How Air Ambulances (Don't) Work
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- เผยแพร่เมื่อ 25 ม.ค. 2021
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Writing by Sam Denby
Research by Sam Denby and Tristan Purdy
Editing by Alexander Williard
Animation by Josh Sherrington
Sound by Graham Haerther
Thumbnail by Simon Buckmaster
Select footage courtesy the AP Archive and Amazon
References
[1] www.umms.org/ummc/health-serv...
[2] www.nature.com/articles/s4159...
[3] onlinelibrary.wiley.com/doi/e...
[4] www.sciencedirect.com/science... pubmed.ncbi.nlm.nih.gov/10155... pubmed.ncbi.nlm.nih.gov/12957... pubmed.ncbi.nlm.nih.gov/12217... pubmed.ncbi.nlm.nih.gov/19783... pubmed.ncbi.nlm.nih.gov/22418... www.researchgate.net/publicat...
[5] www.amtrauma.org/page/traumal...
[6] www.ncbi.nlm.nih.gov/pmc/arti...
[7] healthcostinstitute.org/emerg...
[8] www.gao.gov/assets/690/686167...
[9] onlinelibrary.wiley.com/doi/f...
[10] www.nytimes.com/2015/05/06/bu...
[11] verticalmag.com/features/surp...
[12] www.ncbi.nlm.nih.gov/books/NB...
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My dad’s bill after being flown by heli from an island outside Stockholm to one of the major hospitals followed by an extensive heart surgery: $0 🇸🇪
That's "communism" in American standards lol
Or you could say that it was 50% of his income for every year that he has worked (i.e. an extremely high tax rate). Nothing in life is free.
@@j.t.7697 yeah I’d take that over going bankrupt scrapping my knee.
@@j.t.7697 No. It's 60% of someone's income who could afford to pay it. Only 7% for people who can't. The difference is that having to pay 35k on a medical bill disproportionally ruins the lives of people who can't afford it. Of course nothing in life is free, the question is whether or not the cost is fair.
@@j.t.7697 not just 50% of his income but 50% of every working adults income
The debate about scoop & run vs treat in street (ie does the golden hour exist) is not that complex, all those studies are full of confounders due to a variety of medical cases, but the message is clear - definitive treatment is the priority, if it can be provided on scene, do that, if not, get to where it can be asap. The rest of the vid is so shocking and of course what we've come to expect for healthcare in America. I was listening aghast! Air ambulances in the UK are charitably funded. Patients pay nothing. Americans, I do hope you can join the rest of the world in a civilised society soon.
For profit hospitals are sickening
Totally agree. A couple of years ago my friend had an accident whilst hiking. Air ambulance came incredibly quickly, and potentially saved his life. It’s a pretty incredible thing to have free access too.
Yeah don't bet on that. That's never gonna happen. As soon as the stream of young and bright immigrants dries up, america is done for.
Hey! A sudden Medlife Crisis appeared!
hopefully air ambulances stay charitably funded as well.
My dad got the magic helicopter ride in 2016. The company billed $27,000, but since his 90/10 policy was secondary to Medicare, the bill we got was $77. The follow up video to this one should be on the criminally deficient follow-up care system that patients encounter after the Level 1 trauma center. Breaking his neck, back, ribs & sternum didn't kill my dad - the trauma surgeon fixed those in a matter of hours. Laying around in the contract medical system till the insurance stopped paying killed my dad.
In Brazil we have similar things, but with luck, if you have luck, you could recover from any accident that is not 100% fatal almost with no scars, but if you are unlucky, you could die in the line of the hospital due to cutting your finger at work.
That's still too much.
I was lifeflighted when I was 17 due to a snake bite. They flew me 30 miles. The bill showed the flight being $60,000. Insane.
How much was covered by insurance? Did you end up paying the remainder?
@@johnc646 I was 17 so it was all on my parents but I’m pretty sure insurance covered most and they only paid a small fraction
You ever charter a private aircraft before? It’s expensive. Plus you’re alive. There is no price for someone’s life. But we try real hard to put it into a tangible number. 😅
@@doxx2265 I've chartered a private flight. It was a small plane and we didn't go far, but it cost less than $1k. Not $60k. The amount they charge bears no relation to the cost of providing the service.
@@doxx2265 chartering a large 12 seater helicopter is about 6 000 an hour. We'll use that number because of the doctor. Where does the other 54k come from?
Keyword here: "American" Air ambulances
I think they need to change the title of this one. This piece is not true in the vast majority of countries around the world. Helicopters provide an extremely important roll in saving lives. This is fairly poor and irresponsible reporting.
*person about to die from traumatic injuries
American helicopter ambulance: hippity hoppity your money is now my property
*America moment*
Air ambulances
Change to healthcare
@ Lafayette
A lot of it is true though. The economics is US based.. but the medical considerations are not.
Most of the medevac flights I do are complete BS from an LLTO perspective.
“I saved your life!”
“You didn’t save my life! You ruined my death!”
No wonder supers were banned!
Doc: "we saved your life"
Patient: *looks at $300,000 bill* "why tho"
God are you right on it or what. Some real dark humour.
