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

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

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

4. Helicopters are beneficial for 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 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. Susan Baker PhD. Johns Hopkins Bloomberg School of Public Health.

7. Helicopters dont 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. 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 Physician, CCM Nurse & technologist on board High tech monitoring High tech monitoring Intra aortic balloon pump Intra aortic balloon pump Bad news: Expensive Expensive Time consuming Time consuming Improved outcome? 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.