The New York Times: Tears in the Cockpit: When a School Shooting Strikes Close to Home

By Alan Blinder and Timothy Williams

ATLANTA — The call was for an active shooting at Marshall County High School in rural Kentucky, and tears welled up in Riley Johnson’s eyes as he prepared the medical evacuation helicopter that he flies.

He blinked them away and flew to the campus, where he had run cross-country as a member of Marshall’s class of 2009. He set the helicopter down in an area that he knew well. And then, as colleagues rushed toward a patient, he surveyed the chaotic scene of panicked teenagers and hurried emergency officials.

“I just had a pretty good breakdown and just started bawling my eyes out in the cockpit, not believing what I was seeing,” Mr. Johnson, 27, recalled in an interview on Wednesday. “I can imagine myself being in that school, exactly where this happened.”

A teenage gunman’s rampage in Benton, Ky., a speck of a city near the Illinois border and the latest American town to confront a mass shooting, left two students dead and 18 other people wounded on Tuesday.

And for many of the emergency workers, that meant rushing to a scene that was achingly close to home: the county’s main high school, where they once studied, or where they send their children every day.

“Not for this to sound cold or callous, but it’s a whole lot easier to make those flights on someone you don’t have close personal ties to, versus your hometown, or someone’s mom or dad, or son or daughter, or brother or sister that you know,” said Allen Jones, Mr. Johnson’s commander at the Mayfield, Ky., base of Air Evac Lifeteam, a medical evacuation service.

School shootings are a particularly chilling outgrowth of the gun violence playing out across the country. The smaller the town, though, the more likely the faces of the victims will be familiar to those rushing in.

Capt. Brice Current of the San Juan County Sheriff’s Office in New Mexico had to face that anguish last month, when he responded to a fatal school shooting at Aztec High School. His daughter attends the school, but as he rushed to the scene, he could not reach her on her cellphone.

The sheriff’s office regularly spends entire weeks training for active shooting emergencies, and he tried to focus on the urgent work at hand.

“But mostly, I was nervous about my daughter, to tell you the truth, and about the other kids I knew through our church group,” he said in an interview. “I was going there to engage a shooter, or do whatever I could.”

Once the situation was contained, he sprinted to where two students lay dead. He asked teachers to identify the students, and it was only then that he could be sure that neither was his daughter. Moments later, she called him back.

Beyond the emotional toll, a mass shooting can strain the limited resources of tiny communities.

“It takes time to respond to something like that because we don’t have an officer right around the corner,” said Sheriff Joe D. Tackitt of Wilson County, Tex., where a gunman killed 26 people at a church in Sutherland Springs last autumn.

At the time of the church shooting, the sheriff said, there were just four deputies on duty in the whole county, 53 square miles of countryside southeast of San Antonio.

On Wednesday, Sheriff Kevin Byars of Marshall County, Ky., which includes Benton, issued a statement thanking at least 18 agencies for their help in responding to the shooting at the high school. Some of the assistance came from well beyond the county line: the most seriously wounded were flown to a hospital in Nashville, about 100 miles away.

“We see major incidents on the news and we say, ‘Thank God it didn’t happen here,’ ” the sheriff said. “Yesterday, that has changed for those of us in Marshall County.”

The attack on Tuesday was at least the 11th episode of gunfire on school property in the United States since Jan. 1, and the worsening pace and intensity of shootings in schoolhouses and on college campuses in recent years have left educators and law enforcement officials shaken. About two-thirds of American school districts conducted active-shooter drills last year, federal officials reported.

Training for school shootings has become a standard feature of police work, law enforcement officials and criminologists say. Even small departments, facing the threat of a shooting where backup might not reach the scene quickly, have made such training mandatory in the years since 26 children and staff members were killed at Sandy Hook Elementary School in Newtown, Conn., in 2012.

A scarcity of trauma care capacity can present another challenge. According to the American Trauma Society, there was just one Level I trauma center — one that is “capable of providing total care for every aspect of injury” — within 100 miles of Marshall County High School in Benton, and that one only barely.

“I would be really scared if I had a mass shooting in a rural area where there was no access to a trauma center,” said Dr. Richard S. Miller, the chief of trauma and surgical critical care at that one center, the Vanderbilt University Medical Center in Nashville. “If you don’t do it on a daily basis, you lose that pattern recognition and that competence to take care of something. These rural areas, they don’t see this kind of thing.”

In crises that turn on action in seconds or minutes, not hours or days, local doctors and medics on the scene are still vital. Dr. Miller said that on Tuesday, emergency officials in Kentucky had established clear airways and applied tourniquets to the wounded at the high school, long before the helicopters had carried any of them to the trauma center.

