Air ambulance hits delay

Eagle Air Med wants stronger commitment from hospitals

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A Utah company interested in bringing air ambulance service back to Steamboat Springs is waiting for a stronger commitment from area hospitals before moving forward with the licensing process.

Jim Hunt, vice president of Eagle Air Med in Blanding, Utah, said his company is not discouraged by the delay and is still working to operate from the Steamboat Springs Airport by mid-May. The company originally expected to be operating by April 16.

"We've run into some internal delays, which is to be expected when you combine aviation with the medical industry," he said. "However, we feel comfortable that it won't be too much of a problem. I think there's a misperception that because we're experiencing a delay that we're not coming. That's not correct."

If Eagle Air Med bases one of its King Air C90B twin-engine turboprop air ambulances in Steamboat, it would mark a return of service that was discontinued in January 2005 after the Yampa Valley Air Ambulance crashed near Rawlins, Wyo., killing three people.

Hunt said his company is "trying to get more of a commitment from (The Memorial Hospital in Craig) than they're willing to give" before Eagle Air Med begins the licensing process with the city of Steamboat Springs.

Karl Gills, Yampa Valley Medical Center's chief executive officer, has said he would be "pleased" to have air ambulance service because it will "return the local availability of emergency patient transfer" and "put (the hospital) at a higher level of service than most rural hospitals in the state and nation."

George Rohrich, The Mem-orial Hospital's chief executive officer, did not return calls seeking comment.

Hunt said Eagle Air Med is asking Craig officials to "firm up" their level of commitment to using the service, he said.

Eagle Air Med also has discussed the service with medical facilities in Grand and Rio Blanco counties and Wyoming.

Airport Manager Mel Baker said the city cannot move forward with the license and permit process to base Eagle Air Med out of the airport until the company presents its proposal for operation to the city.

Baker said it could be a challenge to get the appropriate recommendations from the Yampa Valley Airport Commission on a Steamboat Springs City Council agenda before the middle of April or May. The City Council would make a final decision regarding the permits, he said.

-To reach Alexis DeLaCruz, call 871-4234

or e-mail adelacruz@steamboatpilot.com

Comments

dundalk 7 years, 8 months ago

Yes, lets leave YVMC airambulance out of it. I will ignore your earlier reference of it prior. Other than...you bore me and I am done.

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MC 7 years, 8 months ago

OK, let's try to keep a good topic civil. I don't know of ANY flight service that will take an unstable patient out of the ER and put them on a plane/chopper, it just does not happen. My question remains at why some think that the only "top notch" care available is in Denver? St. Mary's has strived for years to be the leading health care facility on the western slope, for a reason. Putting people into anything that can fly and going over the mountains is a risk, not one some are willing to take. I spent a 24 hour shift in the ER of St. Mary's waaaay back when I first became a basic EMT. There were patients ranging from the kid who dove off a bridge into 3 feet of water, splitting his head open, OPEN. He lived and did not get flown to another facility. The patient who had a propane tank explode 10 feet away from them and basically turned them into a human torch. They cared for him right there and he is alive to this day. The two gentlemen in Green River Utah who went off the freeway, rolled the vehicle 14 times(doing 85 mph)ejecting one and pinning the other. Both lived to tell about it thanks to St. Mary's and their flight program. I am not trying to glorify them but giving examples that Denver is not the only place to get world class care. Why give into some money grubbing company who is only interested in it's bottom line rather than the patient and their families? I'll gladly take a 45 minute chopper ride, door to door, than an hour flight, a risky ride through traffic with Denver paramedics in the back of an ambulance and then who knows how long of a wait to get looked at. I was a firsthand witnesses to a horrible accident while traveling to Denver a few years ago. The driver fell asleep, drifted into the median and must have woke up because the vehicle jerked back towards the road but instead of gaining traction it began to roll, 8 times to be exact. It totally destroyed the vehicle and ejected one of the occupants. Traffic was blocked on all three lanes for MILES on I-70. The one had a severe head injury and the other was concious but hurt bad. I was the first one to hop out, grab my kit and give care as were many others. When the Denver paramedic squad arrived you would have thought Jethro and the boys were throwing them into the back of the beverlyhillybilly mobile. I could not believe what I was watching as some of those Denver paramedics yanked them around, and rude, boy, they were lucky cops were present or one of them would have needed an ambulance themselves. Totally went against everything I was taught on how to treat a patient in the field. Even the State Trooper who took our statements said that the EMS care in the Yampa Valley BLOWS AWAY any care that those guys(Denver, i presume)provide. This is one instance and does not in any way reflect on the rest of them but there is an attitude with the "Denver" folk and mostly it is not good. Hopefully TMH won't give in and will continue to use St. Marys. Thanks for letting me speak.

