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20 March 2013
Dear Editors,
Transport of invalids by air has increased worldwide in recent years. The geographical characteristics in Taiwan and unequal development of medical manpower and facilities on remote islands, similar to Greece and a number of countries, have resulted in a growing need of emergency air medical services (EAMS). A lack of the preflight screening mechanism has resulted in rapid growth of unnecessary flights, which increased government expenditures of up to US$6.6 million each year. On account of cost containment, the Taiwan Department of Health established the National Aeromedical Approval Center (NAAC) on October 1, 2002 for preflight screening of patients requesting EAMS in 30 remote locations.
The NAAC is a physician-based 24-hour control center coordinating the transport of severely injured or critically ill patients between Taiwan and its surrounding islands. Before NAAC was established, all EAMS were dispatched upon request of local physician. Average monthly EAMS fights before NAAC was 43.18 and it dropped significantly to 23.01 afterwards.
Between Oct 01, 2002 and Feb 28, 2013, there were 3987 EAMS requests (avg. 1.05/day). Among them, there were 3272 requests for interfacility transports. A total of 2876 interfacility transports were approved, with overall approval rate of 87.9%.
Among all transported patients, male outnumbered female patients (M:F= 2:1). However, average age of patients significantly increases from 45.45 in 2002 to 54.78 in 2013. Among the transported patients, the percentage of elderly (age over 65 years) increased from 22.58% in 2002 to 32.43% in 2013. This is even significant in patients over 75 years old, from 3.23% in 2002 to 21.62% in 2013. While the overall percentage of the elderly in the total population is in 2012 is 10.8%. Aging of patient undergoing air medical transport is worth notice.
Physicians in the NAAC played crucial roles in this aspect. One of the major roles the physicians is the gatekeeper for EAMS approval and transport quality, such as preflight assessment. In addition, physicians in the NAAC co-work with National Rescue Command Center (NRCC), Civil Aeronautics Administration, Central Weather Bureau, and National Airborne Service Corps and provide support, guidance, and medical consultation.
There has been no patient safety or flight safety issue in 2875 flights and savings of government expenditure is US$28,772,000 during the ten years and five months period.
Competing interests: None declared
Shuang Ho Hospital, Taipei Medical University, 250, Wu-Xing St, Taipei 110, Taiwan
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Dear Editors,
Greece has many thousand islands to transport patients from.
Air ambulance doctors use helicopters and small airplanes to save lives.
Unfortunately, nowadays, due to personnel shortages, air transports are made by training interns or even by microbiologists!
This practice can be very dangerous for Greek residents, but also for the millions of tourists that visit Greek islands every summer.
Competing interests: None declared
Private Surgery, Thessaloniki, Greece
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