refusing helicopter service, " he

aid.

It's one more piece of the health insurance puzzle that people should pay

ttention to, according to the Texas Department of Insurance.

Larry Strittmatter said he doesn't recall being asked to give consent for

the

elicopter ride. His wife, he said, " was drugged and could not have

answered

oherently. "

A spokeswoman for UniCare, the insurance company that would pay only part

of

he cost, told me: " You're doing a good story because we see cases like

this

uite a bit. "

Benbrook Fire Chief Tommy said his paramedics contact a hospital

and

ive a patient report. Paramedics decide what kind of transportation is

needed.

" We assess the patient and determine the best care and expedient method

of

ransportation,ransportation

" I understand the situation with the bill. Insurance companies call a lot

of

MS expenses unnecessary and do not dictate patient care. They just decide

what

hey will and will not pay. "

An executive with PHI Air Medical, based in Phoenix, who asked not to be

named

ecause he wasn't authorized to speak publicly, told me: " It's easy to look

at

he case after the fact. The reality is the paramedic is on the scene and

must

ake a split-second decision. They're driven by what's in the patient's

best

nterest. "

Dr. Roy Yamada is the North Texas medical director for PHI Air Medical.

At

the

ame time, he has served as medical director for several North Texas

cities,

ncluding Bedford, Euless, Hurst, Keller, Mansfield, North Richland Hills,

antego and Richland Hills, as well as Dallas/Fort Worth Airport.

In 2007, the Star-Telegram reported that many cities where Yamada trained

the

MS crews also called PHI Air Medical for emergency transports.

The newspaper also reported that, in 2007, a man was flown by PHI Air

Medical

o Parkland, even though PHI was not the closest air ambulance.

The PHI Air Medical executive said Yamada had nothing to do with the

trittmatter case and has no relationship with Benbrook.

When I called Yamada, he said: " I'm over here at one of the fire

departments

ow giving an exam. So I won't be able to talk to you. Call corporate on

that. "

The PHI executive told me that the Strittmatters can still seek a

negotiated

ettlement with the company.

" PHI is more than willing to talk directly with the patient, " he told me.

Larry Strittmatter sent a certified letter to the company last month

asking

or help.

Online extras

Find more Watchdog columns, investigative reports and product recalls at

tar-telegram.tar-telegram

THE WATCHDOG COLUMN APPEARS FRIDAYS AND SUNDAYS. DAVE LIEBER,

WITTER @DAVELIEBER

Looking for comments?

------------------------------------

Yahoo! Groups Links

__________________________________________________________

hat with Messenger straight from your Hotmail inbox.

_ttp://www.microsoftttp://www.micttp://www.

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//ww_

(ttp://www.microsoft.com/windows/windowslive/hotmail_bl1/hotmail_bl1.aspx?ocid=P\

ID23879::T:WLMTAGL:

ON:WL:en-ww:WM_IMHM_4:092009)

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_http://docs.http://dochttp://docs_ (http://docs.yahoo.com/info/terms/)

[Non-text portions of this message have been removed]

-----------------------------------

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----------------------------------------------------------

No virus found in this incoming message.

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or the docs with the training to order, interpret and utilize the

information that might be obtained from those diagnostic and therapeutic

modalities.

ck

In a message dated 12/10/2009 09:21:05 Central Standard Time,

ExLngHrn@... writes:

Let me throw in my $0.05 (adjusted for inflation)..Le

We are overutilizing helicopters for trauma and I'd suspect that we're

UNDERutilizing them for medical emergencies in rural areas. Science is telling

us that there are definitely advantages to taking CVA and MI patients to

facilities where they can be reperfused. Unfortunately, most rural hospitals

don't fit into that category. Yet, time and time again, I see EMS

providers taking MI and CVA patients to rural hospitals that don't have CT

scans,

thrombolytics, and cath labs.