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panky 7 years, 8 months ago

Why should The Memorial Hospital in Craig have to give up their long standing partnership with St. Mary's in Grand Junction and donate their flight patients to a newbie operation in town that may not make it financially?

Hopefully, TMH will keep sending their patients by St. Mary's flight service who will take the patient anywhere that patient needs or wants to go.

If anyone should jump on board it's Steamboat that should support St. Mary's with their incredibly good flight service.

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panky 7 years, 8 months ago

Now that you mention it, sounds like it to me, too.

It also sounds like YVMC by itself doesn't have enough flights to pay for a locally based air ambulance. They need TMH's flights to make this happen.

Hmmmmm. Come to think of it... Eagle Med closed down one of their bases in Kansas because they didn't have enough flights to make it pay.

Could this be related to Steamboat airport issues?

Oh, no, not again....

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panky 7 years, 8 months ago

So true, Hash.

And ponder this... why can't we have patients go by ground ambulance if they aren't life or death?

You see Craig ambulances going to Grand Junction with transfers of sick patients all the time.

Not every patient is gonna die if they go in a ground ambulance instead of a flight. In fact, I think I read where only about 10 or 15 out of 100 transfers to other hospitals are really time critical. That might even be high.

There used to be blue and white ambulances from Steamboat taking patients to Denver. But I've never seen a red one going to Denver and I do a lot of driving thata way.

Maybe it's just weird timing when I see Grand County ambulances on 40, 9 and 70 but never Steamboat's red ambulances. What's up with that?

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dundalk 7 years, 8 months ago

Panky:

You are a little in the dark, my friend. YVMC flies patients to hospitals where the patient can receive the best care. Sometimes head injuries have a better chance of survival if they are flown to Sweedish; a hospital which specializes in such injuries. SOmetimes cardiac patients are flown to Poudre Valley because they have an excellent cardiac reputation. Burn victims are flown to Greeley because that hospital offers top notch burn docs. A lot of orthopaedics go to St. Mary's for the great ortho care. Multi-system trauma patients might go to St. Anthony's or DH because the hospitals are set up for such trauma patients.

Often times it is more advantageous to fly a patient to the hospital than to tie up several hours of personnel and vehicles to have SSFD drive the big red box to the front range.

YVMC utilizes the Flight for Life perk often; apparently more than you know.

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panky 7 years, 8 months ago

I am very well aware of medical necessity and do not dispute the need for more definitive care than we have here At YVMC.

Several hours of personnel time (that could be off-duty EMTs working extra hours) does not add up when YOU are the patient and have to bill your insurance company for $14,000.00 vs. what? $1,000.00 for a ground transport? Come on. In this day and age of rising hospital costs that's a lousy way to spend health care dollars!

What you are confusing is that only a very small percentage of air transfers are life and death and HAVE to be flown. Because there is a "no-compete" situation here ANY tranfer out of Steamboat HAS to cost the patient $14,000.00. You don't even have a choice.

And I am very aware of the flights that leave this valley.

I'd say if anyone is in the dark, it's you, my friend.

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dundalk 7 years, 8 months ago

If my loved one were given an option of whether or not flights were utilized - we'd take the flights over ground transport. Health insurance covers a great portion of the flight, and the care received via flights is second to none. That doesn't mean to impune the excellent care our SSFD would offer, its just that flights get you where you need to be a whole lot sooner.

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dundalk 7 years, 8 months ago

Such a primary question. This younger generation seems content on letting life just whirl by, often times foregoing their health and common sense for more materialism and spur of the moment wealth. Such is a shame. However, there are many in this country who take their health seriously, and make sacrafices so that they have the coverage for life's crisis.

In answer to your question though, I answer you this. Regardless of coverage or not, some of us live by the theory that an extra job will cover the financial crisis, making payments before material pleasures is paramount and that hard work pays off, in the long run.

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panky 7 years, 8 months ago

Please, let me help you understand.

Imagine a patient with a hand laceration that needs a specialized hand surgeon in Denver or Grand Junction. He's just fine otherwise, just a nasty cut. Bleeding controlled, no pain meds, nicely wrapped. No problems, doing great, just that lac.

