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HeliTorque Forum Index » Flight Safety

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EMS Operator Loses Contracts
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PostPosted: Mon Jul 25, 2005 7:06 am    Post subject: EMS Operator Loses Contracts Reply with quote

Seton cancels air ambulance contract
Unaccredited company has had eight accidents since '01

At a time when state and federal regulators are examining the safety of the air ambulance industry, the Seton Healthcare Network said it has canceled its contract with an unaccredited helicopter company that has had at least eight accidents since 2001.

The company, Air Evac Lifeteam, had hoped that the accreditation held by an air ambulance service that it bought in April would transfer to Air Evac.

But after Air Evac realized that it was "not going to be able to prevail" on the accreditation issue, Seton canceled the contract Thursday night, said Bruce Broslat, vice president and chief operating office of Seton's Brackenridge Hospital. Accreditation, which is not required by any regulatory authority for companies to operate, is awarded by the Commission on Accreditation of Medical Transport Systems, and means that a company voluntarily meets standards for patient care, safety and quality.

Seton requires that air ambulances it uses are accredited.

The contract with Air Evac required Seton's eight Central Texas hospitals to call Air Evac first to transfer a patient. Exceptions to the "first-call" contract were made if another company's helicopter could reach the patient faster or if Air Evac was unable to meet the needs of the patient.

The development in Air Evac's relationship with Seton comes as state and federal regulators are discussing bolstering regulations on the industry as issues swirl around the increasing use of air medical helicopters, uneven standards and fierce competition, which some critics say causes some operators to cut corners and jeopardize safety.

Seton officials said Air Evac's safety record ??? which the company defends ??? did not play into their decision to cancel the contract, although it was discussed. It is not yet known how Seton's cancellation could affect Air Evac's business. Air Evac, a for-profit company based in Missouri, has contracts with hospitals throughout Central Texas and is one of the largest air ambulance companies in the country.

The company, which has 11 helicopter bases in Texas, declined to name the Central Texas hospitals with which it has contracts. Nor would company officials comment on the Seton contract situation.

Its accidents, as detailed in National Transportation Safety Board reports, include:

?? A Feb. 21 wreck in Arkansas in which the pilot made a hard landing, killing the patient and resulting in serious injuries to the pilot and crew.

?? A Nov. 9, 2004, crash in Oklahoma in which a blanket came into contact with the helicopter's tail rotor blades "after the baggage compartment door unlatched during flight." It caused two minor injuries.

?? An April 20, 2004, accident in Indiana in which a pilot error led to the helicopter colliding into sloping terrain after takeoff. One person died. Three others were seriously injured.

?? A Nov. 28, 2003, crash in Arkansas in which the safety board found that the pilot was "rushed due to pressure induced by the air ambulance mission" and failed to remove the main rotor tie-down before starting the aircraft. The blade broke and separated from the helicopter. One person suffered minor injuries.

?? A Jan. 22, 2001, incident in Illinois in which a hospital security guard was killed walking into a spinning tail rotor shortly after the pilot started the helicopter.

Critical Air, the company that Air Evac bought in April, had one accident in Llano County about two years ago that did not cause any deaths.

Mike Slack, managing partner of Austin law firm Slack & Davis, which specializes in aviation accidents, including air-ambulance crashes, said eight accidents since 2001 is high.

"That's just unacceptable," he said. "It's like American Airlines saying it's all right for us to have that many crashes because we have more airplanes."

Air Evac officials, however, said this week that they are proud of the company's safety record.

Seth Myers, Air Evac's vice president for operations, said that pilots are not pressured to fly during bad or questionable weather and that Air Evac does not cut corners on safety.

"We operate a very good aircraft, a very stable aircraft, yet we are not subsidized by anyone," he said. "Our crews are well-trained. . . . It wouldn't serve the company to not have your folks trained well."

Dr. Bryan Bledsoe of Midlothian, who also is an adjunct associate professor of emergency medicine at the George Washington University Medical Center in Washington, said that there is no way to accurately judge Air Evac's record. Bledsoe, who compiles data on air medical accidents nationally, says Air Evac has had three fatalities since 2001.

No one knows what the industry average for accidents is because "no one knows how many flights are being made," he said.

