Children’s Hospital in Oakland has a rooftop helicopter pad, and occasionally copters arrive there. It’s a mystery how the system could work.
Firstly, the scene of the car crash. Who decides to call in a copter, instead of an ambulance? When he calls, he must have some idea who/what is going to pay? He’s supposed to be able to decide where/whether the copter can land near the crash scene – near enough that someone (an ambulance crew, already there?) can carry the victim on a stretcher to the copter?
Secondly, the helicopter company. How much territory is one helicopter supposed to guard? It’s fuelled and ready, 24 hours? The crew is on duty, hanging around playing cards waiting for a call? Which likely won’t come? Is that job popular among pilots? When a call comes, how soon can they get airborne? Probably have to check the weather, maybe check the copter? Or are other guys hanging around to do that?
I’ve had many clients transported by medevac helicopters. Yes, it’s very expensive.
The first responders typically call for one when they perceive the need. Obviously, seriously injured victims who need a Level One Trauma Center. (in our area, that’s Harborview Hospital in Seattle). They land near the crash site. In one resent case, it was an adjacent field. In other, the client was sent to the nearby hospital and then flown to Seattle.
As far as the logistics of manning, fueling, and operating the helicopter, I have no information.
I can answer some of that. I was an EMT in Virginia on an ambulance crew. If I thought we needed a helicopter, I asked for one on the radio and it was dispatched. Different ones showed up, sometimes from the state police, or other hospital systems. I assumed it was based on who was available and weather permitting.
A fire crew would be dispatched to set up a landing site near the accident, often in a shopping center parking lot.
When I was an EMT, I believe the state would try to bill insurance for all the services, but never went after the patient if the insurance wouldn’t pay. Thus was all 25 years ago.
I’m a professional pilot, but not a helicopter or medevac guy. However, I have friends in that business.
These are specialized companies, not just Joe’s Helicopters who happens to transport a patient every so often. They may be owned by a hospital system and have specialized crews. Most of the helo pilots are former military, more of a mix in fixed-wing medevac. They also carry trained flight nurses.
There used to be a lot of safety problems. Helos are only called out when things have gone completely to crap, so the crews are very mission oriented and want to get the job done. This has led to flying in hazardous conditions, but in the last 15 or so years it’s changed. Usually, anyone on the crew can say no-go. But it’s hazardous by nature, doing off-airport landings. Add in bad weather and it can be very dicey.
The crews are indeed on standby for a couple of days at a time, usually. One friend of mine works three days a week. They may have a lot to do, or nothing at all, and have bunks and living quarters there at the airport.
Not quite directly answering the OP’s question, but from some police videos I’ve seen, the medevacing isn’t necessarily done by a helicopter or pilot who specializes in that. One video showed a Texas cop being shot and bleeding severely and the footage was being captured by a police helicopter who had been doing the overhead pursuit-follow of the suspect car for a long time as it was fleeing the cops. The helicopter then itself landed right away, picked up the wounded trooper, then flew him to a hospital at once.
In the UK, AFAIK air ambulances are run and funded by charitable trusts, but based at a major regional NHS hospital and called in by the emergency despatch centre:
First responders to the scene would make that decision.
Not at all - priority for the people on scene is rendering aid and saving lives. In the US the air ambulance company will probably bill insurance to start and that sort of thing will be sorted out later. That’s probably true of some other places, which is why travel insurance is sometimes recommended - even if the place you’re vacationing has UHC for its own citizens tourists may not be covered. There is an awareness that this type of transport is expensive and should not be used lightly but where it’s needed at the time it’s used no one is thinking about payment.
The final authority as to whether or not a spot is safe to land is the helicopter pilot. If it’s possible to scout out a location ahead of the chopper arrival that will be done, if there are people available. Air ambulances do come with a crew with medical training and could carry a patient from accident scene to helicopter on a stretcher but EMT’s/paramedics/whatever on site might and can help out with that. Sometimes there’s a bunch of logistics involved in getting the patient to the helicopter. In some cases one of the air ambulance crew might lowered on a rope and have to get the patient into a stretcher/carrier to either get them in the helicopter or get them to a location where the helicopter can land and then load them more securely for further transportation. However, not all crews and the necessary training or equipment to do that sort of rescue. Basically, first responders, including medevac crews, will try to make things work out with whatever scenario they are facing.
I don’t know how that sort of “territory” decision is made.
Is it different than having road ambulance fueled and ready, 24 hours? We pay fire crews to “hang around” until they get a call, how is this different?
