Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Helicopter EMS – The Starbucks Effect.

Dr. Bryan Bledsoe says, “We are putting patients and flight crews at risk, when there is absolutely no chance for the patient to benefit from the risk.”

Does that sound like a definition of malpractice?

Maybe he was just trying to get some attention after a big accident. Maybe he is just trying to make a name for himself.

He wrote about this recently, before this crash, in Alright, I’ll Say It at ems1.com.

“it hit me that I knew more people who have been killed in a medical helicopter accident than by virtually any other means. At some point in my life I have met or spoken with at least five people who later died in medical helicopter crashes. They were all great people and died doing what they loved. We owe it to their legacy to assure that not a single flight nurse, flight paramedic, pilot or patient dies unnecessarily.”

Clearly, not someone trying to take advantage of a tragic situation, but someone trying to protect flight crews and patients.

Back to the video clip at the top of the page. Reporting on this, Tom Costello said, “But the medics on the scene often don’t know how serious the injuries are. And it’s not until the patient gets to a trauma center that those injuries can be assessed.”

Why wouldn’t a medical professional get on camera to say this?

What evidence backs this up? Yes, there are low standards for EMS. I have been very critical of the medical oversight that encourages this incompetence. The medical directors need to stop allowing anyone with a card to go out and inflict their incompetence on patients. Patients are not in a position to know who is competent and who is not. It is the job of the medical director to determine this before signing the paper that says this person is safe to treat patients with all of the life threatening drugs and equipment they carry.

In stead, medical directors write liberal protocols for helicopter transport. These liberal protocols are often violated egregiously, yet the medical director ignores this. Why? He probably does not know, because he is probably never going to see the patient and will never know that the patient chart is largely a work of fiction.

Some examples of bad flight decisions:

An adult with a lower leg fracture, about 20 minutes from trauma centers in two directions by ground. The idiots called for a helicopter for this stable patient, because that is what they do. They are too stupid to appropriately assess and treat the patient. But wait, some of the idiots who do this are the same medics who work on the helicopters on their other job. Why would anyone trust them with a patient, just to try to save a little time? Good pulses, sensation, and movement. No other injuries – at least according to the report that was given to the flight crew. Who knows how incompetent the assessment was that led to this report.

A child with his foot caught under the seat of a car that struck the guard rail. No intrusion into the patient compartment, everyone restrained, the driver was sitting in the seat that was on top of the child’s foot. The driver had an ankle injury (possible fracture) and was flown. Once one person is flown, usually everyone goes by air. So the five occupants of this car, of which the ankle injury was the most serious, were all flown. We had our own little air shown because somebody can’t treat an ankle injury. My patient was the child. I called the trauma center to get permission to drive him to the local hospital, since he is uninjured, but his parents want him checked out. Medical command at the Ivy League trauma center insists that this child must go by air to the pediatric trauma center. The parents are no longer on scene – they were not in the car, but were far from attentive to their child. Had the parents been on scene, maybe I would have been able to get them to sign a refusal for the helicopter transport and transport to the appropriate hospital with pediatricians on staff.

A stabbing to the chest 8 minutes by ground to the trauma center. The first in medic doesn’t quickly move the patient to the stretcher and transport. He calls for a helicopter. 40 minutes later the now pulseless child is placed in a helicopter to fly to a different trauma center. The patient was still alive 30 minutes after the arrival of the first medic. The patient would have arrived at the trauma center alive and had a chance to live – if he had not been flown.

Since the patient was a child the helicopter flew this dead patient and the trauma center worked the code for almost an hour. Nothing can bring back the wasted half hour that might have made the difference between a casket and an ICU bed. The child might have died anyway, but why call the helicopter to delay transport?

As for the Starbucks Effect, the number of medical helicopters has expanded similar to the way Starbucks have exploded across the countryside, but Starbucks does not explode the same way helicopters explode across the countryside. If you look at the chart it does look like the price of SBUX (Starbucks stock symbol), over the past 5 years, has taken off and flown pretty high, only to take an plunge reminiscent of Icarus, or a crashing helicopter. Today Starbucks announced that they are closing 600 stores – the customers are not flying in to buy their scuppie coffees. When will the flight programs put patients first and do something similar? We are creating bogus excuses to put patients in helicopters to satisfy the growing need for paying customers (patients).