I really don't want to see that patient taking a ride in the family car but when you're aware that the surgery can be performed up to 24 hours later, you start to get an understanding for what I'm trying to explain.

On arriving at the receiving hospital this patient could sit in their ER waiting area of Swedish, Poudre Valley, Denver Health, wherever, for HOURS waiting for their turn. What's the rush? For what? A joy ride?

There's a good reason why there's an unrealistic sense of entitlement here that would have someone take a $14,000.00 flight instead of a $1,000.00 ambie ride.

(Now, remember, I'm not talking about the 1 out of 10 YVMC flight transfers for whom the industry was meant to serve. Far from it, when you need it and speed is paramount, then great.)

This warped YVMC flight standard was a deliberate move years ago to make a "no compete" situation with the ground ambulance and it has hung on way too long.

But with the new EagleMed program and YVMC desperately trying to pry flights away from TMH in Craig, it appears patients won't be taking the red bus anytime soon.

Craig, by the way, takes nonemergent patients by ground ambulance to St. Mary's routinely but use the St. Mary's fleet for the truly emergent cases. Kudos, Craig.

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dundalk 7 years, 8 months ago

I understand fine, but thanks for the story. In my opinion, you use an example which is obviously non-life threatening. I suppose one could argue that a flight for a hand lac would make sense if the patient was a world class pianist.

As for the reality of it all, well, I haven't seen nor am I aware of any patients flown with mundane injuries, but rather do see the CHI's that need craniotomies (sp?), or the dislocated joint that requires immediate angiography or the unstable c-spine fx that requires life preserving attention.

I'd rather pay the extra monies to insure that my family member receives the best possible care, with the goal of getting to the specialist at whatever hospital is open and available to trauma, etc.

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panky 7 years, 8 months ago

Decompression for head trauma or unstable c-spine injuries that you cite as counter examples are one of the true necessary procedures that require a patient be transfered and as I have repeatedly explained, am NOT at issue with. The rare severe head trauma is not what I'm addressing.

The lac example was an effort to explains the lack of the need for a speedy transfer that people tend to confuse with air transport. The rest of the world transports these type of patients by ground ambulance, we use the most expensive and in that case, wasteful way that we can.

Obviously, you are not aware of the non-emergent majority of flight patients that are MEDICAL in nature (note that word, it's not unstable trauma) patients that are transferred on a weekly basis. YVMC is a a small rural hospital that will never have the depth of care found in an urban hospital. That's OK.

But how many of the approximately 130 flights a year have you witnessed and assessed the patient for true necessity to FLY to get to the front range?

Your rationale is what will keep health care in a mess. This valley is rife with uninsured folks (it's the working class, in case you didn't know). Charging for unnecessary costs in order to be reimbursed from insurance companies (from those patients fortunate enough to have it) guarantee it will never get any better.

You obviously have no fears of being the family wage earner living in debt to medical bills and losing your comfortable lifestyle.

Too bad for anyone else, right? Good luck that you never find out what you're refusing to understand.

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MC 7 years, 8 months ago

It would be silly for Craig to give up using St. Mary's flight program that they have been partnered with for over 20 years. St. Mary's is a simple 45 minute flight, even in adverse weather(remember, no mountains to fly over) and countless lives have been saved and restored by this valuable service. Besides, the flight personel are top notch prople, trained to the highest degree. Despite what is going on down in the ER, the pilots are always willing to show the wide-eyed kids the aircraft as the world class medics treat and package the patient. It's people like them that make the difference and if it were my family I WOULD NOT hesitate letting them go by this service. Everyone in town knows something bad has happened when they hear those rotors from miles away and see the big blue & white copter sweeping over the city to make its landing. No ambulance rides, no traffic no hassle, it is door-to-door service.

I urge TMH officials NOT to be intimidated by this brand of extortion and to continue a long standing 20+ year relationship with St. Mary's.

How does that song go?

MONEYYYYY, so they say, is the root of all evil toooooday. (Pink Floyd, Dark side of the moon)

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panky 7 years, 8 months ago

You are so right on, MC. Thank goodness, somebody gets it.

You obviously speak from experience and knowlege of the current ploys of disguising financial interests with the "we save lives" smokescreen.

There was an article in the Salina, KS newspaper that made no bones about the fact that the Salina EagleMed base (that no longer exists there) had only 18 flights a month instead of the requisite 27 for a break-even operation.

