Medical Helicopters: Worth the Cost, Risk?

PHOTO: A man that was injured in a car accident arriving by helicopter and rushed to the trauma room for treatment, Grady memorial hospital on July 30, 2006 in Atlanta, Georgia.Jonathan Torgovnik/Getty Images
A man that was injured in a car accident arriving by helicopter and rushed to the trauma room for treatment, Grady memorial hospital on July 30, 2006 in Atlanta, Georgia.

It was an ordinary work day at the trucking company last July for Donnie Smothers, 39, of Camden, Tenn. -- until an 18-wheeler came crashing down off a jack, crushing his head and chest.

The accident occurred 95 miles from the nearest level 1 trauma center at Vanderbilt University Medical Center in Nashville, a distance that could take almost two hours to cover on the ground. An ambulance arrived on scene to find Smothers losing blood quickly. Time was running out, and the paramedics didn't think they could get him to the hospital fast enough in the ambulance to save his life.

They called in a medical helicopter -- a call that may have saved Smothers life.

According to a new study published in the Journal of the American Medical Association on Tuesday, transportation to the hospital by helicopter for trauma patients like Smothers is linked to a 1.5 percent increased rate of survival compared with ground transportation such as ambulance.

For many this number may seem small. But it means that for every 65 patients taken by helicopter, a life will be saved. "I would not be here today without them," Smothers says.

But the flights can be pricey, and -- as a recent surge of medical helicopter crashes shows -- potentially dangerous. According to a report by the National Transportation Safety Board, 2008 saw 12 crashes involving medical helicopters, seven of which were fatal. Medical helicopters have a higher ratio of accidents to number of flight hours than other types of aviation. These potential downsides have some experts concerned that these flights just aren't worth it.

"HEMS [helicopter emergency medical services] is the most dangerous form of helicopter transportation," says Dr. Jeffrey Rabrich, medical director of EMS and disaster preparedness at St. Luke's-Roosevelt Hospital in New York. "They often launch in marginal weather and there have been numerous crashes killing all aboard, including the patient."

The idea of using helicopters to transport ill patients originated in the military with the Vietnam War. The widespread success of medical helicopters in this setting led to the creation of helicopter programs at many hospitals across the world.

In an attempt to show what effect, if any, that helicopters have on survival for trauma patients, the researchers from Johns Hopkins Medical Center studied over 200,000 victims of a wide variety of trauma -- including car crashes, gunshot wounds and workplace accidents like Smothers' -- by using information contained in a national databank. When they matched patients with similar characteristics and similar levels of injury, they found a small increased rate of survival in helicopter-transported patients.

As for how expensive the service is, in Maryland it costs $5,000 for one such flight. Using simple math, the authors estimate the cost to save one life is $325,000. But since Maryland has a relatively low operating cost due to the ideal design of their trauma system, in most states the cost per flight is much higher. In some states, the cost per life is over $1 million.

Doctors Debate Medical Helicopters' Usefulness

Some doctors say the cost is a necessary expense in some areas in which appropriate treatment centers are few and far between.

"The greater Houston area is served by just two level 1 trauma centers for over 5 million people," says Dr. James J. McCarthy, medical director of the emergency center at Memorial Hermann Hospital in Houston.

Yet Dr. Jack Sava, director of trauma at Medstar Washington Hospital Center in Washington D.C., cautions, "Helicopters are not medical treatments, and they are not magic. They're just a fast, expensive way to get to the hospital."

Location appears to play a big part in how useful these helicopters are. In rural areas, where a few medical centers may be scattered over large areas, helicopters can be a real timesaver. But in urban areas where landing a helicopter can be difficult and distances are short, ambulances are often the faster way to go.

"It is generally not recognized by the public that a helicopter is not always faster than an ambulance," says Dr. Amy C. Sisley of Henry Ford Hospital in Detroit, Mich. "Helicopters are often unable to land at the scene of the injury and must land at a distance in a parking lot or other open space."

"I would call a helicopter only if the ground transport time exceeds 60 minutes because less than that and the helicopter isn't saving that much time," Rabrich says. "The helicopters time advantage dissipates rapidly as the distance to the trauma center decreases."

Many experts think the skill level of the crew and superior equipment on helicopters, rather than speed, is what really makes a difference in care. It is not unusual for a helicopter to have a trauma nurse or even a physician on board, something that an ambulance almost never contains. In Smothers case he was able to receive medications for his injuries that the ambulance on scene could not provide him.

"In every instance the capabilities typically available on a helicopter will always be the same -- or greater -- than those available in a ground ambulance," explains Dr. Michael A. West, professor of surgery at the University of California San Francisco, referring to this study an "apples to oranges comparison." He says that instead of helicopters, more emphasis should be placed on packing ambulances with better equipment and enhancing paramedic training.

Still, for every argument against the use of these choppers there is a patient like Smothers, who believes that his life was saved by one. Smothers says he is forever grateful for the emergency medical personnel on the helicopter that day.

"I think of them as second to none, really extraordinary," Smothers says.