Air medical services

Air medical transport refers to the use of fixed-wing (airplanes) or rotor-wing (helicopters) aircraft for transporting patients in medical situations where ground transportation options are less effective. Helicopters are typically used to transport critical patients in cases when time is an important factor for survival, while airplanes are used for carrying patients between states and countries. Air medical services can also be used to increase access and availability to critical care and specialty services. These services also tend to be staffed with well-trained crews capable of transporting seriously ill locations either to regionalized healthcare systems or from remote locations.

Air medical services may be defined as the following:

• Hospital-based, in which a hospital controls the business by providing medical services and staff while contracting pilots, mechanics, and aircraft
• Independent, in which operations are not controlled by a specific medical facility but by independent providers who directly employ the medical and flight crews
• Government-operated, in which a state or municipal government or military unit owns and operates the air ambulances

Air medical services offer various advantages over ground transport. These are namely the speed and maneuverability of air medical transport, when ground transport may be limited by factors such as the availability of roads, road conditions, and traffic. Helicopters, especially, have been shown to be capable of reducing the time to transport to a hospital, which can be especially ideal for trauma patients, whose survival relies on getting into an operating room with a trauma surgeon as soon as possible.

However, the disadvantages, which tend to be common to both fixed-wing and rotor-wing aircraft, begin with the cost. The cost of air medical services depends on factors such as staffing, the type of aircraft, the distance of transport, the cost of purchasing the aircraft, and the maintenance of the aircraft. Air medical services are also more susceptible to weather conditions than ground transport. And in the case especially of helicopters, the weight of the transport has to be carefully calculated to ensure the aircraft engines can produce enough power.

Another disadvantage of air medical transport is its inherent risk when compared to ground transport. Though data through various periods have shown that ground transports tend to be in more accidents than air transports, the recorded accidents involving air transports tended to result in fatal injuries at a higher rate than ground transport. Specific to fixed-wing aircrafts, the availability of a runway is critical, except in the case of a seaplane, which requires a large enough body of water. This tends to limit fixed-wing aircraft to patient transport more often than true emergency operations.

The decision to use air medical services has several considerations. These begin with whether the transport will benefit the patient. For example, aircraft travel faster and further than ground transportation, but the time taken to set up a landing zone or transport to an aircraft and evaluation by a flight crew can render the services comparable in transport time to ground transportation. Another part of that consideration is whether the transportation offers the patient a higher level of care than what a patient is currently receiving.

Helicopters have been the most widely used aircraft for most emergency medical transports and saw their first wide use during the Korean War. Patients were secured to stretchers outside the helicopter, and no care was provided during transport in the conflict. Since then, regional healthcare and emergency medical services (EMS) systems can benefit from helicopter air medical services by extending the level of advanced care through a region, providing a backup for areas with limited healthcare coverage, reducing transport times, and making direct transport to specialized centers available. A 2012 study found patients transported by helicopter showed a benefit in terms of survival, time interval to reach the healthcare facility, time interval to definite treatment, better treatment results, and a general benefit.

The first use of air transport for ill and injured patients began in 1784 when hot air balloons were used to move injured soldiers to a medical facility. The invention of the airplane led to the development of the Curtiss JN-4 biplane, which would be used as an air ambulance in 1918. In 1947, the first Federal Aviation Administration-certified air ambulance was established in Los Angeles, with civilian air ambulances introduced in the 1970s. The U.S. Air Force continued the development of air-medical transport capabilities through the creation of the critical care air transport team at Texas's Lackland Air Force Base in 1994.

Before 2002, hospitals owned and operated most air ambulances. However, in that year, negotiations led to Medicare officials creating a national fee schedule for air ambulances. This increased the Medicare reimbursement rate for helicopter air ambulance transport, particularly raising the rate for rural transports, and enabled for-profit operators to expand their presence in the growing industry.