I dont see a problem here, the medical bills in usa is indeed very high. But you don't have to pay, it's just a bill and you cannot go to jail for it. I still haven't payed a penny for my heart surgery years ago. Yes my credit score is terrible but i dont give a shxt. I have been taken to court, resulting in a wage garnishment (basically if you earn more than you need the extra is taken away from you). I am a freelance worker and I only work just enough so I don't have anything left after food, rent etc.
@@sph4551 how is not paying bills a sustainable system?
Wow! This is an area I’ve spent the last eight years researching, and am pursuing a PhD in it. You did a FANTASTIC job summarizing the literature and state of affairs in the US prehospital trauma care system! Really enjoyed watching.
Then can you explain why the cost of air ambulances is so high? The explanation here doesn't explain it entirely since you should still have competition between air ambulance providers.
That explaination here explains why they are overused but why don't hospitals (and the insurers who have to pay some of the costs) choose the provider which offers cheaper flights?
@@petergerdes1094 the video was pretty clear. You don’t get to choose if and when you are going to use an air ambulance so there are no economic forces pushing the price down.
They can charge whatever they want because you don’t have a say it in
@@hunterhulsey5799 But why doesn't the hospital choose the provider who offers the cheapest price?
The reason they are overused is clear. But unless the hospital gets a cut why don't they choose a provider who charges less?
I'm wondering if the difference is because now care has improved so much prehospital. In the 60's it was almost non-existent apart from basic first aid in comparison to today where air ambulances mostly aim to bring the hospital to the patient, including in London where air ambulance crews will operate on you in the street. Surely these recent trials aren't expecting the same level of care in the 1960s to ensure that you compare findings.
@@Danjs112 But the statistics at the end about the variation in cost and the higher charges by VC owned firms suggest that there is little to no price competition.
As an Aussie, with our huge landmass & oddly distributed population concentrated on the coasts, we have helicopter ambulances, plane ambulances & the flying doctor service; all highly regarded by all but the most hardheaded coastal city bums.
They save many lives each year, and fly patients from remote locations to medical assistance & back.
You guys have something similar up in Alaska, part Coast Guard, part something else.
Yeah, but since Alaska is part of the US, it's part Coast Guard, part money pit.
Nope, not part of the Coast Guard at all.
We have 3 fixed wing and 2 Rotor wing programs in Alaska, Airlift Northwest out of University of Washington, in Juneau; and LifeMed Alaska and Guardian Flight Alaska cover the entire state with aircraft and crews.
The Coast Guard will perform rescues, but do not have the training or capability’s to transport critically ill or injured person. If there is a flight that we can not do, that the Coast Guard can, such as a bariatric patient, we can use Coast Guard assess in emergencies. This is where our flight medic or nurse will jump on a Jayhawk or C-130 to complete the flight.
The difference is, the private Aussie networks are highly funded by mining companies, which is also the biggest customer.
RFDS 🥳🥳🥳
Royal flying doctor service saved my cousin from a heart attack when he was working in the mines , flew him back to the Royal adelaide . Sadly he passed away from another a few months later
Another reason I like the uk air ambulance is a charity and doesn’t cost you a penny either even though they aren’t run by the nhs the nhs only pay the salaries for the paramedics and doctors onboard
Well said. I've had the pleasure to work for two air ambulance charities in the UK, albeit not as a crew member. The crew and the aircraft truly provide local communities hope in the darkest of situations.
Well actually most air ambulances in Scotland are state funded and run by NHS Scotland but charities also contribute their own helicopters as well so it’s not just funded and run by charities.
@@Greggs169 well for the vast, vast majority of the UK this isn’t the case
@@armour7 Fully correct. None of England's air ambulance have direct govt funding. In any case, I am concerned this video's title could mislead people into thinking that 'all' air ambulance do not work. I would prefer to have US air ambulances in the title, just to clarify.
From what I remember, it costs £2-3k just to get the helicopter into the air.... Still want to do some charity for local air ambulances (Yorkshire + Derbyshire), bu haven't been able to get that idea rolling
Wendover Productions: I'm feeling frisky today lets talk about helicopters
It's about the economics & business of healthcare in a country that spends the most yet offers so little.
@@shakiMiki it's a joke
@@Dhjaru it is true, tho
@@shakiMiki then the title should reflect that this is US-only, it sounds like air ambulances don't work internationally. Here it is so specific to the American healthcare system and government legislation.
If he' talks about something that primarily uses wheels and then the earth with explode
Ground medic here 👋👋
This 100% holds true for ground transports as well. Take the propellor off and you'll still find tons and tons and TONS of completely unnecessary and expensive interfacility transports are done every day.
It’s sad that more people are turning to ride share companies such as Uber to be taken to medical facilities in the U.S. The majority of Americans agree that our healthcare system is broken and doesn’t facilitate a culture of preventative care. How many of us wait until the very last minute when the pain is unbearable or when we’re damn near close to dying because of how convoluted the healthcare system is here? More and more wondering why couldn’t I have won the country of birth lottery and been born in Sweden, Norway, Canada, any other sane first world country?
Ground basic, I do BLS transfers all day and they're still super expensive. I had to pick up a medic and a nurse for an OB transfer a week ago that the patient flat out didn't need.
I'm glad my Fire/Rescue's EMS is free, and that state police does free medevacs.