-Wes Ogilvie

-----Original Message-----

From: Henry Barber _hbarber@..._ (mailto:hbarber@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, Dec 10, 2009 8:44 am

Subject: Re: Medical helicopter bill is 'a tough pill to

swallow'

Once again Dudley you are the man. I have a few thoughts about using a

elicopter service I would like to share.

1. I am not dead set against using them.

.. We would not use them if we can get the patient to the appropriate

acility faster. Key here is appropriate.

.. We mostly use the helio for trauma actually that's all we use it for.

.. We have limited neuro coverage at our closest two level III hospitals so

ead injuries or suspected head injuries are a fly for us. If weather is

bad

e take to closest level III and they fly later.

.. I think the idea of a helicopter being exciting was true when it was

new.

owever, we owe it to our patients to attempt to keep the cost down for

them

nd their families. We are their advocates.

.. I think helicopters are a very useful tool for our tool bag and we

should

ever be intimidated into not using them. Lets use them appropriately.

.. We should be able to justify everything we do, every treatment not just

hen we use a bird.

Henry Barber

---- Original Message -----

rom: " Rick " <_aggietrauma@aggietrau_ (mailto:aggietrauma@...) >

o: <_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) >

ent: Tuesday, December 08, 2009 7:40 AM

ubject: Re: Medical helicopter bill is 'a tough pill to

wallow'

reat post Dudley. In answer to your first question. I think the

kills of the ground crews improve on bad weather days.

ick

On 12/7/09, _THEDUDMAN@..._ (mailto:THEDUDMAN@...)

_THEDUDMAN@..._ (mailto:THEDUDMAN@...) > wrote:

A couple things come to mind when I read this article and Wayne's

comments.

1. Odd, on sunny days, we have to wait for air medical support but on

foggy, rainy or windy days, we can take them to the hospital by ground

ambulance...ambulance... I am curious if EMS patients fare worse on ba

2. Ground EMS agencies talk a lot about not having enough

revenue...imagine

if insurance paid this much on a patient that didn't need to fly,

wondering

if the ground agency gave up their full fare by putting this patient on a

helicopter.

3. The idea of " patient consent " intrigues me. Did this patient consent

for " transport " ? A better question, if your patient is AAOX4 and you are

going to fly them, do you get their consent to fly them? Is it INFORMED

consent explaining all risks and benefits?

4. It seems to me our air medical providers are focusing their PR on the

wrong people. The patient is not their customer...because the patient

does

not place the call for their services...we do. Not only does this mean we

have all the power (too often we forget this and place absolutely NO

demands

on our " vendor " because we are too awestruck at the presence of the 'great

god of wind and noise' and we may not be able to get our ACLS or other

free

classes needed for CE if we make them mad) but we also have tremendous

responsibility to make sure we are calling the best resources for our

patients. We need to take this seriously because not only are we going to

continue to be asked about why we flew who we flew when the whirly bird

crashes...but we are very likely going to be asked what process we used to

make sure we were calling the absolute best whirly bird to put our patient

on if we had a choice...

Like all things in our profession, as we get better and smarter...our

level

of accountability rises...and the days are quickly fading where we call

the

helicopter and stand around high fiving each other because we " saved

another

one " ...

Dudley

-----Original Message-----

From: Wayne Dennis _rxmd911@..._ (mailto:rxmd911@...) >

To: Texas EMS List <_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) >

Sent: Sun, Dec 6, 2009 4:53 pm

Subject: RE: Medical helicopter bill is 'a tough pill to

swallow'

hat Dave Lieber don't know is that this is all too uncommon, not only in

places

ike Benbrook, but even in small rural places like Eastland County. Like

Doc

B

as said, there is an abuse of the system. Please don't anyone get me

wrong,

hey (air medical) are a vital assest to the pre-hospital setting and do

save

ives, when they are used the right way.

It seems that here, the provider for 75% of the county can't make a call

without

sking for air medical support. In the case of an active STEMI or Stroke,

hat's understandable. But when you start flying out the diabetic pt that

you

un on a routine bases, that's an abuse of the system. It seem that the

only

ime they are not asking for Southwest is on return calls from the hospital

to

he local nursing home.

