One of the most basic criteria for insurances approving and covering costs of medical flights is establishing that there was actually a medical necessity for availing the service. However, understanding what constitutes a ‘medical necessity’ is important. Of course, we have discussed, in our earlier guides, that the decision to summon air ambulances can only be taken by the treating medical professionals in the hospital or at the site of accidents. Let’s dive into this topic a little deep here.
Medical Flights and their Advantage Over Ground Ambulances
It must be established or deemed important to leverage the advantage that medical flights have over ground ambulances. The instability that comes with transporting a patient via ground ambulance and the need for rapid medical transportation could be the two reasons to avail medical flight services. Further, the condition of the patient should be such that he or she could suffer serious medical consequences or even face death if an air ambulance is not used.
Accessibility of the Destination
An air ambulance can become a ‘medical necessity’ if the destination is located in a region that is remote or completely inaccessible to other forms of transportation. The ground approach to the destination could be such that it poses a serious threat to the patient owing to the terrain.
Time Taken to Reach the Nearest Treating Facility
There are times when a delay as small as 30 minutes to an hour can mean the difference between life and death. The ground ambulances may be available in such scenarios but the time that they take to reach the treating facility could be a deterrent and the advantage of quick transportation that comes with medical flights could be the advantage. Of course, the severity of the illness or the disease condition would be the primary factor behind this decision.
‘Stringent’ is the word that comes to mind when you think of medical flight insurance coverage norms. Cost reimbursements of medical flights can mean between a retaining your life savings and letting it go to cover the huge bills. It is important to know the basis on which insurance companies accept or deny the claims. Of course, the foremost thing is to own a health insurance policy that covers medical flight services or medical transportation of any form for that matter. If this condition is taken care of, following are the other conditions that you must be mindful of.
Insurance Coverage for Medical Flight Services
Medical flight services to and from hospitals are covered by Medicare Part B. It is worthy to note here that air medical transportation to skilled nursing facilities is also covered under Part B. However, it should be noted that medical flight coverage is provided when it is deemed that ground ambulances are not suitable for the medical condition or when it is determined that the patient is in dire need of care and timely care is possible when the patient is carried to the treating facility in the shortest possible time via an air ambulance.
Approval by the Treating Professional is Necessary
The ultimate decision of whether a medical flight service is necessary lies with the treating professional who could be a physician or a paramedic attending an emergency. This decision cannot be taken by the patient and in most cases cannot be overruled either.
If the medical flight company feels that the patient might not be able to pay for its services, it can ask the patient to sign Advance Beneficiary Notice that states that the patient would be responsible for the payment in case the insurance company refuses reimbursement. The patient can refuse to sign this notice; however, if the air ambulance company goes ahead and carries the patient, he or she might still be held responsible for the payment.
Altitude decompression sickness is not unique to airambulance flights or to patients alone. It is a condition that is generally associated with high altitudes. It was only in the 1930s that this phenomenon was recognized by the medical community. The problem was observed in aircrafts as well as high-altitude hot-air balloons. Today, we have a better understanding of altitude decompression sickness, but still, we are not insulated from the dangers of this medical condition. It is a must that medical crews aboard airambulance flights are well aware of this. Here, we explain this condition in simpler terms.
This is What Airambulance Crew Members Need to be Aware of
The basis for understanding altitude decompression sickness is Henry’s Law, which says, “When the pressure of a gas over a liquid is decreased, the amount of gas dissolved in that liquid will also decrease.”
The concept is best explained with the example of soda. What do you observe when the bottle is opened? The formerly ‘calm’ liquid suddenly sees a flurry of activities. The air bubbles that previously were nonexistent suddenly show an insane urgency to escape the bottle, pushing their way through the liquid. Why does this happen? The answer is Henry’s Law.
When the bottle is sealed, the pressure inside is at a constant high, but when it is opened, the liquid is exposed to pressure in the atmosphere outside the bottle, which is comparatively much lower, so much of the gas escapes the liquid.
How Does Henry’s Law Relate to Human Body?
Human beings have high amounts of nitrogen gas throughout the body. When the airambulance is flying at high altitudes, if the cabin is not pressurized, the possibility is that nitrogen will escape the body, owing to the decreased atmospheric pressure that prevails at high altitudes. Of course, modern airambulance vehicles are well insulated from such dangers and can safely travel at high altitudes.
Literally translated, hypoxia means diminished availability of oxygen to the body, something that is quite common in medical air transport scenarios. However, a pre-existing condition that already has made the patient struggle for oxygen can further exacerbate while on the flight. Here, we discuss the reasons and also the different types of hypoxia. The intent is to create a quick reference for medical air transport personnel.