No service member or heart attack victim ever said, "Take your time." Very substantial inaccuracies throughout this video. First responders have very difficult decisions once on scene of a trauma. They don't have xray, mri, CT scans alongside of the road. Many decisions to fly are based on protocol. Compound this with covid and lack of beds in hospitals. Air ambulances are more vital than ever. Too much to even start to comment on.
@@WVMountainMan I know right? The biggest problem for me is the price of private air ambulances.
The narrator talks about many points that from an Australian paramedic's POV seems so 20th Century. Years ago, we changed our holistic approach to ambulance treatment by effectively bringing the hospital to the patient. A group of medical brainiacs drew up a schematic about real time treatment at a trauma unit. They then developed a training module so that paramedics were able to perform most of the procedures done in a trauma unit within the first hour. In Queensland, Australia (a state 2.5 times larger than Texas) ambulance service transport is user free. That includes transport by air ambulance (fixed wing) or helicopter. It's not uncommon for patients to be 1,500km from a major trauma hospital and live beyond the flying range of helicopters. That's where fixed wing aircraft are utilised.
My country is smaller, but we basically treat air ambulances (helicopters) primarily as a way to bring the trauma hospital to the patient. They're literally crewed by ER doctors and nurses and bring a lot of specialist equipment and drugs with them. Sometimes they're used to fly the patient as well but they're risky because treating a really sick patient mid-flight is hard to impossible depending on what's wrong with them. They need to be stable enough that it's safe to transport them but not so stable that going by road isn't better.
@@fang_xianfu Parts of Europe tend to use nurses rather than paramedics. In Australia paramedics have a similar level of training as nurses, just some different modules that focus on emergency medical care. Both careers require a university degree, but paramedics tend to work more autonomously. It's not really that difficult treating critically ill patients in flight. The success lies in stabilising on scene before loading. We have Flying Doctors using fixed wing aircraft and ambulance rescue helicopters that regularly treat and transport critically ill patients. Some towns are either a 15-hour drive on bumpy, dusty tracks or a 1:30 hour flight from a major hospital.
Here in Brazil you could easily be 2000km from an speciality hospital, but you can get an free ride if you can wait to the municipality ambulance to transport you to the hospital or if you are lucky, you can get a free ride with the air force to the nearest air base of the hospital you want or need to go.
"Recent closer of unprofitable rural hospitals." As a non-American, that is such a foreign concept.
Doesn't the NHS close down hospitals that fewer people go to though? That's what it said in "Sick Around the World" at least
@@lincolnsand5127 - I believe the UK even had to reopen a whole bunch of hospitals that were closed when coronavirus hit. This debate occurs in any country that has a sizable enough landmass.
NHS is a whole another pathology. It's not about weather or not the Healthcare system is privatized, you can have a good private healthcare system, like in South Korea, or a shitty state founded system, like in the UK.
Is it though? At least all over central europe many smaller hospitals are already closed, like in France, or were on the brink of closing when the pandemic hit, like in Germany.
This happens even in scandinavia
"...due to closing of unprofitable hospitals"
Me, a european: Are hospitals supposed to be profitable?
Me, a swiss: Yes...yes they are.
At least to a certain extend.
in the US,unfortunately yes
Over in this Capitalist hellhole: apperently...
:(
Me, a German: Yes.
Me, now living in the Netherlands: Yes.
Here in the uk, an air ambulance can be an essential mode of transport to save someone's life, I think its also the same for the rest of Europe
It’s saves lives across the world man. Obviously the morals of a brutal cost is completely unfair but I would still prefer to be alive so I could at least try and pay
yeah no shit it’s the same in the US. that wasn’t the point
@@hunterrodricks1881 a lot of people might not think it that way, especially when it makes your life more detrimental and sufferable
@@patrickbueno3279 yeah fair enough. I just hate how this video tries to summarise that air ambulance therefor isn’t viable. That’s completely wrong. The thumbnail and the sources used are manipulative. The video title should just be on on “ultra capitalistic healthcare system built in the US”
@@hunterrodricks1881 100%. I've loaded numerous patients into helicopters that would not survive the long trip to a trauma center. Would you rather take a stroke victim to a basic hospital, or send them straight to a better equipped one? That "bullshit golden hour rule" can make the difference between living and living with severe disabilities.
And yes the price is crazy. You are getting Paramedics with very high certs mixed with an expensive airframe that costs significant amounts of money to maintain and fuel. Is the pricing high? Probably, but what medical field in the US isnt? Could it be more affordable? Most likely. But to say air ambulances are not worth running is just stupid.
So fun fact. Seattle has a level 1 trauma center that handles 4 separate states. Alaska, Washington, Idaho, and Western Montana.
Seattle is Europe.
@@darthvader5802 what?
@@TurtleSauceGaming I mean Washington state has more policies in common with Europe than average American states
@@darthvader5802 don't know what this has to do with their level 1 trauma center serving four states but ok
@@TurtleSauceGaming I guess it's a thing like that trauma center makes the states more interconected like the eurozone instead of different states in the same country having different laws.
