EMS World

AUG 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

Issue link: https://emsworld.epubxp.com/i/1006214

Contents of this Issue


Page 31 of 51

EMSWORLD.com | AUGUST 2018 31 Stroke—Air medical ser vices are frequently employed to transport patients rapidly from remote scenes to primar y stroke centers (PSCs). But how common is it? The Air Medical Research Institute aggregated deidentified patient data from 67 U.S. air medical ser vice providers from 2004–2011. They found a total of 25,332 patients were transported for the primar y condition of stroke, and that air transports are becoming more common. The incidence of stroke-related transport increased from 1.4% to 3.9% during the study, performed during the time that primar y stroke centers were being accredited across the United States. A total of 96% of transports arrived at definitive care within two hours via HEMS. While 72% of transports were interfacility, 58% were from rural or super-rural localities, meaning 42% of transports originated in urban areas. The authors' conclusion was that HEMS has increased access to stroke care for super- rural, rural, and urban communities, offering timely transport within the treatment window if symptoms are recognized within 2.5 hours of onset. Results of the analysis were published in the Jan.–Feb. 2016 issue of Air Medical Journal. Spinal cord injury—Spinal cord injur y is another time-depen- dent diagnosis Hutton's team was interested in examining. The descriptive study examined deidentified data of HEMS providers from 34 states from 2004–2011. Of almost 7,000 SCI patients transpor ted, the average patient was 21 years old, male, and had a 63-minute total transport time. Of all SCI transports, 42% were classified as urban, 36% rural, and 22% were super-rural. Of all SCI transports in the study, 69% arrived at definitive care within one hour of dispatch request, while over 96% arrived within two hours. "HEMS' abilit y to identif y this subgroup of patients and move them to regional SCI centers early will be cost-effective in the future, because of patients' age and the ability to reduce the societal cost of SCI," concluded the authors. "[This] demonstrates the high level of accuracy in the triage of these patients to trauma centers, and the lack of specialty care in many areas makes HEMS a health system necessity." Cardiac arrest—Hutton's group is nearing completion on a large examination of over 10,000 cardiac arrest calls in rural, super-rural, and urban areas, both scene responses and inter- facility transports. Areas of scrutiny will include demograph- ics, transport, logistics, and regionalization of postarrest care. Hutton acknowledges the current reimbursement structure fueling the industr y is in dire need of overhaul. According to AAMS, current Medicare rates are outdated and not connected to actual cost data. For ever y 10 patients flown, five are on government insurance such as Medicare and Medicaid, neither of which pay close to the cost of an average transport, and two pay nothing at all, according to AAMS. Seven out of 10 air medi- cal transpor ts are un- or underinsured, the association says. "Healthcare charges in the U.S. have escalated for the insured population because the government still pays the same amount they did 30 years ago," Hutton says. "The business is structured wrong financially. The problem is that 80% of the bills are paid by 30% of the patients. So you have 100,000 people paying for the availability of HEMS for 330 million people." Instead of the current structure, Hutton favors hybrid funding via multiple sources, as practiced in other HEMS models around the world. "True sustainability means balancing the financial mission with the clinical mission," he says. ABOUT THE AUTHOR Jonathan Bassett is editorial direc tor of EMS World. Reach him at jon@emsworld.com. ISSUE FOCUS: ADVANCED CARE (800) 338-4045 | www.REACHAir.com Minutes Matter. For More Information Circle 25 on Reader Service Card Traumatic Injury Leads All Air Medical Transports ESO, a Texas-based provider of software for fire and EMS agencies, examined transport data from January 1 through July 9, 2018. Of roughly 3.8 million records in its reposi- tory for that time period, 2,795 were for transfers through the air—less than 1% of their patient records. Diagnoses included: • • 59% traumatic injuries • 16% stroke/acute neurologic emergency • 8% cardiac (heart attack, dysrhythmias) • 17% "other" (no specific complaint) —Source: ESO

Articles in this issue

Links on this page

Archives of this issue

view archives of EMS World - AUG 2018