RE: Ground Vs. Air

["Paul M. Wright, Jr." <pmwright@home.com>]

>>I would like to address this, as I lived in the Navajo Nation...

Larry -

Excellent note - I think you have accurately described the situation based
on my own experiences in providing medical transport in the region.

With respect to the post that started this thread (safety of ground versus
safety of air transport), it is interesting to recall that in addition to
the Seneca versus horse collision you mentioned, there was also a collision
between a KingAir and a horse at Tuba City some years ago (before the
airport was moved from the middle of town to its current location).  So it's
not just Ambulances versus Livestock but the risk profile includes aircraft
as well during that portion of the flight when their altitude is less that
the height on the impinging animal.

I agree that the primary challenge in this region is funding as it is
reflected in staffing numbers and physical facilities, and I share your
observation about the generally high quality and passion of the caregivers.

But it is precisely those inadequate current funding levels that suggest
that too much dependence on air transport might be unwise.  Because of the
high cost relative to other modes of transport, overuse diverts funding from
other uses that might have a more significant impact on the overall health
of the community.  For example, for roughly the same annual cost as that of
operating an air ambulance, you could purchase a CT scanner and provide a
telemedicine link to a university medical center for real-time
interpretation by a radiologist.  For the average cost of ten air medical
transports, you could provide another full-time nurse.  For the average cost
of one transport, you could purchase an AED.  And so on.

However, the criteria for medical necessity are somewhat different because
of the remoteness and in the past, it was not uncommon for contracts to be
issued to provide air taxi transportation for non-emergent medical care such
as renal dialysis visits.  I recall being involved in bid preparation under
a three-tiered system for air medical transport where Level 1 required only
a plane and pilot (i.e. no medical attendant), Level 2 required plane, pilot
and BLS and Level 3 required full ALS capabilities (2 medical attendants,
etc.).

The disparity between outcomes data in rural versus urban Arizona is stark.
For accidents of equal severity, the chances of a fatal outcome are eight
times higher in the rural setting.  Yet, ironically, the only setting in
which a rotor-wing air medical business model has proven itself is in an
urban/suburban setting that provides enough flight density to recover the
fixed and variable costs of the operation plus a fair return to the
operator.

I don't know what the solution is - either in Connie's specific situation at
Kayenta or more generally in other medical under-served and sparsely
populated areas.  Whether a mutually beneficial deal can be worked out with
her prospective vendor that will provide enough margin to the vendor to
operate safely and ethically for the long term, and enough benefit to the
clinic to justify the cost remains to be seen.

But it's certainly a discussion worth having.

paul

Paul M. Wright, Jr.
Mesa, AZ