One boy, who had been shot in the head, died at the hospital. Another, who had been shot in the belly and was in a life-threatening hemorrhagic shock when he arrived at Vanderbilt, remained “very sick” on Wednesday, Dr. Miller said, while three other patients from Benton were doing “extremely well.”

On Tuesday, after flying a student to a hospital in a Bell 206 helicopter, Mr. Johnson, the pilot, flew back to base in neighboring Graves County. Before anyone went home, the crew had a lengthy debriefing with Mr. Jones, the director of the base, and other colleagues, about “all of those things that go along with making that bad call in rural America where you know somebody.”

“We just started to kind of talk about it,” Mr. Jones recalled on Wednesday, “letting them lead the discussion to vent or get out the frustration, the anger.”

Alan Blinder reported from Atlanta, and Timothy Williams from New York.


ABC 15 News: Family meets heroes who saved 1-year-old's life after near-drowning

Horry County, S.C. (WPDE) — A month ago Tuesday, 1-year-old Bentley Martin fell into a swimming pool. His family didn't think he would make it, but because of a group of special first responders, doctors, and nurses, his family is able to spend the holidays with him.

On Tuesday, ABC 15 News was there when the family was reunited with the crews who saved him for the first time.

"When it all happened, I didn't think he was gonna make it," said Cassie Martin, Bentley's mom.

On Sunday, Nov. 19, Cassie was doing the usual housework, and her son, Bentley, and his older brother were playing in the next room.

"Within a minute or two, I realized they were quieter than usual, because usually they're in my mom's pots and pans and I went and we saw them in the pool," she said.

It didn't look good. Cassie's step father performed CPR until EMS arrived on scene.

"The child was very cold, unresponsive and having difficulty breathing," said Matthew Oswald, Horry County Fire Station 15 firefighter and paramedic.

Bentley was taken to Mcleod Loris Hospital, flown to McLeod Hospital in Florence and, nine days later, the miracle the Martin family had been waiting for finally came.

"He was home eating Cheetos, running around the living room is what we were told after that, so hearing that news we decided to do a get together just a few days before Christmas," said Oswald.

For the first time, the heroes got a chance to see a patient they fought so hard to save.

"I've never seen anybody I've flown, so this is super amazing. It's emotional for us--I have a child that's two weeks younger than he is, so it hit home for me," said Jennifer Gray, an Air Reach flight nurse.

Bentley may not be old enough to understand what he's been through, but his family will now have a new tradition this time of year, full of pictures, videos, and the gift of a Christmas miracle to tell him all about.

"I thought it was going to be the worst one I ever had in my life, but it turned out to be the best one. That's the best Thanksgiving I ever had, right there at that hospital with him. He is truly a blessing and I'm just so glad that he's here with us for Christmas," said Lee Martin, Bentley's grandfather.

The Horry County Fire Chief awarded everyone who helped save Bentley an honorary coin, paramedics, doctors and nurses.


Save Our Air Medical Resources Campaign Applauds Introduction of S. 2121, the Ensuring Access to Air Ambulance Services Act

November 14, 2017

WASHINGTON – The Save Our Air Medical Resources (S.O.A.R.) campaign and its partners applaud U.S. Sens. Dean Heller (R-Nev.), Michael Bennet (D-Colo.) and Cory Gardner (R-Colo.) for introducing S. 2121, the Ensuring Access to Air Ambulance Services Act of 2017. This is an important next step for Congress to preserve access to emergency air medical services, following introduction of its companion bill, H.R. 3378 in the House of Representatives by U.S. Reps. Jackie Walorski (R-Ind.), Raul Ruiz (D-Calif.), Suzan DelBene (D-Wash.), Bill Johnson (R-Ohio), and Pete Sessions (R-Tex.).

The proposal is a critical part of the effort to ensure communities across America, particularly in rural parts of the country, have access to life-saving emergency air medical services. 

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. 

“S.O.A.R. stands in full support of this important bipartisan legislation, which will help ensure that rural and urban communities alike can access emergency care,” Carter Johnson, a spokeswoman for S.O.A.R., said. “Low government reimbursement rates that have not been updated in almost two decades continue to threaten Americans’ access to emergency air medical services. This bipartisan, bicameral legislation brings us closer to fixing this reimbursement shortfall, and ensuring that all Americans – no matter where they live – will have access to emergency air medical transport if they ever need it.” 

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. 

“When a stroke happens, minutes matter – getting the right care at the right time can mean the difference between life and death,” National Stroke Association CEO Robyn Moore said. “Emergency air medical services play a critical role by transporting stroke patients every day and helping to ensure that these patients have the care they need when they need it. The National Stroke Association stands behind this bipartisan legislation to ensure that all Americans have timely access to high quality health care no matter where they live.” 