A rep from EagleMed made the statement to the people of Salina and facts is facts. EagleMed shut it down.

WHY is it so hard for our community to understand that it takes a certain number of flights to make an air ambulance base financially feasable here and that YVMC wants Craig's flight patients to make EagleMeds' numbers work.

The saddest part of this deal are the ignored people who are in medical debt because they didn't have an affordable option when they didn't need (notice the carefully chosen word "need") a flight.

Not all flights are needed. Transfers are needed but not all flights. Big distinction. Maybe 1 out of 10 flights is a necessary flight. However, all 10 out of 10 transfers are needed.

That is a tough concept to get across to a community that insists we need a flight for every transfer out of here.

Too many people are in trouble financially because of this convenient confusion of medical necessity and flight necessity.

Let's really be patient advocates and help these folks keep out of medical debt.

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Al_Buterol 7 years, 8 months ago

Hey Panky,..... since you're speaking with such authority, you should verify your facts.

Eagle Med and Eagle Air Med are two entirely DIFFERENT companies. It's like comparing FedEx to UPS. Eagle Med is the Salina Kansas company you keep referring to, Eagle AIR Med is a Utah based company. I won't insult you with a geography lesson, but I think you should reconsider your rant about their past performance until you get the basic facts correct.

Secondly, while I agree with you, about 10% of the flights absolutely required a flight, where minutes count, I'd venture to say that the remaining 90% were not in a condition to be transported by local EMS.

Local Ambulances are staffed with a single medical provider in the back, EMT or Paramedic, with any combination of drivers from another EMT or even un-medically trained drivers.

An Air Ambulance has a Critical Care RN (5 + years ER and ICU at a minimum) and a veteran Critical Care Paramedic, which is an additional 650 hours of education beyond "Paramedic", not to mention the 10 to 15 years of "911" experience and judgement.

Steamboat is seeing the shortage of EMS personnel that the rest of the country is seeing, it's not practical to take the Paramedic dedicated to the community out of service for one of the 90% you keep referring to. This Air Ambulance will fill that void in several ways. First and foremost is that the patient LEAVEING that's under the care of an RN will continue to see RN level care during transport. Should the patient "crash" you've got a veteran Paramedic with a higher knowledge base and skill level. There are 2 higher trained providers in back for the duration. Secondly, this will not tax local resources for an out-of-area transport. It will not take a resource away from the community for the 6 to 8 hours required to drive to a Denver hospital, exchange information and a long empty drive home, especially in bad weather or slowed driving conditions.

If you think this new company would not take the patients where they want to go you're sadly mistaken. Why would you believe that the destination of St. Mary's would be eliminated? What makes you think that they wouldn't got to Grand Junction? Where else would they go? It's a higher level of care than coming back to Steamboat, same as already provided by the highly skilled crew of St Mary's teams. If Eagle's crew can be to Craig faster, isn't that better for the patient in the end?

Just think you need to look at the big picture, that's all.

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panky 7 years, 8 months ago

The EagleMed flight leaves Steamboat empty, goes to Craig , picks up the patient, flies to St. Mary's.

Who said "eliminating St. Mary's?" Not me.

EMS personnel who intern on the Front Range work in the back of an ambulance with transfers from hospital to hospital or patients in far off nursing homes who go to distant hospitals for tests and procedures that require no more than most flights that go out of YVMC. It can easily take hours for one of those transfers. It's the work of EMS. What's bizarre is the 15 minutes our local crews experience with a patient and they think that's all they'll ever have to do. Is it hard work to be on a long transfer with a patient? You bet.

But these patients I'm talking about can fly one day, have their test the next day and be driven home in the family car the day after that. Come on. Tell me the sense to that.

Now I need to remind you here that the tests and the transfer are legit and fine, it's just how a stable patient gets to the hospital that bothers me.

BTW, if there is a chance that a patient will "crash" then that patient has NO business being put in the back of a plane or an ambulance. That patient MUST be stabilized and the crews will discuss "worse case scenario" prior to launch but those cases are so RARE but I'm not talking about those anyway!

Those are the patients that MUST be flown but there are so few truly imperative flights that there are just not enough to keep a flight program operating.

So to say it again... in order for EagleMed to have a financially healthy operation they want (need) to fly Craig's patients to St. Mary's instead of St. Mary's coming up to get the patient themselves. And that's just wrong.