Bledsoe recorded 10 accidents for Air Evac since 2001. Air Evac referred to its Web site for its safety record, which includes eight accident reports since 2001.

Nationally, between 2001 and 2004, Bledsoe said, there were 69 accidents, a big increase over the eight previous years when there were 55 total.

Air helicopter use is way up. In the past four years, the air medical fleet has almost doubled, to 730, Bledsoe said. "One is added a week somewhere in the country," he said.

From 2002 to 2004 in Texas, air ambulance transports soared from 4,144 flights to 11,694, according to state data.

Data also show that air ambulances are more dangerous than ground ambulances.

A report published this week in USA Today, which discussed the air-ambulance industry and patient safety, says that 60 people have died in air ambulance crashes since 2000.

That is why accreditation is so important, Bledsoe said.

"It says an outside agency came in and examined your safety operation, your medical operation, your personnel, your maintenance and said, 'You meet a national standard,' " Bledsoe said. "When helicopters are falling out of the sky at rates we've never seen before, safety is a direct feature of that."

The issue of air ambulance safety has raised concerns among local, state and federal officials, who are worried about accidents and appropriate use of ambulances, said Dr. Ed Racht, medical director of Austin-Travis County Emergency Medical Services.

Minimum standards for all helicopter services are under discussion. The federal government is considering night-vision goggles and possibly banning flights in some areas, said Racht, who serves on the air medical task force of the National Association of EMS Physicians.

In Texas, a proposal is being considered that would require air ambulances to be accredited to be licensed to fly.

"The direction the state is going in is, 'Let's raise the bar and raise the minimum requirements to safely and appropriately operate a helicopter in the state,' " said Racht, who is also chairman of the governor's EMS and trauma advisory council.

Myers of Air Evac said the issue is more about competition between the for-profit helicopter sector, which is expanding rapidly, and helicopters operated by government and nonprofit entities.

Seton also does a lot of business with STAR Flight, the air ambulance service operated by Austin-Travis County EMS, and other helicopter services also bring patients to the Seton-run regional trauma center at Brackenridge Hospital. STAR Flight is accredited, and it has not had a crash in its 20 years of operation, said program manager Casey Ping.

Air Evac charges $6,000 to $8,000 per flight. In some locations, including Wichita Falls, it also sells "memberships" to individuals for $50 and families for $60 a year, entitling them to call Air Evac for service. Those memberships help subsidize the company in sparsely populated areas, said Julie Heavrin, the company's public relations manager.

STAR Flight, by comparison, charges Travis County residents a $2,000 liftoff fee and $55 per mile. Non-county residents pay a $4,500 liftoff fee.

St. David's Medical Center and Heart Hospital of Austin said they do not have "first-call" contracts with any EMS helicopter companies.

One reason that Seton made a deal with Critical Air is that it wasn't happy that STAR Flight, which also serves search and rescue roles, was being diverted from its medical mission, hospital officials said. Since then, issues have been resolved, and the hospital system is looking at expanding STAR Flight's role, such as transporting high-risk mothers and babies.

Martha England, Heart Hospital's vice president of development, said the hospital does not get to choose very often who brings in patients for care because many of the smaller hospitals have contracts with companies, such as Air Evac.

Even EMS agencies, such as Marble Falls Area EMS, have contracts with Air Evac. Loren Stagner, system operations director for the Marble Falls program, said he was happy with Critical Air but is concerned about Air Evac's accident history.

With Air Evac using the same Critical Air pilots, he is hoping that things will not change much, but if they do, the contract could change, Stagner said.

Some question whether it is ethical to make first-call contracts at all.

"We think that is a very bad practice and inappropriate," said David Phillips, director of prehospital services for Scott & White health care system, which operates Stat Air, a nonprofit air ambulance. "We had hospitals ask if we want them to do that . . . (But) I don't care if it makes sense from a business standpoint. The hospital gets stuck. Our approach is, if you think we're the best people for that patient, call us."

As far as Broslat of Brackenridge is concerned, he has seen enough of such contracts after more than a year of negotiations with Critical Air and Air Evac, he said. "I hope to never have a first-call contract with another company ever again."
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