Had this call happened here, there would have been a 98% chance that the

local

MS would have been calling for air medical to transport. The last time

that

I

hecked, those on the ambulance here were certified as EMTs and Paramedics,

eaning they should have the training to handle just about any call that

they

go

n and should be able to ground pound it to the hospital. One of the

biggest

hings you see here, is EMS will drive to the hospital and sit on the pad

aiting for air-medical to arrive. I was always taught that if you have to

wait

0 minutes for air-medical, that you should take them into the hospital,

even

if

t is a level 4, that is better than waiting.

As Doc B said, this is not only an EMS problem, but also a hospital

problem.

ad a family member that was sent to Ft.Worth for a possible MI and at no

time

ere they notified that they were being sent by helicopter. They were

stable,

o changes in 12 lead, labs were off, which was later determined to be a

false

ositive. So, they were flown for nothing and had a bill for about $8,000

that

as not warranted. So, where do we start with the education on where and

when

o call for air-medical?

The article also talks about something else that I have a problem with,

and

that

s calling for air-medical support that is not closer to the call or scene.

For

his area, it would be like someone calling for STAT Air when CareFlite or

ir-Evac maybe closer to the scene. This is something that local EMS will

do.

f SWA is not available, they refuse to call for the next closer provider,

but

ill call another one further away. Again, I was always taught that you

call

he one closer to the scene. But, when the local EMS has members that

either

ork or have worked for their favorite one, they tend to call only that

one.

I

ave a membership with both of the providers in this area that sell

memberships,

nd if needed, will call them direct before calling for local EMS.

I know that its up to the EMS crew on scene when they decide to call for

ir-medical support and they have to do so with the best interest of the pt

in

ind. Last time that I flew out a pt, it was warranted. 4-5 stab wounds

to

the

eft side, with a knife of unknown length. But, it didn't take 30 minutes

for

he helicopter to arrive, so no sitting on the pad and the helicopter with

the

hortest time to the scene was called.

If I need air-medical support, then call the one that is closer to me at

the

ime, and not the one that provides you with the free meals. I have

nothing

gainst any air medical program, because as I said, they are vital to pt

care,

ut we should not be calling them just because we don't want to provide pt

care

nd pass that off to someone else. If you don't feel comfortable in

providing

t care at the paramedic level, then take a critical care paramedic class,

go

ive you that extra training so that you will be able to handle those

calls.

I

hink that one thing is that EMS needs to go back and think what they would

be

oing before all of the air-medical programs started popping up? EMS

provided

are and transported, and did not sit on scene waiting for a helicopter.

Some

ight say this part of EMS is just load and go. It might be, but in your

EMS

raining, you are taught to do as much as you can while going to the ER.

and other docs are right, there is an abuse of the system, but EMS

is

the

eason why. We need to stop and think, does this pt really need to go by

air?

or those that took the classes at the conference given by y with

AirLife

ou would have the extra knowledge to know, fly or no fly? We should also

onsider the cost to the pt, if they are not " sick " enough to go by

air-medical.

an they pay that $17,000 bill we just gave them? They may have to pay

this

ill themselves, and have no insurance, or if so, they may do like the one

in

he article and pay only part, because it was NOT warranted.

Just my thoughts.

Wayne

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

From: _phillipsdo@..._ (mailto:phillipsdo@...)

Date: Fri, 4 Dec 2009 23:38:10 +0000

Subject: Medical helicopter bill is 'a tough pill to

swallow'

Sorry the original didn't post right

Medical helicopter bill is 'a tough pill to swallow'

Posted Thursday, Dec. 03, 2009

By DAVE LIEBER

_watchdog@star-watchdog@wat_ (mailto:watchdog@...)

lieber Dana Strittmatter was boiling water in her kitchen in July when it

pilled on her leg. After paramedics from Benbrook's Emergency Medical

Services

rrived, they called for a medical helicopter from PHI Air Medical, a

for-profit

ompany that operates in Dallas-Fort Worth and elsewhere.