I am an emergency physician and have worked at several rural hospitals. As such I have had to make the decision whether or not to transfer by air countless times. Many times the decision is simple, but all too often, in unclear situations you are confronted with a difficult choice. We always want to err on the side of caution, but the knowledge of the astronomical bill and the harm it can cause does weigh on us for uncertain cases. The problem is we don’t have a crystal ball and don’t know when someone will deteriorate unexpectedly. I think you did a great job of bringing a relatively obscure but important issue to light. Thank you
Compare with Spain, where the only consideration is the health of the patient. Hundreds of thousands of lives have been saved by the helicopters, including an American sailor from a US Navy sub who got his hand amputated, was flown to Valencia, Spain and got it reattached. If it wasn't for the helis, his hand would have necrosed (for a time they put his hand in his leg, to have blood flow): taskandpurpose.com/bulletpoints/sailor-lost-hand-spanish-surgeon/
In Canada...we auto-launch our helicopter based on dispatch criteria
So...as an on-call paramedic in a rural area...the helicopter is in the air about the same time I get my boots on
Often we get on-site and cancel the airevac
We'll transport the patient 90min to our local (20 bed) hospital...who evaluate and may admit or transfer on to the General Hospital by ground or fixed wing
Same event...All the same cost to patient $335.00 one way
No matter where you eventually end up....with no pants
The solution is simple, don't bill the patient for a choice made without their consent, bill the government and get Nancy Pelosi to pay for it out of her own pocket.
@@notlikely4468 There should be NO cost to the patient!! Why charge them at all, when everything else is free?
@@inconnu4961
Ummm.........Because we are not a taxi service?
And this now becomes a case study for my medical ethics class.
Yup, is providing medical care a business and should it bankrupt people?
@@sgriffith2353 In some sense, it is kind of a business; healthcare workers are providing a service in exchange for money (and if it weren't that way, it would be slave labor since healthcare careers--particularly if you include the schooling for them--are labor-intensive). As for whether it should bankrupt people, I think there are multiple ways to defray the cost, but I also think that there's a huge gap between people's expectations of care 50 or 80 years ago and today: We expect to survive things that people back then just didn't expect to survive, and the development and deployment of the technology necessary to do that is *very* expensive.
@@philipmcniel4908 Only in the US every were els not at all. That not an argument back then we didnt hat technology or the knowlage to treat peopl better and more efficent. Us hralthcare sucks thats all .
You should know that he’s wrong about a lot of the stuff in this video
@@xythiera7255 It's not less expensive in other countries, and yes, it does get paid for. Government doesn't actually produce any goods or services; it only shuffles them around.
I agree that the US system is in need of improvement, but you can't get something for nothing.
Army Medic here, and it's really interesting to see the 'outside looking in' perspectives. I've worked clinical, transport, logistics, and of course the on-site injuries, so it's always intriguing to see what outsiders think of how we operate.
Second note, the logistics noted here are really about the US emergency medical system. Not just the money trail/costs, but the actual transport reasons/setup. The emergency protocols aren't the same everywhere.
During my time working in Europe, I learned that they often prefer to treat on site of injury/accident rather than transport ASAP. Trauma doctors are often on call with ambulances, and will come straight out to work the situation on the ground.
Imagine hearing these words: "The fire department was closed due to being not profitable"
Weird? Yes. As it should be with hospitals. Human well-being/survival should not be judged by profitability.
But at the end of the day, the staff of the hospital or fire department need to be paid. They have families to support. Either they are paid by the patient, as in the US. Or they’re paid by the government which is funded by the people.
@@aaronwilliams7731 But would you rather a few hundred rich investors profiting billions of dollars based your payments, or would you rather just pay what you'll actually be using? This is EXACTLY why the US pays among the highest medical costs per capita compared to comparative first world countries. Like you said, insurance is fundamentally EXACTLY the same as universal healthcare, except for the glaring fact that people at the top with ZERO medical experience profit millions personally and billions in the company, something the government doesn't do.
There's laws mandating fire dept coverage in the US, and there's not for EMS, so if a department is ever not profiting in areas that run their EMS through their FD, they downsize and cut their EMS to be taken up by private companies, or potentially even downsize a full time department to be volunteer only.
@@LZC94 you can still choose not to subscribe to the fire dept in some areas of the US and they’ll let it burn and save your neighbours houses. Wild
@@ryanthompson3737 you need profit to run stuff. either profit for a private company to run a service or profit for the governement to run a service. you can’t run a service at a loss, no matter if you get your money through taxes or through consensual exchange of money from your customer.
As a Norwegian, this whole episode is just bonkers.
Canadian here, I fully agree. Universal healthcare should definetly be a thing in the US
@@antoineczevek-morissette2901 The thing stopping it from existing is that the American population has been fed so much propaganda about it that they can't help but hate the idea of Universal Healthcare
@@enotsnavdier6867
BBBBBBBUt muH tAxES!1
Wanna sponsor a refugee?
As a brit. Our actual air ambulance service thats pretty much charity funded is actually useful.
Also free healthcare in britain despite the service being underfunded is just better.
Hearing “the hospitals closed because they were unprofitable” is so jarring as a non American
yeah go pay your insane taxes that you will not benefit 90% of them and somebody else will. enjoy giving your money to other people
@@HR15DE I heard what Americans are paying for health insurance, and I compared with my pay slip, and found I'm paying half that. And I don't have to worry about going broke over a traffic accident. I also get to ride around the whole country in trains that mostly run on time, so I don't actually have to spend hours of my life behind the wheel when I'd much rather read a good book. But I suppose these quality of life things are hard to quantify for the materialists.
