San Antonio Express-News: Will medical air transport be there for you?

By George LaRue

It was a Tuesday in Utopia, Texas and I was having a heart attack that was going to end my life.

The day had been normal in pretty much every way. No dark clouds. No signs that it would be different than any other Tuesday, but oh was it.

I was standing in Hidden Treasures, a charming little gift shop in our small town, when I collapsed.

I had no warning. No chest pain, no shortness of breath. I don’t remember anything about it even happening. One minute I’m browsing knickknacks and the next minute I’m gone.

In our part of Texas, it’s remote living — by design. We like the wide-open spaces and the small-town feel. The trade-off though is that Utopia, much like a lot of Texas and the nation for that matter, is more than an hour by car from a critical care emergency room.

Our volunteer EMS folks do a great job, but they’re limited in what they can do and in critical situations, we all want to know that someone else is going to be there to save us.

When I collapsed, local volunteer EMTs found me and immediately called AirLife in San Antonio. The helicopter came, landed just outside the store, the crew stabilized me, and got me where I needed to go. All together it took AirLife about a half an hour, when an ambulance would have taken about twice that probably.

It’s weird when you hear people you don’t know talking about you and the miracle of your survival.

According to a gentleman named Lee Fernandez, who works for AirLife’s parent company called Air Methods, “This man (that’s me), literally had a zero chance of survival three years ago.” What he was talking about is that today, access to air medical transport, advanced air EMT training, and new medical protocols, gave me the same chance of surviving my heart attack in Utopia as I would have had in downtown San Antonio.

Just because this critical service currently exists, does not mean it’s here to stay.

Much like many rural hospitals that are faced with impossible financial circumstances, air medical transport bases are being forced to close around the nation, leaving Americans without access to life-saving care. Already, 85 million of our fellow citizens (1 in 4) can only reach a Level 1 or 2 Trauma Care facility within an hour if they are brought there by a helicopter air ambulance.

The finances of air medical services are tough because they’re required by law to deploy when they are called regardless of a patient’s ability to pay, about 70 percent of these trips are paid for by some type of government insurance like Medicare or Medicaid, and the government reimbursement rates only cover about 50 percent of the actual cost.

New federal legislation that would improve matters is now working its way through the process. HR 3378, the Ensuring Access to Air Ambulance Services Act, has been introduced by Reps. Jackie Walorski, R-Indiana, and a bipartisan group of five other members of Congress, including Dallas-based Rep. Pete Sessions, R-Dallas. Hopefully, it’ll get enough traction to make it to the President’s desk for his signature soon.

For me, that helicopter and its crew gave me another chance at life. Another chance to go sailing and fishing with my boys and to visit all of my children scattered across the world. This whole experience has put everything in perspective.

According to Save Our Air Medical Resources, a coalition working to ensure access to air medical helicopters, more than 22 percent of hospitals have closed since 1990, with hundreds more at risk of closing. This jeopardizes access to care to millions of Americans who live in rural areas like me.

With the air medical industry under constant threat of having to close down bases servicing rural areas because of the incredibly challenging finances those businesses face, I want to ask you to join me in standing with them. Because one day, you may go through what I went through.

Protecting the folks who work in the emergency air medical industry is just like protecting yourself and your family.

George LaRue is a resident of Utopia, Texas in Uvalde County, west of San Antonio. This oped was submitted by a representative of Save Our Air Medical Resources.


Syracuse Post-Standard: Onondaga County legislators: Fix reimbursement for air ambulances

By David H. Knapp and Christopher J. Ryan

Central New York is a great place to live, work and recreate. We have thriving downtown communities, scenic landscapes, world-class universities and hospitals and incredible outdoor opportunities in our collective backyard. We have something for everyone, and our healthcare system is no exception. Syracuse is home to Upstate University Hospital, New York's only Level I trauma care center for adults and pediatrics, Crouse Hospital, Syracuse VA Medical Center, and St. Joseph's Hospital Health Center. As such we are central in more than geography; individuals from 14-plus counties depend on us for life-saving healthcare.