PHI Air Medical flew her to Parkland Memorial Hospital in Dallas. She was

reated and released in an hour, according to her husband, Larry. She had

econd-degree burns.

But at the hospital, a doctor and others were angry that she had been

ransported by helicopter, Larry Strittmatter said.

One doctor told him that abuse of medical helicopters is a growing

problem.

he hospital expected her to arrive by ambulance.

" They were shocked when the helicopter pilot radioed in announcing his

rrival, " he said.

The final bill was $17,500.

The couple's insurance company, UniCare, paid $3,500, saying the

situation

did

ot warrant a helicopter ride because the injury was not life-threatening,

Larry

trittmatter said.

PHI Air Medical sent them a bill for $14,000 with a cheerful " Thank you

for

llowing us to be of service! "

" A tough pill to swallow, " Larry Strittmatter said.

On my suggestion, he complained to the Texas Department of Insurance, but

that

asn't right. The agency doesn't regulate pricing. Nor does any other part

of

tate government — or the federal government, either.

There are no rules about when a helicopter should be dispatched and which

ervice should get the call. There's no regional dispatch system, either.

With three competing services — PHI, CareFlite and Air Evac Lifeteam —

the

egion has more medical helicopters than most cities.

Yet abuse of medical helicopters " goes on every day in this country, "

said

Dr.

ryan Bledsoe, an emergency room physician in Midlothian and a vocal critic

of

he air ambulance industry.

Recently, Bledsoe said, a patient was brought by helicopter to his

emergency

oom with a sore throat.

" The doctor thought it was an abscess, but it wasn't, " he said. " We

treated

he patient and sent her home. "

Without regulation, the only hope for the Strittmatters is that PHI won't

ggressively collect the entire amount.

" Some operators are very aggressive about filing lawsuits and using liens

to

ollect payments, " Bledsoe said.

The air ambulance companies court the paramedics who make the decisions

about

hether to use a helicopter. Some companies, he said, offer paramedics

small

ifts such as pizza dinners, baseball caps or coffee mugs.

But some patients are getting wise, Bledsoe said.

" We're hearing more stories about people refusing helicopter service, " he

aid.

It's one more piece of the health insurance puzzle that people should pay

ttention to, according to the Texas Department of Insurance.

Larry Strittmatter said he doesn't recall being asked to give consent for

the

elicopter ride. His wife, he said, " was drugged and could not have

answered

oherently. "

A spokeswoman for UniCare, the insurance company that would pay only part

of

he cost, told me: " You're doing a good story because we see cases like

this

uite a bit. "

Benbrook Fire Chief Tommy said his paramedics contact a hospital

and

ive a patient report. Paramedics decide what kind of transportation is

needed.

" We assess the patient and determine the best care and expedient method

of

ransportation,ransportation

" I understand the situation with the bill. Insurance companies call a lot

of

MS expenses unnecessary and do not dictate patient care. They just decide

what

hey will and will not pay. "

An executive with PHI Air Medical, based in Phoenix, who asked not to be

named

ecause he wasn't authorized to speak publicly, told me: " It's easy to look

at

he case after the fact. The reality is the paramedic is on the scene and

must

ake a split-second decision. They're driven by what's in the patient's

best

nterest. "

Dr. Roy Yamada is the North Texas medical director for PHI Air Medical.

At

the

ame time, he has served as medical director for several North Texas

cities,

ncluding Bedford, Euless, Hurst, Keller, Mansfield, North Richland Hills,

antego and Richland Hills, as well as Dallas/Fort Worth Airport.

In 2007, the Star-Telegram reported that many cities where Yamada trained

the

MS crews also called PHI Air Medical for emergency transports.

The newspaper also reported that, in 2007, a man was flown by PHI Air

Medical

o Parkland, even though PHI was not the closest air ambulance.

