When someone in West Marin reports a car crash,
choking child, or elderly person with chest pains, county emergency
dispatchers put a rescue helicopter on standby. These helicopters were
used to ambulance people out of West Marin 42 times last year.
But under new guidelines that will take effect in
January, paramedics will have more discretion to use ground transport
if the time to the hospital door would be roughly comparable. This new
policy should reduce the number of helicopter ambulance rides in the
coming year.
Part of the problem is that neighbors of local hospitals
don’t want helicopters taking off and landing at all hours of the
night. Marin General Hospital will not install a helicopter pad. So
helicopters have to make more expensive flights to the East Bay or Sonoma
counties.
Helicopter ambulance rides are expensive, typically
around $12,000, and many insurance policies only pay part of the expense,
leaving riders with a massive bill.
County overhauling rescue protocols on Jan. 1
Emergency planners said they have realized
that county medical resources are being under utilized with so many
patients being flown outside the county.
For years, neighborhood opposition in has precluded
helipads from being built at Marin County hospitals, including Marin
General, which has a high-grade trauma center. So instead, patients
rescued by helicopter have to be flown to hospitals in Sonoma County
or the East Bay.
In response, the county's Emergency Medical Services
has refined its protocol on how and when to fly patients out of county
as opposed to driving them to Marin General Hospital.
Fire Capt. Mike Giannini told The Light that
while there's a "perception that [West Marin] is a long ways out there,"
ground transport with one of the county's rescue ambulances is often
just as quick.
He pointed to a cardiac patient that county medics
responded to earlier this month in Point Reyes Station. The patient,
he said, "had chest pain that looked like a classic candidate for air
transport. But we drove them from the firestation to Marin General in
32 minutes."
While fly time from West Marin can be as short as
12 minutes from Bolinas to John Muir Medical Center in Walnut Creek,
loading and unloading is still an issue; a patient must first be driven
to the landing zone by a ground ambulance. From there it's 10 minutes
to load, 10 minutes to fly, and 10 minutes to wheel them in to the hospital,
Giannini said.
Giannini said that between January and Dec. 1 of this
year, the county fire department logged 42 flights out of West Marin,
but said under next year's protocol this number could decrease. For
patients in more remote communities like Inverness, he said there probably
wouldn't be much change. But towns like Point Reyes Station become more
of a gray area with fly-times and ground transport often comparable,
he said.
"The county has worked with specialists to refine
the [protocol]; now it's simpler to use, and sends patients to the closest
facility, regardless of the nature of their injuries with the exception
of pediatrics" which are often flown to Children's Hospital in Oakland,
he said.
Paramedics on the scene given more discretion
Marin County EMS Administrator Diane Claytor
said the new protocol will give paramedics on the ground more discretion
on how to transport patients; the emphasis, she said, is on getting
patients to a hospital the fastest whether it's by ground or air.
Claytor said that the county's new policy largely
stems from incidents in urban parts of the county when patients were
flown out of the county when they could have been easily been cared
for closer to home.
The old system, she said, was less efficient and "there
was less ability for the paramedic to make the call" on where the patient
should go. But because of geography, West Marin has traditionally made
up the lion's share of helicopter transports, she said, noting that
in 2002, some 143 patients were flown out-of-county; 92 of these flights
were out of West Marin.
"So typically 65 to 70 percent of our air travel is
from West Marin," she said, adding that only time will tell what effect
the new protocol will have in West Marin.
Helicopter services
West Marin is served by two air ambulances;
REACH in Santa Rosa covers the northwest half of the county, while Bolinas
and Stinson Beach are often served by Calstar in Concord. And in rare
instances, Henry 1, the Sonoma County Sheriff's helicopter responds.
"Air ambulance service is a part of healthcare that's
really under the radar," said Ross Fay, program coordinator for Calstar
air ambulances. "People think that the Coast Guard, or a public agency
are in charge of rescuing people, but it's often a private for profit,
or a not-for-profit" that operates air ambulances. A flight out of West
Marin is typically around $12,000, Fay said.
This was a lesson Tom Levy of Inverness learned in
2001 when he suffered a heart attack and REACH was summoned.
The air ambulance medics -- following the Sonoma County
protocol directing them to the nearest hospital's helipad -- wanted
to fly to Petaluma Valley Hospital. A volunteer with the Inverness Fire
Department for years, Levy knew there was no cardiac facility in Petaluma
and said he insisted that they fly him to Santa Rosa Memorial Hospital.
"They took me to Memorial, which was great, I had
great care there," he said.
But then Levy got a bill for his ride over-the-hill.
His health insurer, Blue Cross, had balked at paying the full amount,
claiming it was excessive. In the end, he convinced Blue Cross to pay
more than they initially offered, but still had to pay $4,000 out of
his own pocket.
REACH spokeswoman Jennifer Hardcastle said that Levy's
story is not unique; many insurance companies won't pay the entire cost
of air transport, with different health plans offering different levels
of coverage.
Reimbursement a 'huge issue' for air ambulance
providers
Of the hundreds of patients flown by Calstar each
year, only half of the patients flown are able to repay the full amount,
said Fay, who coordinates Calstar's three helicopters in Concord, Salinas,
and Gilroy.
"Reimbursement is a huge issue," Fay said. "A large
percentage of the people that you transport don't have the wherewithal
to pay or are uninsured."
So in 1999, as a move to boost revenue as well as
avoid unfortunate bouts of haggling between patients and recalcitrant
insurers, Calstar began offering a subscription program in which households
pay an annual premium and are guaranteed not to be billed if they are
flown by Calstar or one of its partners in Oregon, Idaho, or Wyoming.
As a nonprofit that relies largely on government grants
and community support, Fay said that Calstar's 10,000 subscribers statewide
now account for about 10 percent of it’s funding.
REACH who has helicopters in Santa Rosa, Ukiah, and
Redding, serves much of the rural North Coast, is offering a virtually
identical program. Since September, REACH has offered a similar subscription
service to individuals and households. Both programs cost less than
$50 annually.