And for anyone reading, who might be offended by what I wrote – if it does not apply to you then you know who I’m talking about; if it does apply to you stop being part of the problem and don’t complain that I pointed out your incompetence. Have I gone too far with crash and burn metaphors? I doubt it. Idiots will still be flying minor trauma after reading this.

Dr. Bledsoe says, “We are putting patients and flight crews at risk, when there is absolutely no chance for the patient to benefit from the risk.”

Words worth repeating.

Maybe we should start requiring competence from medics, so that we can protect patients and flight crews.

Here is a link to the abstract of the study mentioned in the video:

Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O’Keefe MF.
Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis.
J Trauma. 2006 Jun;60(6):1257-65; discussion 1265-6. Review.
PMID: 16766969 [PubMed – indexed for MEDLINE]

Another blog to read on the same topic, from a different perspective, is Too Old To Work, Too Young to Retire. His post is Helicopters in EMS. Ambulance Driver also writes about this and gives it more of a human touch in Gut Check….

My other helicopter misuse posts are:

Interfactility Helicopter EMS

Helicopters and Airways

Dispatch would have told us if it were something serious.

Safety über alles!



  1. Amen.

  2. Two different flight agencies cover the district where I work. Now mind you there is absolutely NO reason to EVER fly anybody from ANYWHERE in my district. We are 10-20 minutes away from a level 1 trauma center pretty much wherever you are in the district. So as for the flight agencies. A couple of weeks ago there was a relatively serious MVC on the interstate and someone called and asked for a helicopter. The medic from Flight Agency 1 got on the radio and told the paramedic if he started driving to the hospital now he would have the patient there before the helicopter even got in the air.Then just the other day I was on a minor fender bender one person had insuranceitus and the other person was signing off. I look up and was like “Ummmm who called Flight Agency 2?” as soon as I asked that the medic in the helicopter starts trying to get a hold of me asking if I wanted to fly anybody. It turns out that this particular agency is trying to prove their worth to the community so they self dispatch. In turn a lot of people who don’t need to be flown wind up being flown. I told them that their was no reason to fly my refusals but thanks anyway. They flew a football player with a dislocated knee not to long ago. 10 minutes by ground. Who flies a stinking dislocated knee? It’s scary. It really is.

  3. Stacey,That is one of the problems of helicopter use – they are selling something that often is not needed and they are using good sales technique to do it. It works on the doctors, nurses, and medics. Forget your medical training, we have a shiny pin for you to wear that is much cooler than your stork pin for delivering a baby. We can land at your EMS week event and show off for the kids. And you’ll be on the news, because the news helicopters frequently follow the medical helicopters.I wonder if the first flight medic was reprimanded for his demonstration of common sense.If only we had a job that made patient care a priority – Nah!

  4. Oddly enough, Starbucks is closing 600+ stores this year; most of them were opened after the big 2006 expansion.One wonders if PennSTAR or University Medevac will do the same? Probably not.On the political side, support Congressman Jim Gerlach. He’s pushing for Brandywine Hospital to regain their trauma center status. That would cut back on the knee-jerk ChesCo response to fly ever nick, cut, and scratch.

  5. When your only tool is a hammer, everything starts to look like a nail. When you have a helicopter service to justify, everything stats to look like a trauma patient.

