HealthNet seeing use of its services increase [The Dominion Post, Morgantown, W.Va.]

Aug. 12--KINGWOOD -- Helicopters are landing more and more in rural communities as the use of aero-medical services becomes more common.

Recent favorable weather has increased the presence of Health-Net in Preston County, responding to emergency medical calls and near scenes of traumatic injuries.

While the recent increase is only slight, it is across the board for areas served by the air medical services, according to Dave Cross, director of business development for HealthNet Aeromedical Services.

HealthNet has eight home bases: Morgantown, Buckhannon, Ripley, Huntington, Martinsburg and Beckley, all in West Virginia; Portsmouth, Ohio; and Prestonburg, Ky.

The 501(c)3 not-for-profit agency is owned and sponsored by WVU Hospitals, Charleston Area Medical Center and Cabell-Huntington Hospital, said Clinton Burley, HealthNet's president and CEO.

"The numbers are up slightly," Burley said of flights to Preston County, "but consistent with what we see in the system."

He said the number of requests is consistent, but the percentage of completed flights has increased. And that can possibly be attributed to dry weather and the ability to fly when needed, he said.

In May 2011, HealthNet transported 12 from Preston County. Three were interfacility (hospital to hospital) flights and nine from scene -- five traumatic injuries and four emergency medical calls. In May 2012, there was one interfacility transport, nine trauma cases and six emergency medical calls.

In June 2011, 17 flights were completed from Preston County -- five interfacility and 12 from scene: Nine trauma and three medical. This June, there were 20 completed flights from the county: 16 from scene, 12 trauma and four medical and four interfacility transfers.

While weather may be one factor for the increase in completed flights, Burley said, there is "a nationally increased push for EMS to get medical patients to teaching hospitals in a shorter period of time."

When a patient is having chest pains, "time is muscle," he said. And in the case of a stroke, "we're teaching lay people a stroke is a brain attack and is as time sensitive as a heart attack."

Preston County's terrain slows ground transport, and minutes gained by using air transport can mean the difference between life and death, according to a study published in April's Journal of the American Medical Association.

Researchers determined that there is "a 1.5 percent increased absolute rate of improved survival for 159,511 patients transported by helicopter vs. ground emergency service to level 1 trauma centers." For 63,964 patients taken to level 2 trauma centers, "an absolute survival advantage of 1.4 percent was found for those transported by helicopter compared with ground transport."

The state has published criteria for when it is appropriate to launch an aero medical flight, Burley said. An EMT or paramedic who decides a helicopter is needed talks to medical command (med comm). The trained medical staff there (locally, they're based at Ruby Memorial Hospital) "obtain basic information from the field and compare that to the state criteria and make a determination on whether to launch or go by ground to an area hospital," Burley said.

In addition, Med Comm will take into account "mechanism of injury criteria," he said. Certain types of incidents are known to have a higher risk of a hidden injury, he said, including a patient in a car crash who isn't wearing a seat belt. Though there may be no visible sign other than redness from the patient's chest striking the steering wheel, an X-ray may reveal a more severe injury. You just can't tell that at an accident scene, he said.

A verbal assessment is often enough to warrant putting HealthNet on standby even before an ambulance reaches the patient, said Pam Thomas, a paramedic and president of KAMP Ambulance in Kingwood. "If I hear there's a crash with ejection, I put them on standby," she said.

Once on scene "if they meet the criteria, we fly them."

The protocols include signs of stroke or cardiac arrest, life-threatening injuries, ejection, a vehicle that rolled on them, head injuries, loss of consciousness, if anyone else in the car has been killed and major burns, Thomas said.

Another criteria is patient location. Thomas said a patient a few years ago had fallen 20 feet over a cliff onto rocks. A fire department ATV and a long walk down the cliff were necessary to reach her. It was two hours before they got her out.

"By the time we got her packaged for transport and to Ruby, it would have been another two hours," she said. "For a trauma patient, if you can get them to definitive care within an hour, they have the greatest chance of recovery."

The price of going by air

HealthNet charges a $9,042 lift-off fee, and $134 per mile, but there is no financial screening before Health-Net is launched, Burley said.

"If there's a request, we respond if it's safe to do so. We have a liberal charity care billing process. A lot of our charges every year are written off as charity service, which matches the mission of our sponsor hospitals. A lot of patients we transport don't even know they're flying."

Few refuse transport by medical helicopter, Burley said.

"Of 3,000 transports in a year, I can count on one hand the number of refusals," he said. "Most are unconscious."

But refusals are honored. If someone opts out of a flight, "we'll make other arrangements to transport by ground."

"For the most part, when we go in the patient understands the situation is significant. They understand the link to higher care, to a teaching hospital, and they want to get there," Burley said.

"It is expensive," said Thomas, "but you can't really put a price on a life."

"I think they're an important part of the team," she said. "Care goes up with each step and sometimes that's the difference between life and death."

Thomas said HealthNet is the most frequently used service, but at times its not available, "they [Preston 911] will call the next closest" -- the Maryland State Police's Trooper 5, or Life Flight out of Pittsburgh -- "but they're not here very often."

Is it necessary?

Trauma centers can see about 10 percent of patients who are "over-triaged" -- those flown that many not have required air transport, Burley said.

Cross said there are also those "under-triaged" -- who aren't flown but have no immediately apparent injuries.

"In order to limit the number of under-triaged patients, the thought is that you should be seeing an over-triage and therefore capturing the majority of those who need definitive trauma care," Cross said.

In other words, it's believed that it is better to err on the side of caution when deciding whether or not to transport a patient by air.

"If they meet the protocol, it's better to be safe than sorry," Thomas said. "It's better to fly them."

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(c)2012 The Dominion Post (Morgantown, W.Va.)

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