“On behalf of our nation’s 3.6 million registered nurses – including flight nurses – the American Nurses Association is proud to support this bipartisan legislation that will preserve health care access for Americans, especially those in rural communities,” Michelle Artz, the American Nurses Association Director of Government Affairs, said. “Flight nurses have rescued and treated countless patients and know firsthand the importance of protecting lifesaving emergency air medical services. We will always work to put patients first and ensure all forms of health care remain accessible to them.” 

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 
  • Remain 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


Fort Worth Star-Telegram: A solution to save the air medical service industry – so it can save lives

As too many of us know, a medical emergency can change your life in an instant. Every day, people experience the pain and suffering of car accidents, heart attacks and strokes. In those moments of crisis, getting to a tertiary care or trauma center as quickly as possible can truly be a matter of life or death.

But for 1 in 4 Americans — that’s 85 million people — getting to a Level 1 or Level 2 trauma center within an hour is possible only if they are flown by an air ambulance. Access to trauma facilities is especially limited in rural communities, where 22 percent of hospitals have closed since 1990. This, combined with our aging population, means the need for air medical services is growing.

As an industry leader in emergency air medical services, the team at Air Methods is dedicated to providing lifesaving health care 24/7/365. Since 1980, we have transported over 2.5 million patients from over 300 bases, serving 48 states. From our safety protocols to our patient advocacy philosophy, we are always working to improve and deliver the best patient experience from beginning to end.

This week, many of our team members are in Fort Worth at the annual Air Medical Transport Conference, a gathering of professionals and experts in the emergency air medical transport industry. As we meet to learn about new technologies and trends, there is one issue that will be front of mind — as we fight to save lives, how will we keep our vital service alive?

While the need for our service is growing, our industry is faced with increasing costs and consistent reductions in payments from insurance companies.

Our best practices medical care is vital to the health outcomes of the people we transport, but around-the-clock readiness comes with significant costs. The average cost to operate an air ambulance base is $3 million annually and 84 percent of those costs are incurred regardless of transports.

About 70 percent of the patients we transport have Medicaid, Medicare, some other government insurance or no insurance at all. The current reimbursement from Medicare, Medicaid and some private insurers are drastically below the costs to provide this vital service. Reimbursement rates for Medicare, for example, have not been updated in almost 20 years, and on average, reimburse only about 50 percent of actual cost of transport. In some states, Medicaid reimburses as low as 1/25th of Medicare.

Air medical services represent about half of 1 percent of the average insurance premium, and yet there are companies that consistently downgrade claims or intentionally keep air medical providers out of network. While many private insurance companies do right by their members and cover air medical transportation at a rate that is fair, some insurance companies shirk their responsibility, leaving patients high and dry. At Air Methods, we want to take patients out of the middle and ensure that, while facing a medical emergency, they can count on their insurance provider to pay a reasonable amount for our service that is requested and deemed necessary by emergency medical professionals.

This reimbursement trend cannot continue without putting our services, and the patients we serve, at risk.

At Air Methods, we’re taking several steps to address these issues. First, we are working directly with insurance companies to make sure they offer fair coverage, and second, we are fighting for smart legislative solutions.

One important proposal comes in legislation introduced in Congress to address Medicare reimbursement: H.R. 3378, the Ensuring Access to Air Ambulance Services Act. This bill would modernize the Medicare air ambulance fee schedule and help preserve these services. The bill requires the industry to collect and submit cost data to the U.S. Department of Health and Human Services so that an accurate payment system, based on actual costs, can be developed. While this only addresses part of the shortfall, this legislation goes a long way in easing the problem. We hope that other members of Congress will join the sponsors of the bill — Reps. Pete Sessions, R-Texas, Jackie Walorski, R-Ind., Suzan DelBene, D-Wash., Bill Johnson, R-Ohio, and Raul Ruiz, D-Calif. — in supporting H.R. 3378.

This week, Fort Worth is filled with people who care deeply about the future of air medical services. But our company and our industry cannot address this alone. We need widespread support for reasonable legislation like H.R. 3378.

Lives depend on it.

Dr. David Stuhlmiller is the chief medical officer for Air Methods.

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Duluth News Tribune: Reader's View: Congress can do its part

By Carter Johnson

The Aug. 8 article in the News Tribune about the air ambulance industry missed the point ("Does the Iron Range need two air ambulance bases?").