As we all know, access is critically important in healthcare. The best trauma and emergency departments in the world cannot save someone who can't get there in time. Many people who call Onondaga County and Central New York home live in rural communities and when they experience traumatic accident, heart attack, stroke or other emergent conditions, they need to get to one of Syracuse's medical centers quickly because local facilities may not be equipped to treat them.

Our regional neighbors are not alone in living a considerable distancefrom life-saving healthcare centers. Eighty-five million Americans live more than an hour from a Level I or Level II trauma center by ground transport, and that number will only grow. Since 1990, more than 22 percent of America's hospitals have closed. According to the Center for Rural Affairs, rural hospitals have been closing at a rate of nearly one per month since 2010. Air medical transportation has emerged as a crucial link for these individuals who have no option for appropriate emergency care without air transport.

Rural residents aren't the only ones who depend on air ambulances in an emergency. First responders have to make the best possible decision in the moment and lives depend on the right medical services being available and dispatched quickly, regardless of where the medical event occurs. Unfortunately, the system that reimburses air medical providers is broken.

Most emergency transport providers are being squeezed by drastically low government reimbursement rates and insurers reluctant to negotiate fair rates. It is not unusual for seven of every 10 air medical transports to be substantially under-reimbursed. This system unfairly shifts the cost from under-reimbursed transports to other patients. If the current system is not fixed, then lives will ultimately be lost because these providers may have to curtail or cut service. While many people in Onondaga County have access to appropriate care through ground transport, the loss of emergency air service will affect our trauma and emergency centers, and many of our friends and relatives.

Thankfully there are efforts at the federal level to update the Medicare reimbursement rates for air ambulance transports. The Onondaga County Legislature recently voted to support the work of the Save Our Air Medical Resources (SOAR) Coalition to address this issue.

As county legislators representing the city of Syracuse and the rural stretches of the county, we must ensure continued access to this critical lifeline. Federal legislation that modernizes Medicare reimbursement rates for emergency air medical transport will help make that happen. New York state can also help by continuing to provide supplemental payments for ground service providers while advocating for increased Medicaid reimbursements. And lastly, insurers and air medical transport providers must work in good faith to forge fair, in-network agreements.

We love living in Central New York and we are incredibly proud of our healthcare institutions. We deserve to know that if trauma strikes, resources are available to care for everyone who needs it.

David H. Knapp represents the 12th District in the Onondaga County Legislature. He chairs the Ways and Means Committee. Christopher J. Ryan represents the 8th District in the county legislature. He is vice-chair of Planning and Economic Development.


Florida Times-Union: Air ambulances illustrate that seconds really matter

By David Ebler, physician

As a trauma surgeon, I have a deep understanding of how important emergency air medical transport can be when a patient’s life is on the line.

Trauma patients often require time-sensitive care that can only be delivered by specialized or advanced medical facilities that may be miles away.

As just one example, on Mother’s Day, a young child was brought to our facility by air ambulance, transferred from a community hospital that realized it was not equipped to provide the level of care required.

Thanks to our ability to respond rapidly, I was able to have a completely different conversation with the child’s mother that day. I was able to let her know her child was alive and stable. I do not believe that would have been possible without the speed and availability of the emergency air ambulance.

However, many similar lifesaving air medical services are at risk of closing in Florida and around the country.

A large part of this financial strain is a result of the inadequate rates of reimbursement for air medical transport providers from Medicare, Medicaid and some private insurers.

Providers often don’t get reimbursed the full amount it costs to transport patients at their time of urgent need.

Air medical transport is expensive, especially when you factor in the costs of operating a 24-hour base, maintaining flight equipment and keeping experienced medical staff on standby. These expenses are necessary to deliver top-notch medical care to critically injured patients.

We cannot afford to cut corners. Clearly, policymakers at the state and federal levels need to make sure the cost of operating these services is adequately addressed by federal programs and private insurance.

While an air ambulance service is no guarantee of a full recovery, if we can make a measurable difference in the lives of most of these patients, shouldn’t we? Air medical transport is a critical part of our health care system and one that everyone should have access to, regardless of cost, in their time of greatest need.

David Ebler

Ebler is a physician, assistant professor of acute care surgery at the UF College of Medicine – Jacksonville and medical director for TraumaOne Flight Services at UF Health Jacksonville.



