On kangaroos, koalas and air medical services

Just before the Air Medical Transport Conference in St. Louis, I was fo r tuna te enough to a t tend the Fourth International Congress of the International Society of Aeromedica l Serv ices in Sydney, Australia. This event, which has as its theme "Care Above the Ordinary," was attended by more than 250 people representing countries from Papua New Guinea to Norway, from Sri Lanka to the United States, from the Czech Republic to Japan. I want to share several of my observations about this trip to the land Down Under. First, having never been to Australia, I was immediately and repeatedly struck by the genuine friendliness of the Australians, the beauty of their land, and the first-class nature of almost every product , se rv ice and sys t em to which I came in contact. Even stronger, though, were my impressions of the Congress itself, particularly during the tea-time conversat ions with other at tendees. The diversity of problems faced by our colleagues in other countries is staggering. Attendees listened to presentations by various flight programs in Australia that routinely transport patients 200 to 2,000 kilometers (124 to 1,240 miles). Such Herculean transports are often accomplished before morning tea in a land where no other means of transport is feasible. This flight plan, however, stood in stark contrast to the situation in Germany, where , in a count ry slightly larger than the state of New York, there are 48 helicopters, and the average flight lasts only eight minutes . Yet, accord ing to the Germans' presentations, no matter how short the flights, they believe that they have proven their programs to be cost-effective when considering the long-term cost of inhospital trauma care. Even more astounding, consider the situation in Japan. Despite a fairly strong economy, a societal fascination with technology and a geography favorable to the air medical mode of transport, the Japanese are just now completing their fourth pilot study of the feasibility of a helicopter air medical service. Or take New Zealand, where the worldwide downturn in the oil business has lead several off-shore helicopter operators to attach the word "rescue" to their business in hopes of receiving government grants. Some of these operators conduct only a few rescues a year, and there are no standards of practice or operations. It was obvious at this Congress that none of us have solved all of the problems associated with air medical transport. It was equally obvious that most, if not all, of the participants have something to offer fellow providers . Nor th America appears to be a leader in developing a profession-based assessment and accreditation program with the advent of the Commiss ion on the Accreditation of Air Medical Services (CAAMS), as well as formalizing the training of the air medical crews. The Austra l ians , South Africans and several American and European private concerns have the handle on long-distance repatriations. Germany, South Africa and Austral ia repor ted the effective amalgamation of various public and private concerns encompassing all aspects of emergency transport, complete with centralized dispatch in many areas. The United Kingdom may be able to teach us all something about funding, since the service represented was supported entirely by business and voluntary donations. Germany may actually be starting to prove the cost-effectiveness of he l icopters when cons idered against the long-term cost of resuscitating, revitalizing and rehabilitating the trauma victims. If this true, they have accomplished something that should make all American air medical programs, the whole of Amer ican medic ine and the reformists who view helicopters as expensive toys take notice. The Congress not only allowed us to learn from each other, but to realize that despite our differences in language, economies, crew conf igurat ions and so on, we share common problems and concerns. For example , I a t t ended an impromptu meeting to discuss the proposed Joint Aviation Regulations (JAR). If adopted by the Joint Aviation Authorities, a European cooperative quas i -governmenta l body, these regulations could change the face of air transport medicine as we know it simply by mandating operation specifications that cannot now be met by the air medical transport helicopters in use around the world.