Presumably, the supply of air ambulances somewhat matches the need. There might be slow days, but this sort of operation is expensive and has to be used a certain amount of the time or it won’t continue to exist. There are probably enough “jobs” out there to keep most of these companies flying, not everything involving medevac makes the news.
For some pilots - some of them like the excitement, landing off-field, saving lives, etc.
Depends on the set up, whether or not fueling or resupply of the ambulance part of the aircraft is required. If everything is ready to go and the chopper is warmed up (maybe from a prior run) 1-2 minutes. If starting cold maybe 5-10 minutes after engine start for more complex aircraft.
The company or head pilot is probably going to be checking the weather throughout the day since they’re on call. When called the final weather check probably won’t take more than minute or two, plus the pilot will have to plan their flight to get there and back, talk to ATC, etc. Medevac gets priority over pretty much anything else so they don’t get the wait times commercial passenger craft do, and they don’t normally fly where passenger/cargo jets do so that simplifies the planning in some ways. Having to deal with ground obstacles when flying low can complicate things. However, everyone involved are trained professionals so this is not a big deal.
Depending on circumstances there may be a ground crew to help out with inspections, pre-flight checks, fueling, etc. in others that might be on the pilot and crew.
Good question. Usually a patient’s insurance is billed first. If not covered the patient may get a very large bill in circumstances where this is not publicly funded or subsidized. After that I would suggest negotiations or a payment plan.
That can happen, but that’s not the usual medevac situation. It’s like when the Las Vegas country music concert was shot up and people were being transported to the hospital in the back of pick-up trucks rather than actual ambulance. Sure, it can be done but it’s not the preferred method.
How exactly these operations are run varies considerably from one place to another, and one nation to another.
A few years back, I spent almost two weeks in a hospital. My room overlooked the helipad across the street. I saw them land at least once a day, and usually more. Seemed like a cool job to me!
And note that these helicopters aren’t only used for transport from accident sites to hospitals. Sometimes, they are used to move patients from one hospital to another, often rural hospitals to larger academic ones that have special skills.
One of my son’s childhood friends had some kind of lung malady over a decade ago, and had to be moved from one hospital in our city to another one which had an available ECMO machine. When it came time for the transfer to be done, they used a conventional ambulance, but for a while thought that it might be necessary to use a helicopter flight to save about 2 minutes door-to-door - that’s how ill he was.
One of my personal metrics about the intensity of the pandemic was the number of helicopters landing or taking off from one of the two hospitals near our house. I would often see them while I was taking the dog for an evening walk. One week I saw eleven, a bit under one per day for each hospital.
Here’s recent flight tracking data for N709P, a Cleveland Clinic helicopter. It is a Sikorsky S-76 owned and operated by PHI Health, LLC. As you can see, it maintains a busy flight schedule (a lot of short hops), and there’s not that much sitting around waiting for an emergency call:
This is the most American of views. Here in Ontario, medical emergency transport is handled by Ornge (yes, it’s really spelled like that!). It’s a non-profit largely funded by the province and operates fixed wing and rotary aircraft.
I was an EMT for 8 years in rural Indiana and Kentucky.
In our area, depending on the nature of the accident (single car vs multi, known ejections, etc), the location, and the road conditions (road construction, railroad tracks, etc), we would call for the helicopter as soon as we got in the vehicle to head to the scene. Most of the ones that responded in our area usually required 15-20 minutes to get there, and it’s better to cancel them en route than to have to wait that additional time for them to prep and get there.
For a few years I Iived in a highrise a few city blocks from a major regional trauma center. We could see and hear medevac helos every couple hours all day and most of the night.
For-profit medical providers are one of the many banes of the American medical landscapes. Operations run by private equity firms seem the most egregious, and looking at.the video @Stranger_On_A_Train posted confirms this: take advantage of the most vulnerable with a support out profit margins or die scenario.
Based on the differences in quality of service (from direct experience) I would always choose the non-profit provider unless there was no other choice.
I remember reading a story about a family in, I think, Sacramento that had a very sick child. The hospital advised them to transfer the child to a children’s hospital in San Francisco and because of the urgency, the transport was via helicopter. Later they received a bill for something like $50,000. Now, imagine that’s your critically ill child and you’re given the same advice. Are you going to question the cost or whether it’s covered by insurance?
I don’t think anyone upthread mentioned yet that in at least some places, you can pay for something like a $99 yearly “membership” in a medevac service. Locally, I see people with stickers like the logo below in the back window of their vehicles that show they have prepaid for medevac service to get them to the hospital, rather than going by ambulance.