@@nullplan01 your health insurance maybe half buy the tax you pay on stuff is probably pretty high. you think you getting stuff for free but actually some way or other you even pay more for it. compare gas price compare car prices with US and you will see
@@HR15DE Thing is, without all the profit centres and the insurance middlemen, the tax portion paid by civilized countries towards their health care systems are dramatically less than the insurance you americans pay. We pay LESS, and get statistically better outcomes. We just call it "tax" instead of "insurance", personally I don't care what it's called as long as I pay less total and get better outcomes.
@@HR15DE me when i plug my ears and spout republican conspiracy while ignoring the entirety of the rest of the world
Here in Switzerland people get hurt in the mountains everyday, in places impossible to reach with traditional rescue means, for that reason, helicopter rescue and transport is essential and saves lives daily. Also, remember that air ambulances play a huge role in transporting organs quickly beetween hospitals.
I had a spokesperson for the UK-based West Midlands air ambulance, who are a non-profit organisation, they said that each flight usually costs between £2000 and £7000. This just shows how much profit the US for profit air ambulances make per helpless person they “help”. In the UK we have no for profit air ambulance operators and they are much more effective at saving lives.
Some UK air ambulances are for profit. Look up the salaries of their staff. My county air ambulance employs a team of back room “admin” staff and some pay themselves £80,000 a year from peoples donations. This scam is why I don’t donate to charity.
@@notmenotme614Not for profit doesn't mean that nobody gets paid. It means that they only charge enough to cover their costs, including salaries (even for executives. They work too) with little left over (profit).
$80,000 is not an unreasonable salary for some higher level management positions. If you want someone with decent management experience, who can keep the organization running efficiently, you will likely need to pay above entry level wages.
There's also a different model in the UK - the helicopter isn't soley used to move the patient it's used to bring a medical team to the hosptial who (through exposure to lots of similar cases) and extended skills can do more to help the patient - essentially it matches a scarce resource to a rare and geographically distributed event. It is used to move the patient to the most appropriate hosptial too (sometimes that means leaving them for road ambulances to transport or going with the patient by road) actually transporting the patient by air can be a difficult decision as often it's not possible to get good access to the patient once they're loaded.
"You survived... But at what cost..."
Pretty fucked up ngl.
welcome to life.
@@brandonmcmahan676 welcome to America.
I think I'd rather die tbh...
Better than dying from debt
What’s really bad is I have heard about Air Methods bills being in the mail before a lot of patients are discharged. It’s a race to get paid first from auto insurance.
wrg
Nobody:
American air ambulance crew: "You are being rescued! Please do not resist."
underrated comment ahhahahah
Well it's in America, so probably they have a gun
Did you spot the image at 6:28? A UK video production company doing a video about US Air Ambulances, and the picture is a car crash scene in Toronto Ontario. The TTC bus is pretty distinctive, and the street sign for Keele St and the sign in the background for Downsview confirms the location. (and the tow truck from Abrams towing)
@@danielhandika8767 guns exist in other countries as well. Also you're ignorant of the fact that some US states are very strict on gun control, even more strict than Canada, Australia or Switzerland.
Please, i dont want to pay the private helucopter trip in this executive helicopter. Just leave to die..... the american way
IT'S NOT JUST DEATH!!! My spinal injuries were so unstable that a bumpy ground ambulance ride would've certainly left me PARALYZED.
My pilot was so smooth I could barely tell when we turned and landed.
My late wife and I were both fixed wing flight paramedics for 3.5 years. I was also a helicopter flight paramedic for 1.5 years.
In our experience, it was rare that the time saved by air transport had a positive impact on the patient's condition.
You can feel his usually calm voice being compromised on this video.
Agreed, it's not often that we witness him being unable to maintain verbal objectivity. But then, perhaps the gravity and significant impact of the situation warranted the need for a change of tone in his speech.
RIGHT??
At the end, you can tell he's genuinely concerned about this subject
Sam's genuinely concerned about all his Wendover Productions. I think this is just one of the few times the anger built up to the point where his mastery of verbal objectivity was broken.
Poor Sam lives in the San Rafael Swell.. ☹️
Would love to his take on consulting firms that come up with some of these off the wall policy suggestions for companies. Not knowing how it will effect everyday people or even their own families later on.
Deep in his heart, Sam knows a free healthcare system is the solution for this. Given his foreign viewers, I wonder why he didn't came close to this topic. Well, in the world news video he says terrible lies about the 2019 Bolivian coup, so as Žižek would say, it is pure ideology.
@@feyh Deep in his heart Sam is proud for making another video with flying man made stuff again...
As a former rural volunteer firefighter.... There are literally hundreds of factors that come into play. We still use the golden hour rule. However, its based on traumatic injuries from the time of the injury until you want them under the hands of a trauma specialist whether that's in the field or in the hospital. The longer a person's trauma goes untreated the more long term tissue damage they experience. This is exceptionally important when it comes to brain injuries because just like a stroke any injury within the cranial cavity its imperative to get it treated as fast as possible before it starts to kill portions of the brain. This is so complex that there's no way to have an algorithm or formula for whether or not the golden hour applies. Things like road conditions, exact injuries, manner of injury, location, weather, the skills of the first responders on scene all factor in!
