Priceless but costly

A patient is taken from Hazel Hawkins Hospital to a waiting

Gilroy
– An easy call for CALSTAR: David Cross, an employee at
Goldmsith Seeds, had just been knocked off his bike by a driver
speeding along Hecker Pass Highway. There was a good chance he had
internal bleeding or a brain injury. The closest trauma center was
more than 40 minutes away by ambulance. The

Platinum 15 minutes

were over. The

Golden Hour

was slipping away.
Gilroy – An easy call for CALSTAR: David Cross, an employee at Goldmsith Seeds, had just been knocked off his bike by a driver speeding along Hecker Pass Highway. There was a good chance he had internal bleeding or a brain injury. The closest trauma center was more than 40 minutes away by ambulance. The “Platinum 15 minutes” were over. The “Golden Hour” was slipping away.

So on the morning of May 10, Cross was airlifted to Stanford University Medical Center and then released later that day after receiving treatment for his scrapes and bruises. In hindsight, Cross didn’t need the air ambulance, and his case is fodder for critics who say that emergency responders who rely too much on air ambulances are driving up medical costs and gambling with limited resources. But as air ambulance advocates say, what is the price of someone’s life?

“They’re either the Angels of Mercy or the Albatrosses of Advertising, depending on your perspective,” said Dr. Maurice Ramirez, a former flight physician and an emergency room doctor at South Bay Hospital near Tampa Bay, Fla.

The albatross is the well-marked helicopter, often from a for-profit medical provider, seen hovering in great numbers above traumatic accidents all over the country, waiting to provide a service that isn’t always necessary but that can be very lucrative. Air ambulances can charge $15,000 or more for a ride. That’s several times what ground transport costs, and depending on the length of the trip and the injuries involved, a profitable journey.

“The medical community has fostered this. We created the expectation that a big bird will appear in the sky and whisk your loved one to safety,” Ramirez said. “Leasing helicopters to hospitals can be an extremely profitable prospect. You make money on every aspect of the deal.”

And with its large population in a rural, sometimes inaccessible area close enough to trauma centers to make the service economically viable, South Valley is the ideal marketplace. Almost all patients transported by air to trauma centers in San Jose and Stanford come from South County and the eastern foothills. So far, the county has managed to keep the albatrosses away.

Of the 70,000 to 80,000 emergency calls the county receives each year, about 2 to 3 percent are answered by a helicopter. The county’s largest providers are the non-profit CALSTAR, which next week celebrates its 11th anniversary in Gilroy and handles more than 600 calls a year, and Life Flight, a service of Stanford Medical. Reach Air Medical Services, a for-profit company that operates in six California counties, provides backup service and answered 28 calls last year in Santa Clara County.

Bruce Lee, Santa Clara County’s emergency medical services administrator, said his staff tracks air ambulances closely to ensure they’re not being employed needlessly.

“The issue anywhere in the country or in this region is the question of their utilization,” Lee said. “We want to make sure they are transporting the right patient at the right time to the right facility because number one, they’re expensive, and number two, they’re risky.”

The economics of air transport can be troubling to everyone involved. Depending on services, air transport costs anywhere from $5,000 to $15,000. To be effective, CALSTAR must take off from its bases in Gilroy and Salinas before it knows whether it will transport a patient. The agency cancels about half of the 55 calls it receives every month, losing money each time. When a pick-up is made, if the patient doesn’t have insurance, he’s looking at years of payments or ruined credit. Even the nonprofit CALSTAR refers those who can’t pay to collection agencies.

“The fact of the matter is that person can get hit with an ambulance bill, an emergency room bill and a trauma-activation bill. It’s easy to ring up a $30,000 or $40,000 bill in an hour-and-a-half,” said CALSTAR President Joe Cook.

CALSTAR Program Manager Tom Goff said that finances are the last thing any flight nurse or paramedic is thinking about at the scene of a traumatic accident. For everyone who’s been treated and released, there’s a memory of a patient who seemed fine and then died from unseen injuries. Emergency crews work under two deadlines. They want to get to a victim within 15 minutes of an accident and get that patient to a trauma center before the “Golden Hour” expires.

“You’re damned if you do and damned if you don’t,” Goff said. “I’ve been on flights where I’ve seen people get out of a car, take three steps, and keel over. We don’t have X-rays, we don’t have MRIs. We have to make decisions based on what we see.”

Once they arrive on a scene, CALSTAR crews decide whether to airlift the victim, but the decision to call for an ambulance is made by the county’s emergency medical services team.

Goff said that the highly trained county crews almost never call for air support without a real need.

“There are certain days we get lots of calls without ever doing a transport and I say ‘holy moly that’s very expensive,'” Goff said. “But our paramedics are incredibly well trained and if they’re going to make an error of any sort it’s on the side of the patient.”

Dr. Richard Kline is medical director of the new trauma unit at Regional Medical Center in east San Jose and was associate director of the trauma center at the now-closed San Jose Medical Center. He said that air ambulances have played a huge role in improving the quality of care for people outside of urban areas.

“I think the helicopters have brought great benefits to the county,” Kline said. “Helicopters have given patients who wouldn’t have access to care access. That’s why they have proliferated. We have multiple patients a year who come to us from south of Pacheco Pass, from San Benito, Monterey, Santa Cruz County. There may be times when an ambulance is just as good, but you don’t know that in advance.”

And on a busy Memorial Day weekend, CALSTAR was everywhere, transporting patients, responding to auto accidents and plucking two men from Hollister Hills after a dirt bike collision. That weekend, there weren’t any questions about the service air ambulances provide.

“Because we were there they received a level of care that they couldn’t have gotten any other way,” Goff said. “It might have been an hour or more drive rather than a 10-minute helicopter flight.”

Protocol for air ambulance

Helicopter requested if trauma occurs on:

Pacheco Pass highway, east of Ferguson Road; Hecker Pass corridor, west of Watsonville Road; Mount Hamilton Region, San Antonio Valley; east of Anderson Reservoir; in any area inaccessible to ground units

Or if closest trauma center is more than 20 minutes by ambulance and patient has one or more of the following:

• low blood pressure or shock; unstable airway; active seizures not suppressed by medication; cardiovascular instability; critical burns

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