The PHI Air Medical executive said Yamada had nothing to do with the

trittmatter case and has no relationship with Benbrook.

When I called Yamada, he said: " I'm over here at one of the fire

departments

ow giving an exam. So I won't be able to talk to you. Call corporate on

that. "

The PHI executive told me that the Strittmatters can still seek a

negotiated

ettlement with the company.

" PHI is more than willing to talk directly with the patient, " he told me.

Larry Strittmatter sent a certified letter to the company last month

asking

or help.

Online extras

Find more Watchdog columns, investigative reports and product recalls at

tar-telegram.tar-telegram

THE WATCHDOG COLUMN APPEARS FRIDAYS AND SUNDAYS. DAVE LIEBER,

WITTER @DAVELIEBER

Looking for comments?

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[Non-text portions of this message have been removed]

[Guest guest]

On Thursday, December 10, 2009 08:44, " Henry Barber " hbarber@...>

said:

> 5. I think the idea of a helicopter being exciting was true when it was new.

Unfortunately, the transient nature of the EMS workforce assures that HEMS

remains " new " to over half of the providers in the field, perpetuating the

cycle. And without that " new " and " exciting " lure, half of those people would

never have even joined EMS.

Rob

[Guest guest]

That's the key Wes...CT scans, thrombolytics and cath labs...actually, many many

rural facilities have CT scanners and getting a CVA there for a scan and

thrombolytics is the bomb...and after attending the State STEMI conference in

October, if you can't get a STEMI to a PCI center in under 90 minutes then get

them thrombolytics ASAP...then the time expands to potentially 6 hours for a

cath.

I agree, there are some really great uses for helicopters...unfortunately like

ground providers we can't regulate where and how many helicopters there are in

any given area. Imagine a state system where the helicopters have assigned

areas and are compensated for maintaining certain response times...and although

they would have to " compete " for these areas every few years, they wouldn't need

to fight everyday to survive...then they could be part of the QI system that

actually evaluates if a flight is appropriate or not. No air medical provider

will do that today because they know the agency they talk to will call their

competitor tomorrow....

Helicopters have a time and place for use...and like Henry, we use them...but we

evaluate every use of a helicopter to verify that a cogent thought process was

used in determining a need for them and that using them actually did not delay

definitive care for the patient in extremis.

Dudley

Medical helicopter bill is 'a tough pill to

swallow'

Sorry the original didn't post right

Medical helicopter bill is 'a tough pill to swallow'

Posted Thursday, Dec. 03, 2009

By DAVE LIEBER

watchdog@...

lieber Dana Strittmatter was boiling water in her kitchen in July when it

pilled on her leg. After paramedics from Benbrook's Emergency Medical

Services

rrived, they called for a medical helicopter from PHI Air Medical, a

for-profit

ompany that operates in Dallas-Fort Worth and elsewhere.

PHI Air Medical flew her to Parkland Memorial Hospital in Dallas. She was

reated and released in an hour, according to her husband, Larry. She had

econd-degree burns.

But at the hospital, a doctor and others were angry that she had been

ransported by helicopter, Larry Strittmatter said.

One doctor told him that abuse of medical helicopters is a growing

problem.

he hospital expected her to arrive by ambulance.

" They were shocked when the helicopter pilot radioed in announcing his

rrival, " he said.

The final bill was $17,500.

The couple's insurance company, UniCare, paid $3,500, saying the

situation

did

ot warrant a helicopter ride because the injury was not life-threatening,

Larry

trittmatter said.

PHI Air Medical sent them a bill for $14,000 with a cheerful " Thank you

for

llowing us to be of service! "

" A tough pill to swallow, " Larry Strittmatter said.

On my suggestion, he complained to the Texas Department of Insurance, but

that

asn't right. The agency doesn't regulate pricing. Nor does any other part

of

tate government — or the federal government, either.

There are no rules about when a helicopter should be dispatched and which

ervice should get the call. There's no regional dispatch system, either.

