How Air Ambulances (Don't) Work

This paragraph introduces the development of emergency medicine through the experiences of Dr. R Adams Cowley during World War Two. Dr. Cowley observed that patients in 'shock' following trauma often led to death and aimed to treat these untreatable injuries. In 1960, he established the first trauma department in the US at the University of Maryland Medical Center with a two-bed unit. His survival rate improved over time, but he identified a critical issue: the time it took for patients to reach him was often too long. He proposed the 'Golden Hour' concept, suggesting a 60-minute window to reach medical care after trauma. To improve this, he advocated for direct transport of trauma patients to equipped hospitals and the use of helicopters, significantly reducing the time to care. These principles have become central to the Emergency Medical Service system.

The second paragraph delves into the validity of the Golden Hour principle. An academic review in 2001 questioned the principle's scientific basis, finding no strong evidence to support the idea that faster care universally improves outcomes. Subsequent research has been mixed, with some studies supporting the principle and others finding no significant link between transport time and survival outcomes. This has led to ongoing uncertainty about the relevance of the Golden Hour in modern trauma care, despite it being a foundational assumption of the EMS system.

This paragraph examines the role of air ambulances in trauma care. It explains that air ambulances are crucial for reaching remote areas where ground ambulances cannot meet the Golden Hour standard. However, it challenges the assumption that air ambulances always save lives. It points out that most air ambulance trips are hospital-to-hospital transfers within a hierarchical trauma care system, rather than direct from the scene. The paragraph also discusses the issue of overtriage, where patients are unnecessarily transferred to higher-level trauma centers, leading to high costs without necessarily improving outcomes.

The fourth paragraph highlights the financial impact of air ambulance services. It reveals that the average cost of an air ambulance flight is significantly high, often resulting in patients receiving bills that far exceed their annual income. The paragraph questions the pricing, given that the actual operational cost for companies is much lower, suggesting a substantial profit margin. It also discusses the lack of market regulation and the unique situation where demand does not decrease with increased prices due to the lack of patient choice in the matter.

This paragraph discusses the market failure within the air ambulance industry. It explains that the industry operates without regulation and that attempts to control prices have been met with legal challenges due to the Airline Deregulation Act. The paragraph also addresses the role of insurance, noting that most air ambulance flights are out-of-network, leaving patients with substantial bills. It points out that the industry is exploiting this market failure, with prices tripling over time and private equity firms owning most of the companies, leading to increased profits at the expense of patients.

The final paragraph presents an ethical dilemma regarding the use of air ambulances. It states that while air ambulances can save lives, the financial burden they impose can cause significant harm to patients and their families. The paragraph suggests that in many cases, the use of air ambulances may not be justified by the outcomes, as for every 100 flights, only four lives are estimated to be saved. It concludes with a call to action for reform, mentioning the No Surprises Act and its potential impact on the industry, and reflects on the medical principle of 'first, do no harm'.