After World War II, the medical industry and hospitals grew rapidly because of new knowledge gained in the war. We learned how to do surgeries that we never did before, and developed new antibiotics, new medicines and new and expensive equipment. Over the years, we experienced an economy with spiraling costs for everything from cotton balls to hospital beds, and high tech equipment that is used to practically keep tabs on every cell in the body. This has made it difficult for many smaller hospitals to keep pace. When hospital beds are not full, revenue is down. Added to this are new ways of treating patients on an outpatient basis as opposed to inpatient. New medicines and technology has also tended to shorten hospital stays; even patients who have undergone surgery no longer stay in the hospital very long. All of these factors have made for a climate in which many hospitals and practitioners have literally had to fight for survival.

The general helicopter industry had comparable experiences in their growth and decline. Historically, helicopters have been a vehicle of the military, and later metropolitan police departments for use in traffic control and surveillance. One of the largest users of helicopters has been the oil industry for exploration. A worldwide slump in oil prices managed to drive many helicopter companies out of business. However, helicopter vendors who refused to become a dying statistic flocked to the medevac industry.

Since 1980, there has been a boom in EMS helicopter services as new programs have sprung up to get in on what has looked like a lucrative market. Where there had only been one or two services there are many. This sudden change of events caused the helicopter medevac industry to grow up Willie Nillie with no particular design or guidelines. Standards were not determined for conduct, staff qualifications, or equipment for air ambulances.

On the medical side, there was no legislation to clearly designate trauma centers and enforce health standards and conduct.

In 1980, only 30 helicopter medevac programs existed in the United States. According to Hospital Aviation Magazine, the first five years of the ‘80s saw the creation of more than 80 new programs. Today, in 2014, there are over 800. This has made for a climate of cutthroat competition for both helicopter operators and hospitals who were eager to cash in on what looked like a lucrative market. Those who have been able to enter the medevac industry have been able to keep their ships flying. At the same time, hospitals have a highly visible marketing tool and the capability of increasing their sphere of influence to take on many more patients. Fast and furious competition forced hospitals to develop a helicopter service just to keep a toehold in their own area.

A virtual explosion in growth created an industry with an almost total lack of federal or state regulations in either the medical or aviation arena. This resulted in minimal control over who flies, what they fly, or where they take the patient.

It can cost a hospital $60,000 or more a month to operate a helicopter. At the same time, severe trauma cases can draw $18,000-$26,000 in revenue for direct patient services. For a hospital to enter the trauma care arena under the best of circumstances, it can easily cost a million dollars. Not all hospitals with helicopter programs have elected to go into the business of being a bona fide trauma care facility. Further, it would not be cost effective for every hospital to become a trauma center. Still, it is difficult for some to forego the temptation to pick up trauma revenue.

Helicopters are secondary responders called in by another authority who has determined that a helicopter is necessary. Very quickly, which helicopter service is called to the scene, and where the victim is taken becomes a crucial issue for those wishing to gain their share of the market. This is a highly controversial issue whether one is concerned about economic survival or the best interests of the victim. Many have reared up in protest to demand that standards be met before a hospital can be designated as a trauma center capable of ministering to the needs of the critically injured.

On the helicopter side of things, is the question of who is qualified to transport a critically ill or injured patient. What kind of personnel and equipment is on board, and where is the patient taken. If competing helicopter services are within the same general vicinity, the situation can become more complicated. Paramedics and EMTs who arrive at the scene first suddenly become very powerful. Social, political and economic variables can run rampant, and have an impact on how a trauma case is handled.

The marriage of the helicopter to the hospital industry has not been without passion, controversy, and irony. Just about every helicopter medevac program carries a name that conveys benevolent motives of the highest order. Still, it is in the public’s best interest to ask: Are they really as good as they sound? Do they serve the best interest of the critically ill or injured?

After World War II, the medical industry and hospitals grew rapidly because of new knowledge gained in the war. We learned how to do surgeries that we never did before, and developed new antibiotics, new medicines and new and expensive equipment. Over the years, we experienced an economy with spiraling costs for everything from cotton balls to hospital beds, and high tech equipment that is used to practically keep tabs on every cell in the body. This has made it difficult for many smaller hospitals to keep pace. When hospital beds are not full, revenue is down. Added to this are new ways of treating patients on an outpatient basis as opposed to inpatient. New medicines and technology has also tended to shorten hospital stays; even patients who have undergone surgery no longer stay in the hospital very long. All of these factors have made for a climate in which many hospitals and practitioners have literally had to fight for survival.

The general helicopter industry had comparable experiences in their growth and decline. Historically, helicopters have been a vehicle of the military, and later metropolitan police departments for use in traffic control and surveillance. One of the largest users of helicopters has been the oil industry for exploration. A worldwide slump in oil prices managed to drive many helicopter companies out of business. However, helicopter vendors who refused to become a dying statistic flocked to the medevac industry.

Since 1980, there has been a boom in EMS helicopter services as new programs have sprung up to get in on what has looked like a lucrative market. Where there had only been one or two services there are many. This sudden change of events caused the helicopter medevac industry to grow up Willie Nillie with no particular design or guidelines. Standards were not determined for conduct, staff qualifications, or equipment for air ambulances.

On the medical side, there was no legislation to clearly designate trauma centers and enforce health standards and conduct.

In 1980, only 30 helicopter medevac programs existed in the United States. According to Hospital Aviation Magazine, the first five years of the ‘80s saw the creation of more than 80 new programs. Today, in 2014, there are over 800. This has made for a climate of cutthroat competition for both helicopter operators and hospitals who were eager to cash in on what looked like a lucrative market. Those who have been able to enter the medevac industry have been able to keep their ships flying. At the same time, hospitals have a highly visible marketing tool and the capability of increasing their sphere of influence to take on many more patients. Fast and furious competition forced hospitals to develop a helicopter service just to keep a toehold in their own area.

A virtual explosion in growth created an industry with an almost total lack of federal or state regulations in either the medical or aviation arena. This resulted in minimal control over who flies, what they fly, or where they take the patient.

It can cost a hospital $60,000 or more a month to operate a helicopter. At the same time, severe trauma cases can draw $18,000-$26,000 in revenue for direct patient services. For a hospital to enter the trauma care arena under the best of circumstances, it can easily cost a million dollars. Not all hospitals with helicopter programs have elected to go into the business of being a bona fide trauma care facility. Further, it would not be cost effective for every hospital to become a trauma center. Still, it is difficult for some to forego the temptation to pick up trauma revenue.

Helicopters are secondary responders called in by another authority who has determined that a helicopter is necessary. Very quickly, which helicopter service is called to the scene, and where the victim is taken becomes a crucial issue for those wishing to gain their share of the market. This is a highly controversial issue whether one is concerned about economic survival or the best interests of the victim. Many have reared up in protest to demand that standards be met before a hospital can be designated as a trauma center capable of ministering to the needs of the critically injured.

On the helicopter side of things, is the question of who is qualified to transport a critically ill or injured patient. What kind of personnel and equipment is on board, and where is the patient taken. If competing helicopter services are within the same general vicinity, the situation can become more complicated. Paramedics and EMTs who arrive at the scene first suddenly become very powerful. Social, political and economic variables can run rampant, and have an impact on how a trauma case is handled.

The marriage of the helicopter to the hospital industry has not been without passion, controversy, and irony. Just about every helicopter medevac program carries a name that conveys benevolent motives of the highest order. Still, it is in the public’s best interest to ask: Are they really as good as they sound? Do they serve the best interest of the critically ill or injured?