With three competing services — PHI, CareFlite and Air Evac Lifeteam —

the

egion has more medical helicopters than most cities.

Yet abuse of medical helicopters " goes on every day in this country, "

said

Dr.

ryan Bledsoe, an emergency room physician in Midlothian and a vocal critic

of

he air ambulance industry.

Recently, Bledsoe said, a patient was brought by helicopter to his

emergency

oom with a sore throat.

" The doctor thought it was an abscess, but it wasn't, " he said. " We

treated

he patient and sent her home. "

Without regulation, the only hope for the Strittmatters is that PHI won't

ggressively collect the entire amount.

" Some operators are very aggressive about filing lawsuits and using liens

to

ollect payments, " Bledsoe said.

The air ambulance companies court the paramedics who make the decisions

about

hether to use a helicopter. Some companies, he said, offer paramedics

small

ifts such as pizza dinners, baseball caps or coffee mugs.

But some patients are getting wise, Bledsoe said.

" We're hearing more stories about people refusing helicopter service, " he

aid.

It's one more piece of the health insurance puzzle that people should pay

ttention to, according to the Texas Department of Insurance.

Larry Strittmatter said he doesn't recall being asked to give consent for

the

elicopter ride. His wife, he said, " was drugged and could not have

answered

oherently. "

A spokeswoman for UniCare, the insurance company that would pay only part

of

he cost, told me: " You're doing a good story because we see cases like

this

uite a bit. "

Benbrook Fire Chief Tommy said his paramedics contact a hospital

and

ive a patient report. Paramedics decide what kind of transportation is

needed.

" We assess the patient and determine the best care and expedient method

of

ransportation, " he told me.

" I understand the situation with the bill. Insurance companies call a lot

of

MS expenses unnecessary and do not dictate patient care. They just decide

what

hey will and will not pay. "

An executive with PHI Air Medical, based in Phoenix, who asked not to be

named

ecause he wasn't authorized to speak publicly, told me: " It's easy to look

at

he case after the fact. The reality is the paramedic is on the scene and

must

ake a split-second decision. They're driven by what's in the patient's

best

nterest. "

Dr. Roy Yamada is the North Texas medical director for PHI Air Medical.

At

the

ame time, he has served as medical director for several North Texas

cities,

ncluding Bedford, Euless, Hurst, Keller, Mansfield, North Richland Hills,

antego and Richland Hills, as well as Dallas/Fort Worth Airport.

In 2007, the Star-Telegram reported that many cities where Yamada trained

the

MS crews also called PHI Air Medical for emergency transports.

The newspaper also reported that, in 2007, a man was flown by PHI Air

Medical

o Parkland, even though PHI was not the closest air ambulance.

The PHI Air Medical executive said Yamada had nothing to do with the

trittmatter case and has no relationship with Benbrook.

When I called Yamada, he said: " I'm over here at one of the fire

departments

ow giving an exam. So I won't be able to talk to you. Call corporate on

that. "

The PHI executive told me that the Strittmatters can still seek a

negotiated

ettlement with the company.

" PHI is more than willing to talk directly with the patient, " he told me.

Larry Strittmatter sent a certified letter to the company last month

asking

or help.

Online extras

Find more Watchdog columns, investigative reports and product recalls at

tar-telegram.com/watchdog

THE WATCHDOG COLUMN APPEARS FRIDAYS AND SUNDAYS. DAVE LIEBER,

WITTER @DAVELIEBER

Looking for comments?

------------------------------------

[Guest guest]

Well their leaders are not that transient so they should step up

Henry

Re: Medical helicopter bill is 'a tough pill to swallow'

On Thursday, December 10, 2009 08:44, " Henry Barber " hbarber@...>

said:

> 5. I think the idea of a helicopter being exciting was true when it was new.

Unfortunately, the transient nature of the EMS workforce assures that HEMS

remains " new " to over half of the providers in the field, perpetuating the

cycle. And without that " new " and " exciting " lure, half of those people would

never have even joined EMS.

Rob

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