Air medical services are a critical part of the health care delivery system in the U.S., particularly for rural communities. Air ambulance suppliers and providers do not "find more people to put in helicopters," as Tom Judge, executive director of LifeFlight of Maine, commented in the article. Medical helicopters only respond when a first responder requests the helicopter to the scene or a physician at the hospital summons the helicopter to transfer a patient to a higher level of care. Medical helicopters do not self-dispatch.

The claim that, "air ambulance rates have become very lucrative" is far from the truth. Today, the reimbursement for seven of 10 patients does not cover costs, regardless of whether you are a not-for-profit hospital or consortium business model or whether you are a for-profit air ambulance supplier or provider. Cost-shifting is needed by all services.

The real challenge is the way in which these vital services are reimbursed. Seven out of 10 transports are patients with Medicare, Medicaid, or no insurance. Because Medicare reimbursements haven't been updated in almost 20 years, it vastly under-reimburses providers for air medical services, on average covering only 30 percent to 50 percent of the actual cost.

That's why a bill has been introduced in Congress, the Ensuring Access for Air Ambulance Services Act, to address this shortfall.

We with the Save Our Air-Medical Resources, or S.O.A.R., Campaign, urge Congress to approve this legislation so all Americans can rest assured they'll have access to emergency air medical transport when it's needed most.

Carter Johnson

Washington, D.C.

The writer is from the Save Our Air-Medical Resources Campaign, or S.O.A.R. Campaign.


Duluth News Tribune: In Response: We need to protect life-saving air ambulance services

By Daniel Hankins

Imagine you and your loved ones are hiking through the Chippewa National Forest, fishing on Mille Lacs Lake, or relaxing on your family farm. Suddenly, you start to notice tingling sensations in your arms followed by chest tightness and pain and a struggle to catch your breath. Imagine all of a sudden you're having a heart attack.

When unexpected medical emergencies like this strike, it is critical to access the right kind of care as quickly and as safely as possible. In a state like Minnesota, filled with forests and farms, sometimes the closest trauma center can be hundreds of miles away.

When time is of the essence in emergency situations, air medical services can be the only way to get the life-saving treatment you need.

Today, one in four Americans — about 85 million people — can only get to a Level I or Level II 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 80 rural hospitals closing their doors since 2010, including two in Minnesota. As a result, access to emergency air medical transport has become more and more critical.

As an emergency physician, I know firsthand that access to emergency air medical services can mean the difference between life and death, especially for the millions of Americans living in rural communities. Air ambulances essentially serve as emergency rooms in the sky, providing life-saving care until they can transport patients to the closest trauma center.

However, access to these critical services is being threatened ("Does the Iron Range need two air ambulance bases?" Aug 18).

Reimbursement rates provided by Medicaid and Medicare, as well as many private insurers, fail to cover a significant portion of the cost to operate air ambulance services. That's alarming when you consider that 70 percent of transport patients are covered by government insurance or have no insurance at all.

Emergency air medical services are standing by ready to respond to the urgent call of physicians or first responders at a moment's notice — 24 hours a day, seven days a week, 365 days a year. 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.

All three of the air medical services based in Minnesota are not-for-profit and cooperative in referring patients to other services if their service is not available. All of the services have strong medical oversight to ensure transports are appropriately done.

Thankfully, a bipartisan group of federal legislators recently proposed solutions to address this reimbursement shortfall. U.S. Reps. Jackie Walorski, R-Ind.; Suzan DelBene, D-Wash.; Bill Johnson, R-Ohio; Raul Ruiz, D-Calif.; and Pete Sessions, R-Texas introduced the Ensuring Access to Air Ambulance Services Act. This legislation would require the U.S. Department of Health and Human Services to develop an accurate payment system based on the actual costs of providing care; establish a mandatory quality reporting program; and improve the transparency of costs among providers, patients, and insurers.

Passing this legislation would be an important step in ensuring communities across America — including in rural Minnesota — maintain access to life-saving emergency air medical services.

Whether you or a loved one experience an unexpected heart attack, stroke, or traumatic injury, you may need to rely on emergency air medical services to access immediate care. It is essential we do everything we can to protect and preserve access to these services so they remain a realistic, life-saving option for everyone.

Dr. Daniel Hankins of Oronoco, Minn., is a fellow of the American College of Emergency Physicians and a retired emergency medicine and EMS physician.


Health, Consumer Organizations Unite to Call on House Ways & Means Committee to Address Air Ambulances in Medicare Extender Legislation

September 7, 2017

WASHINGTON – Today, eight organizations joined the Save Our Air Medical Resources (S.O.A.R.) campaign in a letter to the U.S. House Ways & Means Committee calling for the inclusion of air ambulances in Medicare extenders legislation. The organizations are urging Congress to treat air and ground ambulance equally, ensuring both are given temporary Medicare payment increases while the Center for Medicare and Medicaid Services (CMS) collects cost data to accurately set reimbursement rates in the future.

