Emergency crews slow to use? local air ambulance services.

Byline: The Register-Guard

Since May 15, a rotating crew of flight medics and nurses have been on duty 24 hours a day at the Eugene Airport, ready to respond at a moment's notice to a medical emergency or trauma in the southern Willamette Valley.

But the service provided by the nonprofit Life Flight Network hasn't yet been embraced by local doctors, who sometimes prefer to put a patient in a ground ambulance for a trip to a Portland hospital rather than call for a costly helicopter, local emergency medical service officials say.

"There's some reluctance on the part of some physicians to utilize an air ambulance," said Michael Griffiths, a flight nurse and executive director of Life Flight Network, which is owned by Legacy Emanuel Hospital & Health Center, Oregon Health & Science University and Providence Health System.

Springfield Fire Chief Dennis Murphy said emergency physicians are "just starting to warm up" to the idea of a locally-based air ambulance.

"We need to have more dialogue with doctors," Murphy said. "We're finding our doctors are not used to using helicopters. They're very reluctant to use them because we never had helicopters available down here."

Life Flight crews transport patients from emergency scenes to hospitals, and from one hospital to another. In addition to Life Flight, REACH Air Medical, a California company that operates out of the Corvallis airport, also provides air ambulance service in this area.

EMS officials have been meeting with doctors and hospital officials, and Griffiths said he hopes local doctors will make greater use of the air ambulance service.

"If it's not utilized, it will not remain in the area," he said. "There needs to be a minimum number of flights to financially sustain the aircraft."

Since starting its service here, Life Flight crews have been transporting about five patients a month from the Eugene-Springfield area hospitals to Portland, Griffiths said. He wouldn't say how many trips are needed for the program to be sustainable.

Dr. Ken Starr, an emergency physician at the Sacred Heart hospitals in Eugene and Springfield and Oregon medical director for REACH, said if a patient has a need for a higher level of care than is available locally, doctors will send them to a Portland hospital "by the most appropriate means necessary, and sometimes that is air medical transport," he said.

"That is more expensive, but it is also using a higher level of clinical care," he said.

Sometimes, patients need to be transferred from one hospital to another but don't need air transport, he said. For instance, if a newborn child is in stable condition but needs to be taken to a Portland hospital, doctors might call for a special pediatric ambulance operated by OHSU, he said. In other cases, particularly those involving cardiac and stroke patients where every minute counts, air transport is more appropriate, he said.

Starr said he and other doctors affiliated with emergency medical services need to educate other physicians about the appropriateness of air medical transport, and not just for trauma cases, he said.

"We need to open a dialogue and have some discussion among physicians in our community" about air ambulance service," he said. He predicted emergency physicians will be "calling on air medical transport more frequently to take critically injured patients to Portland."

Aurora-based Life Flight also operates out of Aurora, Hillsboro, and The Dalles airports, and is about to begin service in the Kelso-Longview area of Washington state.

Springfield officials, who run the local FireMed ambulance membership program, signed a one-year agreement with Life Flight last winter. Life Flight agreed to pay FireMed $99,000 for advertising and marketing. At the time, Murphy called the advent of air ambulance service "one of the most significant improvements in emergency transport and service in Lane County's history."

Subscribers in central Lane County pay $52 a year for the basic FireMed, which covers ground ambulance service, or $84 for FireMed Plus, which covers ground and air ambulance service. The FireMed program has about 34,000 subscribers, including more than 10,000 who have signed up for FireMed Plus. The extra $32 for FireMed Plus goes to Life Flight.

If a subscriber needs an ambulance trip, they pay nothing. Nonsubscribers get a bill for ambulance service. Commercial health insurance will often cover ambulance trips. Uninsured patients either have to pay out of pocket or else the ambulance service provider eats the cost.

Murphy wants doctors to make more use of the air ambulance to transfer patients between hospitals because that would take the pressure off his ground ambulance crews. Springfield ambulance crews make about three trips a week to Portland hospitals, Murphy said.

Ground crews use two paramedics when transporting a patient to Portland, one of whom is driving. It takes at least 90 minutes to get to Portland, longer if traffic is bad, Murphy said. Sending a two-person crew to Portland in the middle of the night isn't safe because of fatigue, he added.

Life Flight uses three-person crews, with two paramedics and a flight nurse. One of those is also the pilot. The trip takes about 35 minutes, Griffiths said.

Transporting patients by helicopter is far costlier than by ground. It costs about $15,000 to take a patient to Portland by air, Griffiths said. A ground ambulance has a base rate of $1,150, plus $15 per mile, Murphy said, so a one-way trip to Portland would cost about $3,000.

Griffiths said Life Flight is "not about money, it's about helping the community." It transports patients without regard for their ability to pay, and it has a "very generous charity program," frequently writing off more than 50 percent of a patient's bill, he said. The community can support Life Flight by joining FireMed, and the medical community can support by using the service when appropriate, he said.

Cost can't be ignored, Griffiths said, but doctors should give no more consideration to the cost of an air ambulance trip than they do to the procedures and tests they routinely order.

"What the patient, needs should be put before cost," he said.?

- Tim Christie