The study, titled, “Medical Necessity of Helicopter Emergency Medical Services Transports: Results of a National Cohort Utilization Review,” reviewed all of the flights performed in 2009 by Air Evac EMS Inc. (Air Evac Lifeteam), a large national air medical company with bases in 14 states. A critical care registered nurse gauged the medical appropriateness of flights based on criteria from the Medicare Benefit Policy Manual, industry guidelines from the Commission on the Accreditation of Medical Transport Systems (CAMTS), Air Medical Physicians Association (AMPA) position papers, the Center for Disease Control’s guidelines for field triage, and Medicare reimbursement appeal decisions. Records indicating a possible inappropriate flight were further reviewed by a senior quality assurance/quality improvement nurse or a senior medical director. Additionally, the reviewers of Air Evac Lifeteam’s flights used a higher level of scrutiny for flights under 30 miles in distance. Utilizing this process, the reviewers found that only 1.4% of the flights that year could be deemed medically inappropriate.
The authors of the study noted that on-scene flights were more likely to be classified as medically unnecessary than transfer flights and that the most common reason a flight was deemed medically unnecessary was because it met the criteria for ground rather than air transportation. Though the rate of medically inappropriate flights was found to be very low, the researches stated that a lack of EMS resources in rural areas may be falsely elevating this rate. For example, a patient who does not meet the criteria for air transportation may nevertheless need to be transported by helicopter because of inadequate ground resources.
“Amid growing concerns of HEMS utilization for noncritical patients, this study supports the fact that the emergency medical transport community works hard to ensure the appropriate transport of the most critically ill or injured patients,” commented Dr. Daniel Hankins, MD, FACEP, emergency physician and president of the Association of Air Medical Services (AAMS). “Our consistent goal is the right patient transported with the right crew in the right vehicle to the right treatment facility.”
The abstract for “Medical Necessity of Helicopter Emergency Medical Services Transports: Results of a National Cohort Utilization Review” appears in the January/March 2011 issue of Prehospital Emergency Care.
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CALSTAR is a nonprofit air medical program serving California and Northern Nevada. Our mission is "to save lives, reduce disability and speed recovery for victims of trauma and illness through rapid transport, quality medical care and education."