‘Imperfect System--Everywhere’ : Life Flight Defended; Doctors Back on Job

Life Flight officials Friday vigorously defended the emergency helicopter service against claims that the program is making unnecessary flights and endangering crew members’ lives.

Citing what they called an “overreaction” by some Life Flight doctors to last week’s crash of a Life Flight helicopter on Interstate 5 in La Jolla, officials of the program said the service is not over-utilized and is safer than driving on the freeway. No one was seriously injured in the accident, the first since Life Flight was started in March, 1980.

“It’s difficult to think about this in a rational manner after an accident,” said Dr. Bill Baxt, Life Flight medical director, referring to a group of part-time Life Flight doctors who complained about too many flights involving routine cases where life was not threatened.

Baxt had said Thursday that as many as three of the part-time physicians were leaving the program. But on Friday he said that two of the doctors had reconsidered and were staying and that the third had indicated he probably would also continue flying.

The three part-time doctors and other hospital emergency room and trauma unit doctors in the San Diego County Life Flight network have said that helicopter over-utilization is widespread and some reforms, including better screening of calls, is necessary.

Dr. Steve Shackford, head of the trauma unit at UC San Diego, which operates Life Flight, said that when the program first started, an evaluation team “told us the helicopter is under-utilized” and that as many as half of the trauma patients in the county were receiving inadequate care.

Shackford, whose face was often flushed with anger and his tone strident in response to reporters’ questions at the UC San Diego Medical Center news conference, said the most recent information available shows that 37% of patients airlifted by Life Flight are “over-triaged,” meaning they didn’t turn out to be life-threatening cases. (Triage is a term used in the trauma system describing procedures by which paramedics, police, dispatchers and doctors evaluate the seriousness of an injury, and where and how to transport the patient.)

Shackford said statistics for the last year of Life Flight have yet to be compiled, but that the hospital intends to evaluate both the transport figures and the results of an ongoing in-depth analysis of Life Flight patients.

The 37% over-utilization statistic, Shackford said, compares favorably to a national figure of 50% that a group of medical experts studying helicopter emergency services nationwide estimated as likely.

While there are county Emergency Medical Services System procedures for putting the three Life Flight helicopters into use, Shackford said there are pitfalls. For example, he described a car accident in which several people were injured. Initially, he said, it appeared there were severe injuries and that Life Flight was needed. Only after the patients were delivered to one of the six hospitals in the county’s trauma network was it discovered that the injuries weren’t life-threatening.

“It’s an imperfect system and it’s imperfect everywhere,” said Baxt, who noted that on average, for every 100 people in need of emergency care, three are trauma cases. After the press conference, Baxt said, “The problem is identifying the 97 who aren’t.”

Gail Cooper, head of the county’s Emergency Medical Services System, who says that the Life Flight program needs improvement in screening its calls to cut down on unnecessary flights, said that in the end, “We (the hospital trauma network) want to make sure we err on the side of the patient.”

“On the whole, the (Life Flight) system seems to be working,” she said.

The county has an advisory committee studying the trauma system, including Life Flight, Cooper said. But Baxt, Shackford and Michael Stringer, director of UCSD Medical Center, who also attended the news conference, said there were no plans to bring in outside experts to evaluate Life Flight as a result of the over-utilization complaints stemming from last week’s crash.

Budget figures released by UCSD Medical Center later in the day show that Life Flight has a shortfall of about $700,000 this year, which is being picked up by the medical center. The 1985-86 Life Flight operating budget amounts to about $3.3 million.

Revenues come from the following sources: $1.3 million (38%) from patient fees; $1.4 million (41%) in payments from five of the six hospitals in the trauma treatment systems--UCSD Medical Center, Children’s Hospital, Scripps Memorial Hospital, Sharp Memorial Hospital and Mercy Hospital, and $700,000 exclusively from the UCSD Medical Center.

Pat JaCoby, UCSD Medical Center spokeswoman, said the shortfall is due in part to patients who don’t have insurance or skip out of paying their bills and the county not paying for all the costs of some patients. “We feel some of that (shortfall) should be shared by the other hospitals,” JaCoby said.

It costs an average of $1,586 each time a Life Flight helicopter is dispatched and the average patient who is airlifted pays $900. Both costs can varying depending on the injury and length of trip.