Statement from Save Our Air Medical Resources Campaign Lauding Introduction of H.R. 3378, the Ensuring Access to Air Ambulance Services Act of 2017

Washington, D.C. (July 26, 2017) – The S.O.A.R. campaign and its partners applaud the introduction this week of H.R. 3378, the Ensuring Access to Air Ambulance Services Act, by U.S. Representatives Jackie Walorski (R, IN-02), Suzan DelBene (D, WA-01), Bill Johnson (R, OH-06), Raul Ruiz (D, CA-36), and Pete Sessions (R, TX-32). The proposal is an important step in ensuring that communities across America, particularly in rural parts of the country, have access to life-saving emergency air medical services.

“S.O.A.R. stands in full support of this important bipartisan legislation, which will help bridge the gap between rural and urban communities’ access to emergency care when it’s needed the most,” said S.O.A.R. spokeswoman Carter Johnson. “Today, emergency air medical services are being threatened by low government reimbursement rates, including federal Medicare reimbursement rate that has not been updated in 20 years, resulting in a major reimbursement shortfall. This legislation brings us one step closer to fixing that, and ensuring that all Americans, no matter where they live, can rest assured that they have access to emergency air medical transport if they ever need it.”

Medicare and Medicaid dramatically under-reimburse for air medical services, and the majority (70 percent) of patients who are transported have Medicare or Medicaid, or are uninsured altogether. A recent study shows that Medicare reimburses only 59 percent of the true cost of service. In some states, Medicaid reimburses less than half of the cost of fuel alone for a transport. Repeated extreme under-reimbursement is making it more difficult for air medical bases to remain open, and where they remain, costs are unduly shifted to the 30 percent of patients who have private insurance.

Today, one in four Americans—85 million people—can only get to a Level 1 or Level 2 trauma center within an hour if they are flown by helicopter. At the same time, hospitals—especially in rural areas—are closing at alarming rates, with 78 rural hospitals closing their doors since 2010. As a result, access to emergency air medical transport has never been more critical.

Specifically, the Ensuring Access to Air Ambulance Services Act of 2017 will:

  • Require air medical operators to collect and submit cost data to HHS so that it can develop an accurate payment system based on actual costs of providing care;
  • Establish a mandatory air medical quality reporting program;
  • Implement a value-based purchasing program to promote high-quality air medical services; and
  • Provide reasonable immediate, but temporary, relief to providers while the data collection and analysis is occurring; and
  • Designed to be budget neutral.

For more information on the legislation, see here. For more information about the S.O.A.R. campaign and the effort to preserve and protect access to emergency air medical services, see here.


WCBD-TV: 4 year old girl saved by MUSC doctors

By Colby Thelen

 A four year old girl is alive and recovering, a week after a series brain injury nearly took her life.

Annie Nichols arrived at MUSC Children’s Hospital in critical condition, with little time to spare. She was lethargic with one pupil was dilated, the result of an epidural blood clot that was pressing on her brain.

It formed after an accident on Saturday afternoon. She and her younger brother were playing in the pool and a little bit of water leaked into the family garage. While running through the garage Annie slipped and hit her head on the concrete.

A little shaken up, she was brought inside and watched closely. A nurse, and friend of the family, checked for a concussion, but she seemed to be doing fine. Her father Billy says that she even got up and came outside with him while he grilled out.

45 minutes later she began screaming that her head hurt and wanted to close her eyes. Her parents knew it was time to take her to the hospital. They arrived at the Waccamaw Community Hospital and were immediately taken back for a cat scan.

Billy says what happened next was surreal.

“They immediately came out and said this is big, were going to need to airlift her to MUSC,” he said.

Turning to prayer, the family waited for the helicopter to arrive. It was a ride that was nearly unable to make it. It was booked for a call elsewhere, but that trip was canceled. It also appeared as if a storm would block their path, but it stalled in Florence long enough for them to pass.

“All those were signs from God for us,” says Billy.

When the helicopter arrived Annie was immediately rushed into the O.R. which was prepped and opened by the team of neurosurgeons, led by Dr. Stephen Kalhorn.

“She was as close to dying as you can get,” recalls Kalhorn. “She was knocking on deaths door.”

