FORT WORTH, Texas -- When Fort Worth, Texas, emergency medical services personnel need to call air ambulances, they do what most other EMS teams do throughout the country:
Instead of using a centralized dispatch focused on getting the closest helicopter to the scene, they make their own calls.
That method was not an issue when the only major operator in the area was CareFlite, the Grand Prairie-based nonprofit service.
But the air ambulance industry has changed dramatically in recent years, drawing more for-profit operators.
Should the way helicopters are dispatched be changed as well?
Some involved in the process say yes.
It just seems like there should be a better way to do it, said Steve Lemming, EMS administrative officer for the Azle Fire Department.
Two major for-profit operators -- PHI Air Medical, based in Lafayette, La., and Air Evac Lifeteam, based in West Plains, Mo. -- also serve Dallas-Fort Worth and the outlying area.
To our knowledge, we have more air medical assets in the North Texas region than anywhere else in the United States, said Scott Mitchell, an assistant fire chief in Flower Mound who recently concluded a two-year term as chairman of the North Central Texas Trauma Regional Advisory Council.
The growth in for-profit operators nationally has given EMS providers more options, but it also has subjected them to marketing pitches and other influences that can affect patient care, some industry observers believe.
Bryan Bledsoe, an emergency physician in Midlothian who has become a vocal critic of the air ambulance industry, said there is pressure to use certain providers or helicopters when ground ambulances would suffice.
I m all for a free-market society, he said. But when people see dollar signs instead of patients, you start to see patient care compromised. The primary concern is getting flights on the helicopter. The secondary concern is benefiting the patient, which goes against every tenet of medicine.
Bledsoe said the solution is to make the dispatching of helicopters part of the EMS system, with very rigid criteria for usage and a central dispatch.
Only one state, Maryland, has such a system, he said.
Howard Ragsdale, director of PHI Air Medical Group, said Bledsoe s criticism is unfounded.
We provide a quality product, Ragsdale said. Business ethics are more critical to our industry than most any other industry I ve been around.
Simply calling the closest available helicopter can be problematic.
Dispatchers must hope they are given accurate information when air ambulance providers estimate times of arrival or promise to contact another service that may be closer.
The only online tool at dispatchers disposal is a Web site developed by a company, EMSystem, and contracted through the Texas Department of State Health Services.
The site details the availability of helicopters as well as other information of significance to first responders, but it is not a definitive source because updating can be sporadic.
Lemming is among those in the North Texas EMS community who believe the best solution would be a central dispatch.
Just for efficiency, I would think it would make things a lot easier on the dispatch personnel if there was one number they could call to get an idea of which helicopter was closest, he said.
In 2005, Lemming sent an e-mail to Mitchell wondering whether such a plan was possible.
In my area alone, we have four companies to coordinate transfers through, he wrote. We would like to be on a rotation or a closest ship basis to prevent favoritism or exclude other capable services. To do this through one number would greatly reduce the number of calls to find the most appropriate service to send.
The North Central Texas council, one of 22 groups set up by the state to deal with EMS issues, has discussed the idea, Mitchell said.
But no action is likely anytime soon.
It s really a corporate discussion that would have to be driven by CEOs, and we have no power over them, he said.
Sure, it would be a nice thing to do. It would also be nice to have a central dispatch for all the police and fire departments -- especially the fire departments. But that s not going to happen either.