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Al_Buterol 7 years, 8 months ago

Wow.....Totally ignored the fact you're ranting about the wrong company I see. So apparently you're not the type to admit when you're wrong?

Denver also has CRITCAL CARE TRANSPORT units that take these "stable" patients on interfacility transfers. These units are staffed IDENTICALLY to the crew configurations of a flight team. One of them frequently makes trips from Frisco to Denver.

Have you done any research to compaire the likelyhood of being in an accident in an Ambulance?

Apparently you only have a problem with this specific new company doing the transfers.

So, what's your stand on a person that complains of chest pains, is placed on a medication at YVMC local EMS is not allowed to administer, transfered by other means to the front range (maybe PVH?) for thier exceptional cardiac care and then discharged the next day?

You're arguments are slowly loosing credibility, and it's become a personal thing for you.

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panky 7 years, 8 months ago

You keep talking about patients that need a flight.

That is NOT the issue. Never was.

Steamboat Ambulance should take BLS patients to Denver.

Critical Care is for critical patients, right? NOT for taking someone to a hospital for a cancer screening or a cath lab for a stable patient.

If the patient needs ALS care then that's the crew they need. If it's a flt nurse and paramedic, then that's what is needed. No argument there from either of us, I'm sure.

Patients (stable and no time issues) should be transferred to Denver in the least expensive mode. You may as well be asking for a person suffering from a dog bite on the pinkie needing a hand surgeon to reattach a ligament to be flown by Lear jet and "Who cares?" about the cost. Just bill the insurance company or have the patient pay for it for the next 20 years. Isn't that what you are arguing for? That's just nuts.

As far as the YVMC air ambulance and Stmbt F/R track record for "accidents" looks like I'll take my chances on the ground, thank you very much!

There are two distinct issues here but they are related.

  1. Craig's TMH and St. Mary's Flight Co. should not have to give over their flight patients over to EagleMed (with Steamboat's flight crew) so that EagleMed has enough flights to survive in Steamboat.

  2. YVMC and Stmbt F/R should start providing a ground transport for patients that are not critical and can go by ground.

Is that clear enough or should I try AGAIN?

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dundalk 7 years, 8 months ago

Panky:

YOu had an ounce of decency up until the under handed remark about the YVMC air ambulance. 4 outstanding human beings were on that ill-fated flight a few years ago, on a cold January night. They were doing their job; and now you use them as a punch in your argument.

4 people got on that ill-fated flight, 3 got off permanently and we grieve still over the loss. One paramedic, an outstanding person survived that crash yet lives with the memories and guilt of surviving, waiting in the dark cold night for rescue and having to hear his fellow team members draw their last breaths.

Just to give you an example though of why it is crucial for flights to handle cases. A 50ish fellow obtains a CHI while skiing and has a hemlet on at the time of the fall. He is a "stable patient" but does have a brain bleed. When loading him into the St. Anthony's Flight for Life, he begins to complain of nausea and headache. He is "stable" when he is loaded and remains that way until 10 minutes out from Sweedish. He craters in the chopper, and then is intubated before the chopper reaches Sweedish. The flight nurses are able to "stablize" him after tubing him and land at Sweedish with a critical care patient. He SURVIVES.

One could argue that he shouldn't have been flying. Some argue that its a good thing he was in the hands of expert flight nurses who were able to handle his crashing with stellar care.

Its not that St. Mary's or any other ground crew could have done the same thing...maybe, maybe not. But, being in flight, headed to Sweedish as a "stable" patient and then going south, his chances improved because he had top notch neuro docs on him far faster than a ground crew would have been able to attend.

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panky 7 years, 8 months ago

You're way off point going into to the YVAA crash.

That's inapproprite here and has no place in this discussion.

Try to focus ...Qualify all patients for appropriate transport mode.

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dundalk 7 years, 8 months ago

...As far as the YVMC air ambulance and Stmbt F/R track record for "accidents" looks like I'll take my chances on the ground, thank you very much! posted by Panky!

"That's inapproprite here and has no place in this discussion." posted by Panky.

Guess the same decorum you wish from others doesn't apply to you. Now I am done. See ya.

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panky 7 years, 8 months ago

You're really reaching on that one, Dundalk.

I hope you're getting some help. You obviously need it.