Removing the blood clot is a common procedure in their field, but he says removing it from the brain of a child with so much life ahead of her was a daunting task. But the staff moved quickly and efficiently, pulling back a small section of her skull, removing the blood clot and stopping the rapid flow of blood coming from a tiny puncture in her brain.

“I’d say within 15 minutes we had the epidural blood clot out of her head,”  says Dr. Kalhorn. His eyes fill with tears as he goes on to talk about the efforts of his staff. “one of the most impressive concerted efforts to help a patient than I’ve ever seen,” he added, “it’s why we do what we do. It’s what we’re called to do.”

Annie has a long road to recovery ahead of her. It could be weeks or even months of rehabilitation and therapy.

Her dad now wears her favorite necklace around his wrist, waiting for the moment she is able to ask for it back, which he says she won’t hesitate to do when she is well. He says they are still amazed at the heroic efforts of all the parties involved. He now describes them as his miracle team.

As for Doctor Kalhorn, he says the operation’s success was like pitching a no hitter in the last game of the world series. He says he will be forever amazed by the staff and network of MUSC.

From here, Annie will go to a children’s hospital in Charlotte where she will undergo rehab. Her parents now pray that they’ll soon see their funny, happy child smiling and back to normal, and they say if this experience has taught them anything it’s the power of prayer.


San Antonio Express-News: Celebrate freedom and service on July 4

By Neil Murray

For our family, the Fourth of July holiday is one of our favorite days of the year.

It’s a day when everyone of us shows our pride in our country. We visibly shed all doubt about the promise of freedom that our nation still provides the world. And we truly understand, if only for this one day, the deep obligation we have as the most powerful force for good the world has ever seen.

For those of us who served in the armed forces, it’s yet another opportunity to not just wave the flag but to remember those who served with us overseas, fighting for the freedoms we enjoy, and to think of those who never made it home.

I’m asked from time to time “why we do it.”

As a veteran, I can tell you that those who join up do so for their own reasons, from a desire to defend country and Constitution, to stuff that’s much more deeply personal.

My story in the Air Force began right after 9/11. I was drawn to the military’s unrelenting drive for excellence in everything it did. As a combat medic in Afghanistan, deploying in support of an elite team of special operators, I had to know my medicine, had to be ever mindful of safety, and had to make good decisions in times of stress. That’s what lured me, in addition to love of country and a desire to defend our way of life against the terrorists who struck at us, killing 2,996 when the towers fell.

While we may join for different reasons, we stay and we fight and we give our lives for one. That’s love for one another, for the brother or sister who’s next to us in the foxhole or, in my case, the helicopter.

That may surprise some people. The notion that love keeps us in the service. But it does.

When you prepare for war together, you get to know people. You know their spouses, you know their kids, you’ve heard conversations with family back home when those on both ends of the phone call shed tears.

I can tell you that there is nothing more worth fighting for than to make sure your brother or sister in uniform gets home to see those children. And there’s nothing more heartbreaking than losing a friend and picturing the reactions of the children left behind when they learn of it.

I’m one of the lucky ones. I returned from Afghanistan after having served there in Helmand Province from 2013 to 2014. I had a chance to serve in a unit that literally rewrote the book on air medical qualifications, training and certification for the entire Army, based on experiences overseas. And today, I love my job working in the air medical services industry as a flight nurse here in San Antonio.

I get the chance every day, when we get the call, to deploy with my team, several of whom are also veterans, and save lives. We get to deliver the highest quality of care that exists on the planet to local residents who may be suffering from traumatic injuries or having a heart attack or stroke and need medical evacuation.

Some 85 million Americans live more than an hour away from the critical care facility they need, and air medical transport can be their only hope for survival.

Those of us on my team and throughout the air medical transport world, an industry that provides a perfect landing spot for many veterans, get to “win” each day. We get to rewrite those stories we carry with us from combat, where not everyone made it back, and replace them with stories here at home where everyone gets to take another breath and see their families again.

But we must not forget those who didn’t make it home. And we must mourn our losses on behalf of our military families, husbands, wives, mothers, fathers, sons and daughters who carry the burden of war for all of us.