Have always known it as golden hour for definitive care and 'platinum 10' for time to get pre hospital.
Here noone pays for air ambulances which is honestly mind blowing after watching this.
Wrong.
Anytime it seems like "no one pays" for some obviously outrageously expensive service, the reality is the exact opposite. EVERYONE PAYS for it, not just the individuals who need it, but you and me and your mother and all your friends and all your enemies. EVERYONE gets taxed to pay cover the bill for the 1 in a million who actually use it - and often (not always) does so because of their own irresponsible choices to do totally unnecessary dangerous things.
Personally, I DESPISE the idea that I am having to pay for some idiot's luxury private chopper ride because they wanted to do some stupid extreme sport, chose to drive drunk or wandered into the woods and got lost. Screw those people and the horse they fell off of. If they want to do stupid things let them buy their own stupidity insurance.
you do pay through taxes tho. overall in america we keep more money in our pocket at the end of the year especially if we got insurance
@@user-rd5nc1nb9f nope air ambulances are charities, we don't pay for them. Also that is some serious shit your chatting about keeping more money in your pocket at the end of the year 🤣🤣 a country that has a minimum wage akin to a 3rd world country. Your insurance fucks you over if you need it, if I get hit by a car I am given care all the way from the roadside to discharge for the price of a little bit of tax that everyone pays into.
“The system wasn’t equipped for that”
So he changed the system
That’s a pro-gamer move
It was actually a pro doctor move.
having good wealthcare system is communism don't you know?
american don't want good healthcare because it takes away MA FREEDOM
@@MijnAfspeellijst1234 It hurts me to say that I'd have laughed at that, if it was a joke
Wendover- I was hoping you'd touch on the fact that the original agency mentioned in this video- (the Maryland State Police) still have one of the best medevac systems in the country and the cost of the flights are paid for from taxes with no additional cost to the patient.
bob A breath of fresh air thanks
As it should be! The US Medical system is always so baffeling to but what's even more baffeling to me are the people defending this system...
Boston Med Flight as well has a world class program and is a not for profit and only bills what insurance will pay, and if someone has no insurance the care is free.
@@Micsmit_45 I'm American and it baffles me as well.
That is under the assumption that the patient is a non taxpayer, which is ignorant
It’s not always about speed. Often times helicopter paramedics and nurses have capabilities not available by ground units. They may show up and place a chest tube, intubate, and administer blood products for a trauma patient in rural areas that otherwise wouldn’t have the capabilities to do so. Their transport time in extremely rural areas can still be 30+ minutes once in the air. But they’ve stabilized the patient that otherwise wouldn’t have been, and would have likely perished in a ground ambulance with only BLS capabilities(which most rural areas are).
Unfortunately in Germany hospitals have been privatized too and a system called Diagnosis Related Groups incentivizes doctors to do operations when none would be necessary, also because nowadays a hospital needs to make profit. "A sick patient needs to bring profit" is so disgusting to hear, but it's currently the reality. I hope things change soon as more doctors and nurses exit the hospital system, because they don't want to work under these conditions. :(
From the UK here and I'll say straight up that our health system is serverly broken. I always thought that Germany used privatised hospitals paid for by the gov but they had to give a certain minimum of care set by the gov and had to get the contract every year. Is this wrong?
Privatization of healthcare sector is unavoidable. The problem here is the government should keep the price from getting ridiculously expensive like in here (US)
@@minhdo1728 It really isnt. Hospitals are one of those pieces of critical infrastructure that NEVER should be privatized because they a) were never intended for it and b) its fucking disgusting to treat patients like commodities or customers.
In Germanies case the best course of action would be renationalization. But you can be DAMN sure a government with the FDP (the kinds of people who want to de-regulate and cut taxes for the rich who can easily afford them) wont do anything like that.
Its deeply disgusting that while billions are pumped in the US military to fund ill-planned interventions in foreign countries who end up worse for it, there are countless suffering from not just extreme illnesses or wounds but also ridiculous debts.
Thankfully Germany hasn't fallen anywhere that low yet when it comes to healthcare. Easy Access to Free Healthcare is a human right. One shouldn't get the permission to live from someone in exchange for paper.
@@jamesward6460 its funny when u say it's broken. Did u ever thought it's working as intended? it might just matter of intended people that benefit it
@@countsudoku6305 I understand where you are coming from, what I mean when it's broken is that Doctor and nurse burn out is ridiculously high and I believe I read somewhere (this source is trust me bro by the way so do take with a pinch of salt!!) It's something like 0.5 (probably less now) doctors to a bed and 10+ administrators to a bed which is definitely seems excessive. Our hospitals in the UK run around 98% capacity so struggle during flu season etc whereas most of western Europe I believe (it's that word again!!) Is around 70% capacity. That is why I assumed the German system was better. I would love someone to enlighten me further on this subject though...
This title needs to have “in America” inserted into it. Because this is not the reality outside of the USA.
Well, the United States is a third world country.
@@Half_Finis The United States gives you all of the technology the world has today. Most countries are decades behind us, especially in medical care.
@@NoCumBacksiFunny No, actually. Germany gave you guys (America) so much. They gave you jets, rockets, cannons, many things that we wouldn't have without them. No one would be on the moon had it not been for Germany's technology in ww2+. America hasn't done shit, it has almost all been Germany's technologies.