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dundalk 7 years, 8 months ago

MC:

In response to your post. About 6 years ago (forgive me, it might be less) I had contact with a patient who decided that building a snow ramp on Rabbit Ears pass, and snowboarding it was a cool thing to do. He is a young man, and for some reason I have never forgotten him. Mainly because after we extricated him from an excellent snow structure his friend had built around him to keep him from moving his head, but more so because as we packaged him up, dragged him out of the snow and into the awaiting ambulance on 40, this young man was still moving his appendages. SMOE x 4, alert etc. Strong vitals. All c-spine precautions were taken and he arrived at YVMC without incident.

After a C-Spine xray revealed a perilous c4-5 fx, he was fitted for a halo and we flew him to St. Marys. Why St. Marys? First, and rightly so, the path over Harrison Creek (up on the pass) was sketchy due to the storm, but also because St. Marys offered then, as they still do today, the best emergent care for this young man.

Even with a unstable c-spine fx, flight and even the liter rescue out of the woods, this kid made it, and maintained his movement of body. He is not a para or quad, but a walking young man with no neuro deficiets.

THe story, for lack of better explanation tells the accounts of what St. Mary's is quite capable of. One need only see some of the horrific accidents that come off 70, west of Junction, towards Rabbit Valley and Green River through the San Rafeal swell, to know that St. Mary's does a great job. I am happy that this state has some of the best hospitals and trauma centers around.

My loyalites, if you wish to call them that, for flight services comes from hearing the happy stories of patients who benefitted from the attention they received from hospitals not directly in our zip code. YVMC has an excellent staff and our ER is great. So great indeed that we do not flinch if we need to utilize whatever flight service is available for the BEST INTERESTS OF THE PATIENT.

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panky 7 years, 8 months ago

Steamboat Pilot Sept. 13, 2005

Yampa Valley Medical Center's decision not to re-establish its air ambulance service was the right one.

The hospital's board of directors made the decision at a meeting last month and announced it Thursday. Hospital officials said the decision was driven by economics.

We agree.

Although it is important to have access to medical flights out of the Yampa Valley, history has shown that those flights do not have to originate with a local service. And given the crash of the Yampa Valley Air Ambulance crash that killed three people in January, it's hard to blame the hospital's board for its reluctance to re-establish such a service. The pain of that tragedy lingers long after the crash.

The National Transportation Safety Board is investigating the crash, which occurred near Rawlins, Wyo. The air ambulance was en route to Rawlins to pick up a patient for transfer to Casper, Wyo., when it crashed near the Rawlins airport. The pilot and two hospital employees assigned to the air ambulance died. One crewmember survived.

Without the Maddoxes and Mountain Flight Service, the hospital would have to start anew with an air ambulance service. The hospital's board of directors recognized that such a move would be cost prohibitive.

NTSB Regional Director David Bowling noted two things that were unique about the Yampa Valley Air Ambulance: the contractual arrangement between the hospital and Mountain Flight Service and the use of the air ambulance to transport patients for reasons other than emergency care.

Such unresolved questions underscore the hospital board's decision. At this juncture, the risks -- financial and otherwise -- of operating an air ambulance service appear to outweigh the benefits. We would suggest that the money previously invested in the air ambulance might better be used trying to recruit a full-time cardiologist and oncologist. Doing so could reduce some need for air ambulance services.

Even when the air ambulance was in use, that service was supplemented with medical flights from the Front Range and Grand Junction. Since the crash, out-of-town services have been used without incident.

True, a locally based air ambulance provided us with a certain security that, in the event of an emergency, we had the quickest possible transportation to medical care. But we have learned that the service can be provided efficiently in other ways. Given recent events, moving ahead without a locally based air ambulance was the right decision.

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med8 7 years, 8 months ago

Panky... You have very little understanding and a lot of ignorance concerning EagleAirMed, the Memorial Hospital, YVMC, and the former Yampa Air Ambulance(even if you are or were associated with EMS and or HEMS as you hint) and make horrendous statements that are not only wrong but insult yourself and others. Maybe that is why you stay anonymous. Ask yourself if Steamboat needs an air ambulance when you have the massive MI. By the way "out-of-town services have been used without incident" is not even remotely true.

Dundalk- Thank you for your insightful, compassionate, and well thought out statements.

MC- Almost every patient transferred by air are unstable. Very unstable. that is why they are flown to tertiary hospitals who have the services to treat the "unstable". Be it St. Mary's or Denver facilities.

Tim Baldwin -YVAA survivor 1-11-05 NREMT-P /CCEMTP/C-FP/NSP

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