Tuesday, March 9, 2010

As the chief executive officer of Lower Keys Medical Center (LKMC), I would like to clarify several facts regarding air medical transport services in the Lower Keys. LKMC is committed to delivering consistent, high-quality health care services in a safe manner that meets the needs of the patients in our community. To that end, there are circumstances when a patient's health care needs dictate that the patient be transferred to another facility where he or she can receive care that is not available in the Lower Keys. Such inter-facility transfer decisions are made by medical professionals based upon the patient's needs.

Medical professionals evaluate patient medical status, patient safety, and quality of care when determining the appropriate mode of transport for an inter-facility patient transfer. Oftentimes, these variables must be rapidly assessed during a medical emergency. Medical professionals at both LKMC and the receiving hospital work together to determine the level and type of transport service that is appropriate for the patient. Once a decision is made, the medical professionals and hospital remain responsible for the safe transport of the patient.

At the present time, the three principal air medical transport services utilized by Florida Keys hospitals are Life Net, Life Flight (Miami Children's Hospital), and Trauma Star (Monroe County). Hospitals do not receive compensation based on the choice of air medical transport service provider. Life Net and Life Flight have been available to the Lower Keys for many years, while Trauma Star has not always been an available service to those in need. It should be noted that air medical transport systems are not created equal. The greatest differences are training of staff, experience of staff, credentials of staff, and availability of specialized equipment. In critical situations, the education, training, and experience of the health care professionals performing the transport are of utmost importance for the outcome of the patient.

Life Net is a private service, is part of the largest air ambulance service in the United States, is the predominant service for inter-facility transfers, and acts as backup for Trauma Star when it is not available. Life Flight is a private service predominately utilized by Miami Children's Hospital for specialized neonate and pediatric transfers and provides helicopter and fixed-wing (Learjet) services. If the helicopter is unable to fly due to bad weather, the professionals at Miami Children's are able to send the fixed-wing plane. Trauma Star is the Monroe County service whose primary mission, based on Monroe County policy, is emergency scene transport rather than inter-facility transport.

In recent newspaper comments, Monroe County Commissioner Mario Di Gennaro has stated that hospitals should "notify patients that they can choose the Sheriff's Office Trauma Star helicopter to take them to hospitals outside the county for non-emergency health conditions."

First, it should be noted that medical professionals do not utilize air transport unless they determine that the patient's condition is an emergency that requires rapid transport. Patients may be transported by ground ambulance if the medical professional determines that ground transport is safe and appropriate for the patient.

Second, it is unreasonable to expect physicians, nurses, medics, and others to consider transport politics in the midst of a life-saving activity. Finally, it is unacceptable for medical professionals to base treatment decisions on a patient's ability to pay, type of insurance or political decisions. To ensure patient safety, patient transport decisions cannot be made by non-medical personnel, patients, or family members who may not understand the consequences of such a decision.

In a patient transport situation, the goal is always to provide the highest possible level of care to effectuate a safe transport of the patient. The transport decision must be made by highly educated medical professionals who base the decision upon clinical considerations.

Nicki Will is CEO of Lower Keys Medical Center on Stock Island.