This Fourth of July, I’ll be thinking about a brother-in-arms, 18-year old Pvt. Errol Milliard. He was hit by an RPG on July 4, 2013, four years ago. He died a hero.

His story motivates me every day to give nothing but the best and to strive for excellence.

Most of us in San Antonio have some connection to the military. I challenge you to find a story to tell this Fourth of July of a hero you knew and the family he or she left behind. And to never forget that we live in the land of the free because of the brave.

Neil Murray is a registered flight nurse for Air Methods at the AirLIFE 6 Base in Laredo. He served in Afghanistan as a combat medic.


Paris Extra: Reno toddler who almost drowned meets the people that saved her life

By Lea Emerson

What started out as a normal Sunday afternoon quickly turned into a nightmare for local mom, Haley Trammel.

Haley had taken her children to their grandparent’s house for the afternoon, planning to enjoy the sun and swim in the pool. Her girls, Brynlee (3 years old), and Brystlee (4 years old) suited up to swim while their Mom finished applying sunscreen to her youngest child.

Trammel stated, “The girls ran ahead to the backyard to play before we came out. The gate to the pool is always locked, so I didn’t think there was anything to worry about. Right away my four-year-old came running inside just as I was headed out to meet them. She told me that Brynlee had fallen in the pool.”

“I didn’t have time to think, I just ran to the pool and jumped in for her. She was already at the bottom, facing up. I pulled her out, and her lips were blue. I started CPR and she coughed up some blood and water. She wouldn’t talk or anything, just lifeless.”

Trammel then called 911 and the ambulance and helicopter arrived right away. Shortly after, Brynlee was transported to Children’s Medical Center of Dallas.

Paris EMS Paramedic, Rachele Estes, responded to the incident. She told us that Brynlee was conscious but weak and very lethargic. “It was necessary for her to go to Children’s Medical so they could keep an eye on her and make sure everything was okay,” said Estes.

Earlier this week, after returning home, Brynlee asked her Mom if she could meet the people she saw on Sunday that saved her life.  On Friday at 10 a.m. she met the team along with her sister Brystlee who Trammel said is her hero!

“My four-year-old daughter, along with the people here, saved Bynlee’s life. Brystlee is a hero, even though she doesn’t fully understand how important of a role she played in this,” said Trammel.

Brynlee is still recovering at this stage, and will head to Children’s Medical again for a follow up due to a cough and increase in temperature.


Watertown Daily Times: Gouverneur Rescue Squad promotes SOAR campaign

The Gouverneur Volunteer Rescue Squad and the Adirondack Rafting Co. have joined the Save Our Air Medical Resources (SOAR) coalition. SOAR is a national campaign dedicated to preserving access to emergency air medical services for Americans across the country.

In the event of critical illness, severe injury or trauma, emergency air medical services provide transportation for patients, particularly in rural communities with limited access to hospitals, emergency rooms or trauma centers.


The Capitolist: Searching for Solutions to the High Price of Air Ambulances

By John Lucas

It was Super Bowl weekend 2001.

Tampa was playing host to the big game between the Baltimore Ravens and the New York Giants.

As 41- year-old Robin Powell left work that Friday night, she warned her coworkers to be cautious on the roads. Little did she know they were words of caution that would apply to her the following Saturday morning.

“I did not know when I left the house about 10 in the morning, I did not know my life was going to change in less than two hours later,” says Powell.

At 11:45 a.m. the car that Powell was riding in was hit head-on by a 21-year-old woman who had worked overnight and decided to spend the morning drinking.

“I could hear all the screams in the background with tears and all of that,”  Powell clearly recalls that morning. “My son would not leave my side. I couldn’t talk with him. I couldn’t say baby it is going to be okay. I couldn’t tell him I love him.”

Her neck was broken. Time was of the essence. Traffic was heavy because of the big weekend.

Paramedics decided to call in an air medical service to airlift Powell to a nearby hospital. It was a decision that she’s convinced saved her life.

“To this day I owe them my life.”

Medical experts say access to a Level I or Level II trauma facility within an hour after a person suffers a major medical problem is critical to ensuring a positive outcome.

With the current network of ground and air ambulances, most Floridians are within an hour of a Level I or Level II facility.

