3 Life Flight Doctors Quit; Safety Fears Cited

The medical director of Life Flight--San Diego County’s emergency helicopter service--said Thursday that as many as three doctors who work part-time are leaving the program, apparently over concerns about unnecessary flights that put them at personal risk.

At issue are Life Flight missions that could be handled by ground-based ambulances without endangering the lives of the helicopter crews. This worry was heightened last week when a Life Flight helicopter crashed on Interstate 5 in La Jolla.

No one was seriously injured in the accident--the first since Life Flight began service in March, 1980--but in its aftermath emergency room and trauma unit doctors have stepped forward to talk about what appears to them as an overabundance of flights.

“I think the physicians at all the hospitals are aware that some of the flights are unnecessary. I don’t think that’s the issue. Everyone agrees there is some over-utilization,” said Dr. Tom Kravis, director of emergency care at Mercy Hospital. “There is more of a use of Life Flight than was first intended, and you can’t attribute the large increase (in calls) only in terms of a higher population or a higher frequency of people (being) injured.”

Life Flight responds to about 200 calls a month, said Pat JaCoby, spokeswoman for UC San Diego Medical Center, which operates Life Flight. In 1981, according to Kravis, the system responded to 300 calls all year.

“It was supposed to be used only for patients whose transfer would take an inordinate amount of time or who were in inaccessible places,” Kravis said. “It was intended to be a limited use program. The practice and interpretation (of Life Flight guidelines) have changed.”

What’s needed, he said, is better screening and tightening of procedures, including a larger role for the doctor at the nearest hospital trauma center. In addition, an outside group of experts should evaluate Life Flight and the county’s trauma care system, Kravis said. Such a group, he added, could work alongside a county emergency medical committee that is soon to look at the county’s trauma care system.

Dr. A. Brent Eastman, head of the trauma unit at Scripps Memorial Hospital, said “there is clearly an element of over-triage . . . by the helicopter.” (Triage is a term used in the trauma system that describes the procedure by which paramedics, police, dispatchers and doctors evaluate the seriousness of an injury, and where and how to transport the patient.)

“We are struggling with this all the time,” Eastman said. “We only want to provide the great effort to someone who really needs the service of the trauma center.”

But, Eastman said, making a decision out in the field to transport a victim by helicopter is sometimes very tricky and leads to some needless calls. “You can’t just list those to take who have no blood pressure or an open chest or an open abdomen,” he said. “Those are easy, it’s the others where you have to be careful.

“I think that for everyone that turned out not to be badly hurt, we have an equal number who didn’t appear to be badly hurt but turned out to have major internal injuries.” Eastman said he serves on a national committee that is trying to write guidelines that specify which injuries are indicative of severe trauma, to avoid the type of needless calls Life Flight sometimes responds to.

Dr. William Baxt, Life Flight medical director, declined to talk about the question of unnecessary flights, opting instead to release a prepared statement and announcing a press conference for today.

Baxt’s statement said that one part-time Life Flight doctor, Dr. John E. Mattison, had resigned; that another, Dr. Gresham Bayne, had indicated he probably would resign, and that Dr. Phil Mathis is expected to make a decision in July, when he returns from a trip. None of the three was available for comment, though Mathis and Bayne told the San Diego Tribune they were leaving because they felt they were at risk because of the abundance of unnecessary flights.

Baxt’s statement noted that the part-time doctors “fill a small percentage of the shifts in the Life Flight program.”

Gail Cooper, head of the county’s Emergency Medical Services System, said the dispatching of Life Flight helicopters occurs in a variety of ways, but most often is done when either paramedics, police, firefighters or ambulance crews arrive at the scene of an accident or injury.

While UCSD Medical Center is responsible for operating Life Flight, the county has issued policies for when a helicopter should be called. These instances include: multiple casualties and not enough ambulances; cases where treatment would be delayed, as in a car accident where a victim is trapped for a long time; areas inaccessible by an ambulance; where transportation to a trauma unit is faster than by ambulance, usually from rural areas; all driving accidents where neck or spinal injuries are suspected and a trip by ambulance would entail traveling over rough terrain or bumpy roads, and at the discretion of the first agency responding to an accident or scene of an injury.

“I think their utilization program pattern in the past has been to go when asked,” Cooper said. “Whether that’s right or wrong, I don’t have a judgment on that, but I think it’s something they should look at to make sure they remain truly for serious trauma cases. Their mission is to provide the best level of service they can . . . and that maybe causes over-utilization.”

What Cooper hasn’t been able to identify is whether the unnecessary calls fit a pattern. For example, she said, whether one group of dispatchers or police “needs to be trained again” on when Life Flight should be used.

JaCoby, the spokeswoman for the UCSD hospital, said Life Flight has grown from a one-helicopter program in 1980 to a service that uses three copters, 13 flight nurses, several per diem nurses, eight dispatchers and a supervisor, 20 flight paramedics, eight full-time doctors, several part-time physicians, seven pilots and three mechanics. She was unable to produce figures on the cost of operating the around-the-clock program.

Since the service began, it has responded to about 7,000 calls and transported about 6,000 patients, she said. The difference between the two figures, she explained, is that some victims didn’t require Life Flight transportation.