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Bayflite call not injured's to make

Early edition: The chopper is sent if a victim meets any of several state-mandated criteria.

By JONATHAN ABEL
Published November 22, 2006


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SPRING HILL — William Skelton  flipped his rock truck last year in the shadow of Spring Hill Regional Hospital, cutting his back on some broken glass.

He expected the paramedics would take him next door.

Instead, he was loaded into a Bayflite helicopter and flown 30-plus miles to St. Joseph’s Hospital in Tampa.

“I didn’t ask to be taken. I didn’t give them my permission,” said Skelton, still angry a year later. “They just strapped me to the board, loaded me up and flew me away.”

Skelton, 56, of Weeki Wachee, walked out of the hospital seven hours later feeling fine — until he got Bayflite’s $8,000. That’s roughly the price of four round-trip tickets to Australia. His insurance covered only the first $1,000, and he can’t pay the rest.

He is not the only Bayflite case sent home the same day, hospital and paramedic statistics show.

About 24 percent  of all trauma patients flown into St. Joseph’s this year were sent home the same day, the majority of them airlifted by Bayflite. At Bayfront Medical Center in St. Petersburg, 24 percent  of Bayflite trauma transports this year were sent home the same day. Tampa General Hospital could not provide data on people flown there.

Hernando County Fire Rescue reports that 18 percent  of its Bayflite trauma flights this year were sent home the same day. In Pinellas that number was about 16 percent  in fiscal 2004-05, the last year those numbers were available. Ninety-nine percent of the Pinellas patients were flown by Bayflite.

While the length of hospital stay isn’t necessarily a direct indication of whether someone should have been airlifted, Bayflite program manager Jeff See  said the state benchmark aims to keep the rate of patients sent home within 24 hours to about 15 to 20 percent.

It is better to err on the side of caution, See said. That approach has saved countless lives but also led to disgruntled patients like Skelton. See says the guidelines work.

“The state of Florida has put in place criteria to call the helicopter...  ,” he said. “The standard the state sets is they want more people to go to trauma centers — you want to overtriage; otherwise you’ll have some people who will fall outside the system into small hospitals and die.”

Besides, See said, about 50 percent of Bayflite’s patients don’t have the right insurance and can’t afford to pay. In such cases, the hospital eats the cost, See said.

Two levels of criteria

Bayflite started out 20 years ago this month  as a rare phenomenon — a miraculous swooping rescue — but it has became an everyday occurrence, bringing the entire bay area within range of trauma centers.

Owned by Bayfront Medical Center, a not-for-profit hospital, Bayflite is on track to carry about 3,000 patients this year at an average cost to the patient of $8,000 to $9,000 per flight: $5,100  for liftoff and $100 for every patient-mile traveled.

The Florida Department of Health sets the criteria for who gets transported, and individual counties refine them.
People must go to trauma centers if badly injured in a car wreck, severely burned or in danger of paralysis, among other criteria.

The goal is to get the patient to the hospital within the so-called “Golden Hour,” when the chance of survival is the highest. When trauma centers are far away that’s only possible by airlifting.

But even if the patient doesn’t meet any of the most severe criteria, there’s a second scorecard with less critical conditions. Meet any two of them and it’s time to call the helicopter.

Among those secondary criteria is one that applies to many in Tampa Bay: being 55 or older.

If the patient is 56 and happens to break a leg in a car crash, for instance, that person will be flown to the hospital.

“If you’re 55 or over, you walk around with one (point) in your pocket,” said Jay Wilkins,  a paramedic with Bayflite and a lieutenant with Hillsborough County Fire Rescue.

Some fire rescue services, which are responsible for calling the helicopter, keep track of who is flown to trauma centers and how long they stay. Others do not.

“Our thinking is that if they are admitted to the trauma center, they needed to go,” said Hernando County Fire Rescue Chief Mike Nickerson.  “If we send them down there and they are checked out and sent home, then obviously we want to keep (those numbers) as low as possible because of the cost.”

The majority of airlifted patients are admitted to the trauma center, but that still leaves some unhappy customers.

“The medical responders are in a Catch-22,” said Brooksville fire Chief Tim Mossgrove.  “We’re going to err on the side of safety and fly you out. If you get released and come back and complain about the $9,000 bill — at the time your level of care demanded that you get sent by air.”

Chopper service varies

Bayflite’s four helicopters — based in Sarasota,  Tampa,  Odessa  and Brooksville  — are not the only medical choppers. Aeromed,  run by Tampa General Hospital, operates three helicopters. And Air Methods, a company not owned by the local hospitals, has two.

All the Tampa Bay area helicopters are run by private companies. Elsewhere, governments own medical choppers at a lower cost to patients.

The Maryland State Police, for example, keep eight medevac choppers on duty, all funded by taxes. Patients pay nothing for transportation.

Miami-Dade Fire Rescue keeps two helicopters ready 24 hours a day for medevac service. There is no charge to patients, said spokeswoman Elizabeth Calzadilla-Fiallo , though the department plans to change that.

No matter how the fleets are funded, helicopter rescues are not moneymakers.

Bayflite is now a “little better than break even” after years of losses, See said.

Industry experts like Edward Eroe,  president of the Association of Air Medical Services , said this was typical of the leading edge of flight programs, which have gotten better at collecting bills and at setting the price high enough to pay for the service.

While Eroe acknowledged the high cost of an air rescue, he cautioned that it must be put in perspective.

“On a total cost of a trauma patient or a heart patient,” he said, “it’s a very small part of the overall cost.”

But for Skelton, the truck driver, the flight was just too expensive and that’s what he told Bayflite.

“I haven’t received a bill from Bayflite (since),” he said.

Jonathan Abel can be reached at jabel@sptimes.com or (352) 754-6114.

[Last modified November 22, 2006, 20:28:55]


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