But, emergency air medical services are facing a financial strain that threatens their survival both here in Florida and across the nation.

There are about 30 air medical service bases in Florida. Two bases, covering the Key West and Tallahassee areas, were recently forced to close.

“I think it’s in a fragile state right now,” said Paul Webster, an air medical service based in Colorado. “The services exist and the access exists for 98 percent of Floridians. But, that is at risk because of reimbursement challenges in terms of covering costs.”

Webster is working with emergency air ambulance services across the country to secure their financial existence.

He says it takes about $3 million a year to operate an air medical services base.

The median cost of an emergency air transport is $10,200.

The problem is that seven of every 10 emergency airlifts involve patients who are covered by Medicaid, Medicare, or don’t have insurance at all.  In those cases, emergency air medical transportation services get little or no compensation.

Medicaid reimburses air medical services in Florida about $1200. Medicare covers about $5000 of the costs. In the case of those with no insurance, the air ambulance service is left holding the entire bill.

Webster says there is a basic question facing air medical services, “At the end of the day, when the dust settles, is the provider able to collect enough reimbursement to cover the cost of having that access in that community?”

That’s a question also being asked by the Emergency Medical Transportation Working Group that was created by Florida’s Office of the Insurance Consumer Advocate. The group, which includes representatives from air ambulance providers, insurers, patient advocates, doctors, and local governments, is studying the issue of reimbursement rates for air ambulance transportation service.

The group is spending a year gathering information and analyzing data on how best to address the needs of air medical services, the insurance industry and consumers.

The issue comes down to money. How much should emergency medical air services be compensated for the work they perform?

But, for Robin Powell the debate goes beyond money. She sees the issue in a different context and asks what the cost might be if there is no air medical service available in an emergency situation.

“The odds are you may never need it in your lifetime. But what if you need it one time. I’m 57 years old now and I didn’t know back when I was 41 years old that I would need it one day. Thank God it was there for me."


Valley News: Emergency responders need air medical services to save lives

By Hemet Fire Chief Scott Brown

As the fire chief of Hemet, we never know when our firefighters and paramedics will need to be deployed to respond to an emergency, but we’re always ready. When families in our community face an unexpected incident or medical emergency, we will be there as quickly as possible to ensure they get the appropriate level care they need from the nearest hospital.

During any medical emergency, every decision we make can mean the difference between life and death.  For many who live in the rural pockets of Southern California – up to 100 miles away from the nearest hospital – emergency air medical services is the only option. In fact, across the country, there are 85 million Americans who live in a rural area that is more than an hour from a Level 1 or Level 2 trauma center if driven by ground ambulance.

As a former flight paramedic and having served as a firefighter and paramedic for the Orange County Fire Authority for 18 years, I saw firsthand the difference air medical services could make for patients. In the air, patients receive critical care from highly-trained flight doctors, nurses and paramedics. From strokes to car accidents to heart attacks to other traumatic injuries, we always knew that getting patients the right care in the right amount of time was imperative for saving their lives.

While the benefits of these air services are clear, they are increasingly threatened across California and the nation. The reimbursement rates provided by Medicaid and Medicare fail to cover a significant portion of the cost to operate these services, which is alarming when you consider that 70 percent of transport patients are covered by government insurance or have no insurance at all.

We need Congress to address this funding challenge, or Californians may have to face serious consequences when they or their families face medical emergencies. Just a few months ago, an Air Methods base recently closed in Hazard, Kentucky, and they were forced to shut down because of the cost deficit from Medicare and Medicaid reimbursement rates.

Thankfully, efforts are underway to preserve emergency air medical services. Initiatives like the “Save Our Air Medical Resources” campaign are working to educate the public on the problems and possible solutions surrounding continued air medical services. There are also leaders in Congress, like Rep. Raul Ruiz, D-CA 36, a former emergency room doctor, who understand the importance of these services in saving patients’ lives.

Whether by ground ambulance, air medical transport or on the scene, we need all treatment and transport options available because we know every choice we make counts.  It is essential we do everything we can to protect and preserve access to emergency air medical services so that they remain a realistic, life-saving option for everyone.

Scott Brown is the Hemet fire chief and has served as a paramedic for the Orange County Fire Authority for 18 years.