The organizations who signed onto the letter represent a diverse set of missions, including consumers, patients, medical and EMS professionals, and public safety officials. The organizations include: 

  • American Nurses Association (ANA)
  • Consumer Health Coalition (CHC)
  • Consumer Action
  • National Stroke Association
  • Epilepsy Foundation
  • American Medical Women’s Association (AMWA)
  • International Association of Flight & Critical Care Paramedics (IAFCCP) 
  • State Firefighters' & Fire Marshals' Association of Texas 
  • Combined Law Enforcement Associations of Texas 

The organizations urged Congress to address inadequate Medicare ambulance reimbursement fees:

“It has been almost 20 years since the ambulance Medicare payment system was updated or examined.  Modernizing air ambulance Medicare reimbursement is necessary for the long-term sustainability of air ambulance services.  However, neither ground nor air ambulance providers currently report their costs to the Center for Medicare and Medicaid Services (CMS), making it very difficult to implement or even propose these needed reforms.  The current policy under discussion for inclusion in the Medicare extenders bill would provide ground ambulance providers with five years of higher Medicare payments in return for reporting their costs to CMS.”

The full letter is here.



Save Our Air Medical Resources (S.O.A.R.) is a national campaign dedicated to preserving access to emergency air medical services for Americans across the country by providing important education and resources to the public and to key decision and policy makers. Air medical resources are a critical element of emergency response across the country, particularly for people living in rural areas where access to trauma care facilities is often quite limited.


Carter Johnson
(860) 490-4298

Herald-Tribune: Air ambulances in jeopardy

By Dr. Chris Newcomb

You never know when a medical emergency might occur and force you or a loved one to rely on emergency transport to receive critical care. I have firsthand knowledge of this as a patient, as I was airlifted to a trauma center in Orlando after a life-threatening car accident.

My experience as a physician, especially the time I served in a busy emergency room, made me acutely aware of how important it is for patients to get to high-quality medical facilities as soon as possible.

Consider, for example, the catastrophic power-plant explosion in Tampa earlier this summer that caused multiple critical injuries and fatalities from severe burns. When medics arrived at the scene, two of the victims were flown by emergency air ambulance to Tampa General Hospital’s burn center. Tampa General is one of just three burn centers in Florida to have earned Verification by the American Burn Association/American College of Surgeons, and plays a critical role in providing treatment for burn victims.

Incidents like this highlight the importance of emergency air medical services to protect our communities from unforeseen tragedies. The Association of Air Medical Services estimates that more than 550,000 patients in the U.S. are transported by air ambulances each year.

No one disputes the benefits of air ambulances, but the continued availability of these services in Florida and across the nation is in jeopardy.

Operators of these essential services do not receive adequate reimbursement rates from Medicare, Medicaid and some private insurers, placing a substantial financial strain on air medical transport providers. Right now, the current Medicare Air Ambulance Fee Schedule results in a cost shortfall of over 70 percent.

The fees fail to take into consideration the rising operational costs for air medical transport providers to offer 24/7 top-notch care. Without adequate reimbursement rates, air medical transport providers are being forced to scale back or shut down operations across the nation.

Air ambulance services exist in many different forms, including public providers, nonprofit organizations and private companies. But they all have the same goal: providing quality care as they quickly transport patients in need. In Sarasota, we are fortunate to have air ambulance services like Bayflite that quickly deploy to the scene of an accident. I know I am certainly grateful for these services as both a patient and a physician.

While limited access to emergency air medical transport is a nationwide problem, it specifically affects Floridians because of our state’s expansive rural areas.

Limited availability of specialized care forces Florida’s rural communities to rely on emergency air medical transport to get patients to critical care facilities when a hospital is out of reach. This is especially true for burn victims in rural areas, where a lack of specialized centers give patients even less chance to reach appropriate burn centers in time for necessary treatment.

Recently, U.S. Rep. Jackie Walorski of Indiana introduced legislation that brings these concerns to light. The Ensuring Access to Air Ambulance Services Act (H.R. 3378) would update Medicare reimbursement rates based on actual cost data, instead of the cost estimation that set the current fee schedule. This bill is an excellent start to protecting access to these life-saving services for when we need them most.

No one can plan when a medical emergency will occur. That’s why safeguarding the continued availability of emergency air medical services is important to ensure that the care patients require is available when they need it most.

Dr. Chris Newcomb, M.D., is a Sarasota physician who specializes in internal medicine.


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.