Why Worry About Hypoxia Onboard a Medical Air Transport Vehicle
The biggest risk of hypoxia is when the medical air transport flies over 12,000 square feet above the sea level in an unpressurized air craft. It must be noted that medical flights are pressurized at high altitudes. However, if not, and if no supplemental oxygen is available immediately, it can lead to hypoxia. This kind of hypoxia usually affects the lungs as is caused by partial pressure reduction of O2.
Histotoxic Hypoxia Could be a Danger
Histotoxic hypoxia is diminished ability to filter oxygen owing to narcotic or any other toxic substance. The patient loses the ability to get adequate oxygen. In situations like these, the medical air transport crew must take special care to avoid exacerbating the situation. The combination of histotoxic hypoxia and lack of oxygen pressure due to altitude can prove to be a deadly situation.
Understanding Stagnant Hypoxia
This is another form of hypoxia and is caused by exertion of positive G force in the Z axis. Other causes are heart failures and shock. All these interfere with the blood circulation for the worse and deprive the human body of adequate oxygen. However, medical air transport services always carry oxygen onboard and these conditions are easily taken care of.
Hypemic Hypoxia is Another Cause
This type of hypoxia is caused by health conditions that affect the oxygen levels in the blood. Prime examples for this are anemia and carbon monoxide positioning, both of which affect blood oxygen levels.
Not all medical travels warrant a medical flight. When time is in your hand but the treatment for the ailment demands that you travel long distances, medical flight stretchers can be quite useful and economical. The cost of this service would be a fraction of what an air ambulance would cost you. However, there are certain points that one must keep in mind before booking a medical stretcher and we discuss those in some detail here.
How Isolated is the Patient in the Medical Flight Stretcher?
Medical stretchers naturally occupy more space than a normal seat would. Plus there might be the need of space for some basic medical equipment. All this space translates into higher cost. The agency you have hired might cut corners by trying to make do with minimum space. It is wise to clarify this beforehand. Isolation from the rest of the fight is extremely necessary.
Does the Air Ambulance Company take Care of the Logistics?
You do not want to risk taking the patient in your car to the airport. It is always wise to have an ambulance for this purpose. Does the agency take care of this? Also, the on-boarding and off-boarding of the patient must be a quick process. The agency needs to anticipate all possible hurdles to this and take care of it well in advance.
Booking the Hospital Bed on Arrival in Advance
You do not want to run around to book a bed in the hospital of your desire. While you standby the loved one with health issues, the agency must take care of booking the hospital bed in advance. It is vital that you ask about this beforehand and take confirmation of the booking. Of course, the ambulance too must be ready in the airport upon arrival to save time and get through the process quickly.
Lastly, one must not hesitate to clarify any doubts that they may have, with the coordinator.
We have mentioned in our guides earlier that the best thing to do is leave patient care to the paramedics or emergency medical professionals before the air ambulance arrives. However, there can be times when such help is not available on time. It is in instances like these that the knowledge of some basic facts and maneuvers come handy. We discuss such minimum interventions below.
Pre Air Ambulance Arrival First Aid starts with Calling 911
It is only prudent to first seek professional help and then proceed to offer help. Most times, our foremost instinct is to jump into helping the victim physically, but in the process that precious and live-saving call to 911 emergency services might be delayed significantly. If you strongly feel the need to intervene directly, ensure that you have someone nearby call 911 immediately. Your presence of mind in this matter is vital.
After You Call the Emergency Number
What you do after the emergency call, is entirely situational. Let’s explore some scenarios here:
- Commence cardiopulmonary resuscitation or CPR if you see that the patient is not breathing.
- If the patient is bleeding profusely, apply pressure to stop it. You can prepare a tourniquet by tying a rope to restrict the flow of blood towards the wound.
- If the patient has any amount of food, vomit or blood in the mouth, place the patient on his side with his arm or a pillow-like material under the head.
- If you see that the victim is unconscious while lying face down, turn him over so that he rests on his back.
If the victim is conscious, calm him down by reassuring that help is on the way. Remember, your reassurance to the patient is vital to eliminate anxiety. Bring in some positivity into the situation. Even simply holding the patient’s hand would suffice.
Over the past few years, the medical flight services have steadily risen in cost, so much so that the cost has gone up at a whopping 5% per annum since almost the past 7 years. There have been concerted efforts on the part of state governments and the federal government to bring the cost of medical flight services down, at least to a ‘reasonable’ level. However, the definition of what is reasonable has been rather loose. In the midst of all this, it is natural that people in general are concerned about workers’ compensation and how it deals with medical flight services.
Handling of Medical Flight Services by Workers’ Comp
The big concern of most people is naturally whether they have to pay out of pocket in the eventuality that medical flight services are utilized for a work-related injury. Many would simply ask whether there is a possibility of a balance payment being demanded.
