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Regionalization of health care

Regionalization of health care. Matching supply to demand Maximizing resource allocation National Trauma Centers Network Critical Care Centers Organ Transplant regional models. Ground transport. Good news Cheap Ubiquitous Adequate for initial response Bad news Slow, affected by traffic

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Regionalization of health care

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  1. Regionalization of health care • Matching supply to demand • Maximizing resource allocation • National Trauma Centers Network • Critical Care Centers • Organ Transplant regional models

  2. Ground transport • Good news • Cheap • Ubiquitous • Adequate for initial response • Bad news • Slow, affected by traffic • Not cost effective to provide widespread ALS • Not cost effective to include physicians

  3. Rescue Helicopters • Good news: • Rapid response • Mobile ALS capability • Cost effective to carry physicians • Bad news: • Expensive- $5,000 to $10,000 a trip • Affected by weather • Places to land in the city

  4. Helicopters are beneficialfor selected patients In adjusted analysis, helicopter transport was found to be associated with a significant mortality reduction. Conclusion : The results of this study are consistent with an association between helicopter transport mode and increased survival in blunt trauma patients. Thomas, St, et al. J Trauma-Injury Infection & Critical Care. 52(1):136-145, January 2002.

  5. Helicopters are risky 47 accidents in 5 years. 40 fatalities and 36 injuries. 13 helicopter types involved. 70% were attributed to pilot error. The number of accidents increased from a low of 4 in 1997 to a maximum of 12 in both 2000 and 2001. Bledsoe BE. Pre-hospital Emergency Care 2003 Jan-Mar;7(1):94-8. 

  6. Risky to helicopter personnel “crew members, who work 20 hours a week for 20 years would face a 40% chance of being involved in a fatal crash” • Susan Baker PhD. Johns Hopkins Bloomberg School of Public Health.

  7. Helicopters don’t necessarily transport critically ill patients 69.3% of patients had a greater than 90% chance of survival. 25.8% of patients discharged within 24 hours after trauma center arrival. • Bledsoe, B et al. J Trauma 2006 Jun;60(6):1257-65. 37,500 helicopter transported patients determined that 67% had only minor injuries. 25% had injuries too minor to require hospital admission. • Prehospital Emergency Care. Jan 2005.

  8. How effective in “Saving Lives”? • Stanford University trauma surgeon Clayton Shatney conducted a study of 947 Patients flown to Santa Clara Valley Medical Center and concluded that Helicopter service potentially saved the lives of only nine of them -- While potentially serving as detriment to five who could have arrived faster by ground. • Shatney, CH et al. J Trauma 2002 Nov;53(5):817-22. 

  9. Critical Care Transports: “Scoop & Run” vs “Stay and Play” • Good news: • Physician, CCM Nurse & technologist on board • High tech monitoring • Intra aortic balloon pump • Bad news: • Expensive • Time consuming • Improved outcome?

  10. HELLIKER, K FUHRMANS V. Air Ambulances Are Under Fire. THE WALL STREET JOURNAL March 3, 2005 * “In 20 years of experience in urban critical-care helicopter transport, I can count on the fingers of one hand the number of times I thought flying a patient to the hospital made a significant difference in outcome compared to lights and siren," * David Crippen, MD Associate professor Critical Care Medicine University of Pittsburgh Medical Center.

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