Notes on the news:
First, do no harm
Patient welfare should come first in flight and legislation
The casualties mounted in late September as a helicopter crash in Maryland claimed four more livesa patient and three rescue workers. The Maryland State Police helicopter had been transporting victims of a traffic accident when it crashed. Authorities said that the accident was the worst since Maryland state police began flying such missions nearly 40 years ago and the eighth fatal medical helicopter crash in the past 12 months.
An Oct. 5 story in the Baltimore Sun noted that the risk/benefit picture of helicopter ambulances isnt all that clear. While conventional wisdom backs getting patients to the hospital as quickly as possible, there are studies suggesting air transport is less effective than touted. The newspaper cited one study showing helicopter transport made no difference for patients with severe injuries. Other research found that while helicopter patients got initial treatment more quickly, they arrived at the hospital later than patients transported by ground ambulance.
The newspaper quoted Norman E. McSwain Jr., director of trauma at Tulane University and chief of surgery at the trauma center in New Orleans, as saying, There is just too much flying of helicopters for nonmedical reasons or for reasons that really have nothing to do with patient care. Its the kind of thing we have to get under control.
As Modern Healthcares story reported, the number of helicopters involved in air ambulance operations increased by 38% from 2003 to 2005, and the number of locations from which they operated grew by 30%. Most of the growth has been in airports and stand-alone helipads, rather than hospital-based operations. A Government Accountability Office report on the phenomenon said that it has produced more competition in certain areas and potentially led to unsafe practices such as helicopter shoppinga continued search for air ambulance service by emergency dispatchers until an operator agrees to accept a flight.
Local and national officials and providers need to create a rational air transport system. Maryland already decided its emergency medical workers will consult trauma center doctors before using helicopters to transport patients without obvious severe injuries. Thats good because the country has been inching toward violating the ancient directive to first, do no harm.
The governor recently vetoed several measures he championed in his push for comprehensive healthcare reform (Oct. 6, p. 16). He cited a state budget impasse as the reason for his opposition. He took his veto pen to, among other things, measures that would require providers to notify patients of their rights regarding medical records. He also rejected a bill that would have required insurers to prove that members intentionally misled them on applications for individual policies before revoking coverage. That practice, known euphemistically as rescission, has been a scandal in recent years.
Schwarzenegger did find it in his heart to sign legislation that would penalize people and hospitals that violate or fail to protect patient privacy. The bills were crafted in response to incidents at Ronald Reagan UCLA Medical Center, where personnel perused celebrities records, including those of the governors wife, Maria Shriver.
Its always inspiring to see politicians standing up for the rights of the little people.
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