Privately owned medevac helicopters are responding to more emergencies statewide than ever before, providing trauma victims with faster medical service than was previously possible, but also bringing some controversy.
Cape May County has been one of the main beneficiaries of the increasing number of air ambulances. A helicopter has been stationed at Woodbine Municipal Airport since August 2011, and it has halved response times in some places. County emergency responders say saving even a few minutes can be critically important.
A typical response time before MidAtlantic MedEvac stationed its helicopter in Woodbine was about 30 minutes, said Cape May Fire Chief Jerry Inderweis, who oversees emergency medical services, or EMS, in Cape May, Cape May Point and West Cape May. Back then, the only licensed air ambulance in southern New Jersey flew from Virtua hospital in Voorhees, Camden County. Now, he said, it consistently takes 10 to 15 minutes.
Other areas have also seen faster service. In the past seven years, private EMS helicopters have been stationed in Millville and Vineland in Cumberland County and Berkeley Township in Ocean County, bringing the total to five air ambulances in this half of the state.
Still, the increase in private medevac helicopters has raised some health care policy issues.
For 20 years, State Police helicopters handled all calls for air ambulances when patients needed expedited transport from an accident scene or between medical facilities within the state.
New Jersey’s Department of Health and Senior Services began licensing private companies in 2006 to supplement those services. In 2009, it stopped giving priority to State Police helicopters for all calls.
That has allowed private air ambulances, operated in cooperation with area hospitals, to dramatically expand their reach. Meanwhile, State Police helicopters are flying to fewer than half the emergencies they did in 2005.
Virtua filed a challenge to the new state guidelines in January 2011, specifically disagreeing with the issue of a license for a private helicopter stationed in Millville. The health care organization works in cooperation with the State Police Aviation Unit to operate its SouthSTAR helicopter, one of two public air ambulances in the state. SouthSTAR is now based at the Hammonton Municipal Airport.
Virtua officials said that there was not enough oversight of the quality of air medical staff at these private operations and that having more crews meant each would handle fewer emergencies, resulting in less training in the field for everyone.
In November 2011, the state Superior Court’s Appellate Division affirmed the right of the state Health Department to grant the license and apply its guidelines, but scrutiny of the issue has continued.
“We continue to be concerned that the increase in air medical transportation units in NJ is in contrast to the general movement in healthcare toward more partnerships and collaboration among providers to drive high quality and efficiency,” Virtua spokeswoman Peggy Leone wrote in an email.
Assemblyman Herb Conaway Jr., D-Burlington, sponsored a bill last year that would put a moratorium on licensing more private air ambulances until the Health Department completes an evaluation of current EMS helicopter regulations. Gov. Chris Christie issued a conditional veto of the bill in October, disagreeing with the moratorium but agreeing with the proposal to study the situation.
Aside from the concerns about the quality of service, there is also a significant difference in cost between private and state-owned helicopters.
New Jersey residents have subsidized the Jersey Emergency Medical Shock Trauma Air Response program, or JEMSTAR, since its inception, paying a minimum $4 surcharge on every motor-vehicle registration that goes to the program and the State Police. That keeps the bill for a flight on those helicopters at a flat $1,337, most of which insurance covers.
Bills from private providers are different, depending on the company and the mileage traveled. The bills can exceed $12,000, and insurance carriers pay different amounts, with standardized rates for Medicare and Medicaid paid depending on where the response occurs. Companies say that if someone does not have health insurance, they work with the person or family to reach a reasonable amount.
MidAtlantic MedEvac Director Hal Spatz declined to discuss his company’s rates with The Press of Atlantic City.
Fairness is a factor. Also luck plays a part in whether a JEMSTAR helicopter or a private helicopter responds, because it depends on where and when the emergency occurs. In-state motorists have no choice in helping to fund the state program.
Helicopters are called when emergency responders determine expedited service is necessary. Head-on accidents, vehicle rollovers, stabbings, shootings, industrial accidents, high falls, spinal injuries, strokes and heart attacks can all merit an air ambulance.
“There’s a term called the ‘golden hour,’ from the time when an event occurs to when you need to get them to a trauma center,” said Bill King Sr., chief executive officer of Belleplain Emergency Corps, which provides EMS services to Woodbine and Dennis Township in Cape May County and Maurice River Township in Cumberland County.
Once crews make a determination, they call the Regional Emergency Medical Communications System in Newark, which dispatches all medical helicopters in the state. Dispatchers there now send the closest available helicopter, whereas they previously sent a private helicopter only if a JEMSTAR unit was unavailable.
The MidAtlantic helicopter in Woodbine responds to almost all air ambulance calls in Cape May County, which numbered about 350 last year. The calls increase in the summer and include injuries to swimmers and surfers who hurt their head, neck or spine.
As with most medevac helicopters, the majority of its calls are for interfacility transport of patients. Interfacility transport makes up about 70 percent of air ambulance flights nationwide, according to the Association of Air Medical Services.
MidAtlantic is jointly owned by AtlantiCare and Hahnemann University Hospital in Philadelphia. The company contracts with an outside vendor to supply the helicopter and pilot, while the flight nurse and paramedic are MidAtlantic employees. Space is leased from the Woodbine Port Authority for $1,500 a month.
“We’re happy they have a presence here,” said Woodbine Mayor Bill Pikolycky. “It’s obviously good for this region and Woodbine to have a medevac right here at your fingertips.”
On a recent afternoon at the Woodbine airport, flight nurse Dave Tercha, of Philadelphia, said every minute in traumatic cases affects the damage done to a person’s body; and if the person survives, it affects how long and how well they will need to recover.
Not every hospital is equipped or has people trained to handle every case. There are only two trauma centers in southern New Jersey: AtlantiCare Regional Medical Center, City Campus in Atlantic City, and Cooper University Hospital in Camden.
Because almost every trauma victim in Cape May County is flown to Atlantic City, having a helicopter to get them there can save valuable time, especially in the summer, when traffic is congested or stopped on major roads.
“Those are the times when the helicopter’s worth its weight in gold,” Tercha said.
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