@@NoCumBacksiFunny Absolute bullshit. Every 1st world country is at the same technological level for everything except maybe some military secrets. Since the internet and air travel the only barrier to entry in high tech environments is costs. And a lot of countries that aren't as rich as the US are willing to spend vastly larger amounts of money on healthcare.
Well biggest and most advanced medical equipment comes from Europe. The ww2 thing, no matter how bad it was did a lot of help for both military and and medical advances. They killed a lot of people in medical studies and much of what came from that, save life's to day. That is just a terrible fact of history.
I appreciate this video because it really does speak about the difficulty of how expensive air ambulances are. As a paramedic, one critique that I have is that it focuses a bit too strongly on lives saved whereas there are other measures of better outcome. For example, I may choose to fly a patient if I believe that they have a condition like compartment syndrome that is not at all life-threatening, but can be limb threatening and I have done so.
Likewise, I may choose to fly a stroke patient that may well die, but by getting to a stroke center, they may be able to perform an advanced procedure like a thrombectomy that is very time sensitive and can have much greater outcomes.
Additionally, as a rural paramedic, our nearest hospital is a level V center and that center has no blood whatsoever. The next nearest hospital is nearly two hours driving away and if that patient needs blood to not deteriorate, they stand a good chance at a much worse outcome.
So, I do think that because of the focus on life and death, you undersell the value of receiving more rapid care from an air ambulance.
I also think that it's important to understand that designing a study for this type of situation is exceedingly difficult. In the studies that you flashed on screen, one alluded to 8 minute transport times, another to 90 minutes. Those are very different scenarios, but there's also a lot of difficulty with just the amount of variance between different accidents with different injuries. It's hard to have a large enough sample size for very long transports as they are rare, but even when that does happen, the patients may be very different and controlling for that difference is almost impossible.
We do know that time can certainly matter for patient outcomes. For example, it may matter quite a bit for a patient who has a large internal hemorrhage. The problem is that prehospital, it can be difficult to discern the difference between a patient with significant internal bleeding and one without. Overtriage will always be massive because the difference in outcome between a patient with a severe liver laceration that bleeds significantly and causes shock versus another patient that has no laceration and only has a couple of cracked ribs will often present the same to paramedics in the field, initially. Of course we're trained to look for signs and symptoms and to consider the mechanism that caused the injury to make this discernment and of course there are criteria, but those criteria are usually based on having the least risk of bad outcomes.
This can be improved with technologies such as using ultrasound in the field to attempt to detect abdominal bleeding, but until that's the case, many people would not want to risk their lives due to this cost.
But, what I absolutely agree with is that this is a major financial burden that shouldn't be placed on the patient and it's absolutely criminal that these companies are charging people such outrageous bills for their service.
All the while in the US, the ground ambulance system is failing throughout the nation and services are closing down as they can't remain profitable even with underpaid, often even volunteer staff.
Personally, the US has the shittiest healthcare system of any wealthy nation and frankly of many poor nations. We need medicare for all and we need to not incentivize bad behavior. Frankly, this isn't an isolated example of which behavior that causes societal harm is incentivized in an underregulated market.
Very cogent comment
good comment
That was an awesome comment and summed up my counter argument to the video perfectly, thankyou.
Thank you for your contribution to this discussion with first-hand experience.
I literally couldn’t have said it better myself. Everyone looking for the paramedic’s point of view, this is it.
Flown about 42 miles to a level one trauma center following a motorcycle crash in a rural area in 2017. I was extremely grateful it existed, even if the bill was $24,000 lol
I’m a flight medic in Alaska. Allow me to explain the reason WHY 4/100 is actually a misinterpretation of the data.
Here in Alaska, there are hundreds to thousands of small communities that are not connected by road to the rest of the state. There is EXTREMELY LIMITED health care in these communities. Health aides, who are similar in training to an EMT might be the only care in the village. Others have a single mid level provider (NP or PA) that provides care. These clinics have NO in-patient beds. So if a patient needs admitted, a surgical procedure, or even an X-ray/CT scan, they have to leave the village. Commercial airlines will NOT take acutely sick or injured patients on board. This means the patient has no road to get to the hospital, and no option to fly commercial, which leaves the air ambulance as the only option.
When I get called for a patient transfer, I generally have an hour flight out to the patient, and then an hour flight back to Anchorage. Most of the patients that I transport from these bush communities would lose life or limb if they were not transported by my air ambulance. Appendicitis, sepsis, traumas of all shapes and sizes, heart attacks, strokes, none of these can be diagnosed in the little clinics, and while they do a great job of stabilizing the patient, they can’t keep them.
Additionally, in our company’s footprint, our program in Alaska had the most flights. Everyone of those flights is a patient that would not have survived in the bush, regardless of how “critical” they were evaluated.
And how much does your company charge per flight?
@@volderhamer Most flights are not charged to the patient, as we are contracted by the Indian Health Service. Otherwise, I’m not involved in the billing process at all. We do help patients complete bedside sign ups, if they would be charged, so for 120 dollars they receive a year of Medevacs at no further cost to them.
while i am glad alaska can benefit from this system, surely it's not inconceivable to you that someone can get absolutely fucked up financially by being picked up by the wrong heli in the lower 48
@@terribletablevods862 As I said in reply to Doodles, our company does everything it can to limit the financial impact to our patients, from bed side sign ups for our membership for patients so no matter what they don’t receive the bill to working with physicians and facilities to ensure that the right mode of transport is chosen, and contracts with the IHS throughout the US to ensure our patients never see a bill.
