Competing Choppers

New Air Ambulance Service Set to Debut

By Brooke Hewes, 9-22-05

Each time I hear LifeFlight hovering over Missoula’s St. Patrick Hospital as it heads toward what I image to be some heart-wrenching medical emergency, I cringe. It’s been two years since Gunnar’s accident and the sound still rattles me.

When Gunnar fell 70 feet in the Bitterroot’s Kootenai Canyon, he landed on his heels just inches away from a pile of sharp rocks. Within a half hour — thanks to another climber’s cell phone — a nearby field was transformed into a make-shift landing pad.

After 40 agonizing minutes on Highway 93, I arrived at the hospital just as Gunnar was heading into surgery. And despite shuddering screams lurching from his broken body, the doctor said he was going to be OK. LifeFlight, he added, had made all the difference.

So when I recently heard that Missoula would soon have two air ambulances, I thought: Great. The more the better. And according to Dale Dallman, manager of emergency services at Missoula’s Community Medical Center, whose CareFlight will begin operations on Oct.3, that’s precisely how Missoulians should view the situation.

Others, like LifeFlight Chief Nurse Larry Peterman, are wary. Medical helicopters are sprouting up around the country; between 1995 and 2005, the total number of emergency choppers in the United States more than doubled from 295 to 600. And in Missoula, where two hospitals serve one small city, it's inevitable that there will be a certain amount of tug-of-war for patients - and some of that is determined by how patients are getting to the hospitals’ doors. This competition is what makes Peterman questions Community’s motivations.

At least initially, CareFlight will not go head-to-head with LifeFlight over emergency calls like Gunnar's, and as such, will not compete for what ends up being about one-third of LifeFlight’s business. Instead, Community will focus on transporting patients between hospitals for specialized care (a service that accounts for two-thirds of LifeFlight’s trips).

LifeFlight officials, however, are clearly concerned that Community will soon be competing for all types of services.

“They are definitely not doing this because of demand,� Peterman says. “Demand has steadily decreased over the last four years.� LifeFlight made 800 flights in 2001; last year they made 683 in spite of increased marketing—a trend Peterman attributes to the expanding capacity of smaller area hospitals like Hamilton that are growing to meet burgeoning populations.

Oh no, Dallman counters, demand is definitely there.

“Our aircraft isn’t even operational and we have received an average of three to five calls a day requesting emergency transport,� he says, pointing to obstetrics, neonatal and other specialized care for which people specifically want to go to Community. “We have the only board certified pediatric surgeon in the state and one of three pediatric intensive care units.

“From a business standpoint, this is pretty much a no-brainer,� Dallman says. When St. Pat’s LifeFlight transports patients to Community, the hospital typically can recover only some of that from patients and insurerers and must pay St. Pat's the balance. “We pay around a fourth of a million a year … they offer us no discount,� Dallamn says.

CareFlight, by contrast, will be operated by Omniflight Helicopter, Inc., a Dallas-based air medical transport supplier, which will bill patients and insurers directly. Community will be responsible for medical equipment, staff and training. Plus, Dallman adds, they will no longer have to rely on St. Pat’s or Kalispell’s helicopter, Alert, for emergency air transport (although Community will still rely on St. Pat’s and Kalispell Regional Hospital for fixed-wing aircraft.) Dallman adds that St. Pat's isn't always eager to share its business by taking patients to Community.

Regarding this final contention, Peterman, who has worked with LifeFlight for 15 of its 25 years, disagrees.

“When Community first opened their cardiac catheter lab a few years ago, the LifeFlight crew was directed to take all cardiac patients to St. Pat’s, where they could receive full services including open-heart surgery [the latter of which Community did not offer]. It was just while Community’s program was getting their feet under them,� said Peterman. “But for the last year and a half, there is no question. If a patient wants to go there, we take them there. In fact, we have a deal with them to use neonatal nurses and bring premature babies there,� he says, adding that LifeFlight has flown 250 patients to Community since 2000.

Now, unless the Missoula Area Trauma Plan insists that a patient be brought to a level two trauma center — St. Pat’s is level two, Community is a level three —where LifeFlight transports a patient depends on suitable care as determined by their physician.

Still, Peterman has reservations about the new chopper on the block, specifically about the quality of service if and when they start responding to 911 calls, which he thinks they will within the year (“We all need volume to stay afloat,� he says).

“If a dispatcher arbitrarily assigns a [helicopter], we need to
discuss fees and compatibility of services. I am going to question if it makes sense to send a [helicopter] in the woods without night vision and that isn’t accredited,� says Peterman. “Once they take care of those two things, then we can talk.�

Last October LightFlight purchased four pairs of night vision goggles, which are recommended by the Federal Aviation Administration for safety. The St. Pat’s program is also the only Commission on Accreditation of Medical Transport Services accredited operation in the state — a process that took two years, more than 200 pages of paperwork and at least $7,000.

For Community, having their own chopper is bound to increase the number of patients brought to the hospital. Also, as some have suggested, it is a feather in their cap—another service to add to an expanding list (several divisions, Community says, are currently growing, including cardiology, which has traditionally been St. Pats’ baby).

The safety issue is not one to be taken lightly as air ambulance services proliferate. Since 2000, 60 people have died in 84 emergency medical aircraft crashes, and 2004, with 37 of those deaths, was the worst year in air medical history, according to an investigation by USA Today. The paper cited insufficient industry standards and government oversight as part of the problem, though human error accounted for roughly 82 percent of the accidents.

“With all these flight programs popping up, it puts pressure on pilots to fly,� says Peterman. Indeed, if one pilot says no because of poor weather, reported USA Today, there is another pilot at another hospital that may say yes. Risking their own and patient’s lives, in this scenario, becomes a matter of job security.

For now, though, both of Missoula’s hospitals have a wait-and-see attitude. Perhaps two choppers will work. Perhaps not. Competition, however, is not Community’s immediate concern — rather, unwrapping their new chopper is. (An unveiling ceremony will be held September 30 at the hospital.)

I suppose it is also time for my own worries to wane in light of Life Flight’s safety record — incident-free for 20 years — and the fact that two out of three times I hear the swirl of an emergency helicopter’s blades overhead, it is the sound of a stable patient being transported to another hospital for specialized care. Still, I’m not sure it will ever be a neutral noise unless, that is, Gunnar is sitting right beside me with his feet solidly planted on the ground.

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