Such worries, however, have no basis to them. The amount would be settled by the insurance carrier and if the amount being approved by the carrier is less than what the air ambulance company is claiming, the victim of the accident need not be concerned. It is up to the medical flight services company and the carrier to come to a settlement. In most cases, the air ambulance company gives the insurance carrier a discount.
The Clash of Two Laws and the Way Out
Most states have fee schedules that define the extent of medical flight services cost coverage. However, ADA or Airlines Deregulation Act of 1978 allows air ambulance service providers to charge what they feel is reasonable without any questions being raised. The two laws can be, sometimes, contradictory to each other. However, in spite of all this, it still boils down to the air ambulance company and the insurance provider coming to a common monitory agreement, in case there is a dispute.
There’s no denying that an air medical transport pilot’s job pays well and is also quite exciting. Responding to emergencies and being amidst action all the time is definitely thrilling, but how does one get there? That’s what we explain here.
An Air Medical Transport Pilot Must Hold a Degree
It’s not necessary that you are an aeronautical engineer. Choose among subjects such as English, physics or mathematics. Holding at least a 2-year degree is mandatory, although it is preferred that you hold a 4-year degree.
Check Whether You Physically Qualify to Fly an Air Medical Transport Vehicle
Simply visit the Federal Aviation Administration website and look for an Aviation Medical Examiner close to the place that you stay. You will be given a medical test by this examiner and if you pass, you will be given a certificate stating the same. At least a class 2 certificate must be obtained as it is mandatory for commercial flying.
Choose the Right Flight School
It is essential that you enrol in a flight school that is recognized by the Federal Aviation Administration. Look for the various accreditations that the school has. Keep in mind that the trainer too must be certified by the Federal Aviation Administration. During the course, you must gain enough instrument flying experience. Air medical transport pilots often have to fly in adverse weather conditions where visibility is poor. This is when flying with the aid of instruments comes handy. It is a mandatory skill for air medical transport pilots.
Garner Enough Flying Hours
Air ambulance pilots are expected to have a good amount of experience under their belt; however, paying for flight hours can be quite expensive. An easy way out is becoming an instructor. This will give you enough hours so that you can comfortably apply for the job.
Travelling abroad to get treatment is an option that some people explore, mainly for the sole reason that treatment can be cheaper in some countries when the health emergency is not huge. Of course, availing a worldwide air ambulance service might be in order in circumstances like these. How do you prepare for such an eventuality? We cover all those minute details that you must consider.
Before You Take the Worldwide Air Ambulance Service
Speak to your doctor to check whether it is actually a wise decision. The bottom line should always be your health and the cost must only be considered after that. If it’s a complication that is best treated with advanced medical facilities available in your home country, you’re better off not travelling at all. Also, check with the physician whether you’re stable enough to travel. You might also want to take those essential vaccines before you step out of your country.
Do Your Research about the Destination
Medical tourism is a big game all over the world. What happens once you get off your worldwide air ambulance service? Does your service provider have the contacts to set you up with the right treatment facility? If not, you might want to check reviews and even talk to the facility that you choose on your own. You must ensure that you get the standard of care that you expect.
Travel Insurance and Interim Medical Care
Travel insurance is an absolute necessity when you cross borders. You never know what eventuality you might get stuck in when you tread foreign lands. Plus, you worldwide air ambulance might take you on a journey that’s several hours long. Ensure that all the medications that you need are with you. Let the person accompanying you and the medical staff in the air ambulance know about it. Finally, do a financial comparison and only make the move, if it’s really financially viable.
You cannot deny the fact that a medical flight landing near your home or workplace can generate some excitement. Naturally, the inquisitive you would want to know what is happening. We all know that medical flights can perform tracheotomy to minor amputations on the spot. As a responsible person, you might want to help the injured or even the crew. As such noble thoughts run through your mind, you might not realize that you are putting yourself at risk. You might wonder how that is possible. This risk is precisely what we discuss here.
Help the Medical Flight by Helping Yourself
It takes no rocket science to understand that a medical flight or any helicopter, for that matter, needs enough space to land. In your enthusiasm, do not block the landing space. Better still, ask the fellow onlookers to make way for the medical flight to land.
Medical flights exert quite some down-thrust which can simply throw around kids, small pets, and loosely held objects. Stay away from such objects or secure them, while also holding your pets and kids so that they are safe.
Protecting your eyes from the dust that might be roused by the medical flight is important. You do not want to end up being a medical emergency yourself and burden the air ambulance crew.
Offering Personal Help is a Strict No
It is highly unlikely that bystanders are asked for help during medical flight emergencies. Do not approach the crew with an offer to help. You might simply be obstructing their work. Think of it; the crew is usually comprised of experienced paramedics, nurses, doctors and pilots who know their job well. In the event that your help is required, rest assured, they will ask for it. Unless that happens, the best thing that you can do is keep yourself out of harm’s way.