  6. TrekMedic251,It would be a good thing to reopen Brandywine’s trauma center, even if only as a level 3. It probably would not make much difference in flights, since there are plenty of medics who think that anything less than a level 1 is not good enough for their patients, in spite of all of the research to the contrary.Ooh, ooh, what if I arrive at the hospital before the trauma surgeon?So what?But, for people who do not know what they are doing, this seems very important.Over the next decade, if the medical directors do not control the helicopters, the lawyers probably will. A lot of them will go away. Helicopters, that is – lawyers are forever. 🙂

  7. TOTWTYTR,The helicopter is the solution to everything.Cheap. Quiet. Low maintenance. Staff do not require supervision or training. Work in all weather. Go anywhere. Maybe I was describing a hammer. 🙂

  8. Chesco is bad – Montco is worse. I’ve seen so many illegitimate flights from there it’s ridiculous.I’m not sure where the attitude towards flying everything comes from. Some of it is peer pressure – I can’t count how many times I’ve been asked “Aren’t you going to fly that?” on simple, BS cases. I think a lot of it is laziness – people don’t want to drive the 35 minutes to LVH, or in the case of my Chesco employer, the 30 to 40 minutes to RMMC.And I totally agree on reopening trauma at BWH. 8 minutes to a trauma center? I’m totally cool with that (I’m from one of the surrounding towns….look at my blog and you’ll know which one, if you’re from the area)Funny issue with BWH, currently, though – most of the docs with the exception of one will refuse to accept anything that even resembles trauma – Even though they’ve got a helicopter sitting outside the door if it’s necessary.Strange, strange….Where are you from, BTW? (Send me an email – I’m curious if you’re somebody I know)

  9. Ken Fritz,I’ve worked in both counties and I agree that MontCo is worse at the “backboard equals helicopter when 20 minutes from the trauma center” attitude.I’m guessing that the doctor at BWH, who is comfortable with trauma is Dr. Doroski. I would expect that with Dr. Anderson and Dr. Traficanti, you just need to convince them that you have done a thorough assessment. They have too many examples of being lied to by EMS to feel comfortable with everyone. Of course, the county medical director should address that problem, but that talk of getting rid of the dangerous medics keeps getting me in trouble. Dr. Nathan should be comfortable with trauma after time in Iraq. The rest, either I don’t know them, or I have nothing positive to say about them.Even though they have the helicopter just down the driveway from the ED, some of the doctors will say “What if the helicopter is out on another call?”It is amazing how doctors go to medical school to learn to justify inaction with the words “What if.”If you really want to be entertained with trauma – PMH and JRH will have fits if you bring anyone on a board from a car crash. Remember, the state protocols have the destination hospital as the LAST one to contact in the destination decision protocols for trauma. Considerations related to contact with medical command:1. When medical command is required for a Category 1 or 2 trauma patient, contact a medical command facility accessible to the EMS provider using the following order of preference:a. The receiving trauma center if the destination is known and that center is also a medical command facility.b. The closest trauma center with a medical command facility.c. The closest medical command facility.2. If the EMS crew has any question regarding the facility to which a patient is to be transported or whether the transport should be made by ground or air ambulance, the crew shall contact a medical command facility for direction.Category 3 trauma patients [Transportation of these patients to the closest receiving facility is generally acceptable.]a. Transport to appropriate local receiving hospital b. Reassess patient frequently for worsening to Category 1 or 2 criteria.This links to the pdf of the state BLS protocols, Section 180 applies to trauma destination decisions (BLS protocols apply to ALS as well).Here is a page that links to important Pennsylvania EMS information including the protocols above. This does not open a pdf, but a page with a bunch of links, some pdfs can be reached from this page. Although some of the links are listed as pdfs, that does not mean that ones not labeled as pdfs aren’t pdfs. It is like a Chinese menu.It is then the responsibility of the trauma center to notify the local hospital about the patient.If fire board contacts you on radio and tells you that you must call command at the destination hospital immediately, wait until you are on the grounds. You already have contacted command and received all the orders you need. If their CAT scan is down, they should have notified fire board of that. Once you are on the grounds EMTALA applies. As far as I know, both JRH and PMH have been fined for doctors coming out to the ambulance bay to chase away an ambulance with minor trauma, so they should try to avoid repeating this juvenile behavior. Should.CMS Regional Office. Region III in Philadelphia (215)861-4140. They may change their phone numbers, after all they are from the government, so they are trying to avoid accountability.http://www.emtala.com/