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Critical Lifelines: Air Ambulances in Rural America

Authored by Gina Lombardo

One-fourth of Americans are unable to access emergency medical care within an hour’s drive from their home. Across the nation, small rural towns are facing a silent, yet deadly, crisis as rural hospitals continue to close and access to care becomes increasingly limited. Since 2010, more than 80 rural hospitals have closed, and an estimated 700 more are forecasted to shut down by 2028, according to the National Rural Health Association. The impact of hospital closures extends far beyond rural communities, however, as many of these communities comprise the backbone of our agricultural and industrial sectors. With an impending threat that can limit access for 85 million Americans to local healthcare services, the utilization of air ambulances is more vital than ever [1]. 

Air ambulances serve over half a million patients each year and have become increasingly important in the delivery of emergency medical care within the last decade. In rural and remote areas, patients have a significantly higher risk of injury-related deaths compared to those in urban areas due to the high physical demand of their livelihoods . Additionally, rural geography and demography pose fundamental challenges for EMS ground transport, as time, terrain, and delayed notifications prolong the time between the emergency incident and the patient’s arrival at a hospital. Furthermore, most EMS services in the United States are locally-based organizations that rely on volunteer efforts and have limited financial means. Without adequate resources in such communities, providing sufficient care to vast regions is incredibly challenging. Even when patients do receive care at a facility in a remote location, they often require transport to a larger hospital for advanced or critical care. Commonly referred to as the “Golden Hour” after an emergency event, most patients only have approximately 60 minutes to receive life-saving care before their chances of survival dramatically decrease [2]. This is ultimately why the utilization of the air ambulance is an essential link in the chain of care;it exists as a necessary medium to increase patients’ likelihood to get to the other side of their “Golden Hour.” 

Air ambulance crews typically have one pilot, one paramedic, and a flight nurse. The North American model does not employ the use of a physician on the helicopter, but this can vary depending on demand for care in different regions of the country. Pilots, nurses, and paramedics on board the aircraft all require extensive training in both medical and flight procedures, and essentially compose a 3-person flying intensive care unit (ICU). Renee Delau, a flight nurse for Lifenet in Saginaw, Michigan, speaks to the importance of air ambulance services, explaining that they serve the “sickest of the sick and most critically injured patients” on a daily basis [3]. Delau and her team respond to accidents and hospital-to-hospital transfers, predominantly in rural areas, in which time is of the essence. “We don't know what we're responding to until we get in the air, which adds to the thrill of it all,” says Delau. Through her 13 years of being a flight nurse, Delau has become highly calculated and efficient in every one of her decisions, as the size and limited personnel on the aircraft forces her to apply her skills to real-life situations. Delau notes, “It's not like being in a hospital where you have unlimited resources to tap into, it's just you and your partner” [3].While there is a variation of different helicopter models suited for medical transport, most of them are a fraction of the size of a hospital room, but have the exact same capabilities. The cabin is equipped with infusion pumps, ventilators, heart monitors, and intubation equipment, allowing paramedics and nurses to practice just as they would bedside. Virtually any injury or illness can be treated, or at least stabilized, in these “flying ICU’s,” which speaks to their importance in protecting and preserving healthcare access across the country - especially in rural communities [4].

There is a major drawback in utilizing air ambulances as the primary EMS response in rural areas: the costly price. The median price for an air ambulance trip is $36,000, and the cost of operating just one flight can range from $6,000-$13,000, on average [5]. This cost poses a major problem for Americans in rural communities, as they are historically more uninsured than not. The reimbursement rates provided by medicare and medicaid are also inadequate in comparison to the hefty price tag, and even private insurers fail to cover a significant portion of these services. However, a bipartisan group of lawmakers in both the House and Senate have proposed an act which would require Medicare and Medicaid to develop a fair payment system and fix reimbursement rates - making such care accessible to people who need it most [6]. 

While the cost certainly imposes a challenge, there is a clear and impactful benefit through saving thousands of lives by using air ambulances. Ensuring good access to quality healthcare for these rural communities that compose the backbone of our society is not an option, but a life-saving necessity. 

Works Cited

[1] Whalen, D., Harty, C., Ravalia, M., Renouf, T., Alani, S., Brown, R., & Dubrowski, A. (2016). Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology. Cureus, 8(3), e524.

[2] Ahmed, S., Lieberthal, R. D., Hechtman, D. M., Rayson, L. A., Amirault, D. R., & Haas, S. (2022). Framework for Optimizing Air Ambulance Locations. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2022, 102–111. 

[3] Lifelines: Critically Injured and rural communities. (2023).

[4] Goldbeck, D., Westling, J., O.Kingsley, (2023). Addressing the high costs of air ambulance services. AAF. Americans%20are%20 unaware 

[5] Minemyer, P. (2018, March 22). Air ambulances could improve access to care in rural areas, but high costs pose a major barrier. Fierce Healthcare. 

[6] Rural America’s Health Care Crisis. RealClearHealth. (n.d.). 

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