Yes, I can see how some unscrupulous companies could abuse this to make massive financial gain, but you also have to understand why medical bills are being driven sky high, Government intervention.
When I was doing my work experience at a major trauma centre in London (The Royal London Hospital), which is the home of the London Air Ambulance, I had the privilege to meet one of the doctors who worked on the helicopter and he explained to me that their job was not to bring a patient back to the hospital as soon as possible, but to bring hospital level care to the patient as soon as possible, and in essence create a mini intensive care unit on the roadside and in the helicopter, which gave the patient the best chance of survival. Here is the UK this is all done for free of course.
Yep, the "treat in street" approach (as against Crawley's "scoop and go"). Crawley was right that it's time to treatment that matters, but he made the mistake of thinking that was the same as time to hospital.
I had a patient arrest in the hospital recently, in a normal ward environment. By the end, the patient had had a full ICU treatment, and still didn't make it. It was a long hour, and very sad, but I what really mattered to me was that that man had the best treatment the whole hospital could offer him, as soon as he needed it. Including a peri arrest call so that the arrest team where there when he arrested, cardiology input, an anaesthetist, stroke input, adrenaline infusions, early defib. The whole chain of survival.
It may not be a comfort to his family, but I know that we did everything that patient needed. Being able to bring ICU level care to a patient, whether in the hospital or to the side of a mountain, gives them the absolute best chance of survival possible.
As a german paramedic: congrats on the well researched first half. To the second half: we just have a sane insurance system… ;)
You also took took two back to back Ls in World Wars… #america
@@Mokarney that has nothing to do with his comment and unless he is 160 years old he didn’t lose anything in those wars
@@RrRr-or5tw americans be bringing the weirdest shit up when they’re wrong
@@Jairoalvarz depends on the American but some do. It’s always weird how people in some country’s just aren’t able to except that this system just works better.
What do you get taxed at?
Wow. This video makes me so thankful to live in Australia. We use air ambulances all the time. But rarely have to pay anything for it.
we don’t either if we got insurance. i know a few people who went through the whole thing and paid at most 2500
My partner works in air ambulance and they charge zero to the patient, they are a charity and source their funds from donations and sponsorship
you pay more. the government is wasteful. so taxes end up costing more in the long run.. no thanks. I dont want the government holding a gun to my head to force me to buy things I dont' want. and yes, they will presecute those that dont' pay taxes. so a gun is an accurate picture of how it works.
Oh yes you do. It's just that the cost is hidden in your taxes, local fees, or any number of other things.
Helicopters are extremely expensive to operate. They're not being operated for free. That bill is being paid somehow, by some means.
I've heard stories of people wearing bracelets documenting their known pharmaceutical allergies for first-responders. Some include the instruction to good samaritans that happen across them that unless they are visibly, obviously, significantly injured, to not call an ambulance for them - since they will *definitely* be financially ruined from the trip but only *might* be financially ruined by the consequences of delayed care. I guess they should include the air ambulance in their list the next time they're mountain biking in a remote forest somewhere.
"Youre going to transfer me? Yeah, okay, just give me a wheelchair and the address, I'll call a bro."
To my knowledge, wheel chairs can also be expensive. Ask for the janitor's mop. It'll work fine as a crutch.
My mom got personally billed over $800 for a broken POS wheelchair when she was released from a surgery that left her legs paralyzed.
@@williamrohr8374 that is horrible! the healthcare system is fucked
My Uber's here
Sadly many patients do this
I got airlifted from a smaller hospital to one in a mid size city for testicular torsion in August. It cost 25k, I dont even make that in a year. I was so relieved when they forgave the debt.
Im sry, im not from the US.
So they just said, fck it, we dont charge you anything and let the charity of some sort pay for it?
I bet that was the second biggest relief that came out of that situation.
@@florian9540 Yes, I had to show them how little I make and they took pity on me.
@@youjustgotcarled Good for you, but please let me ask how that u ear so low? U are fresh in workmarket or for years in shity job? bad life decisions?
It's scary how much Americans seem okay with huge hospital bills for those without insurance.
My dad had to do a flight from Darwin NT Australia to Adelaide SA Australia. Cost there and back. $0 was on a personal jet admittedly and had more than just him on-board
Who says we're okay with it?
That's what decades of
brainwashing do.
Everything that doesn't end up as revenue for shareholders or on Wallstreet is deemed "evil communism" and must be fought no matter the cost.
Americans have been brainwashed so much, that they think, having thousands of their own veterans and ordinary people being homeless because they just could not afford to pay a simple medical pay is the absolute best thing you could wish for, since in their mind those people deserved to be homeless, since they weren't rich enough to pay those ridiculous bills by themselves.
And if you are not rich you are just lazy.
That is their thinking.
And they have been brainwashed to be like this since the early 1900's.
And all of those brainwashing is done by politicians which are bribed by those same companies on Wallstreet that are the ones that get rich from exploiting the people with ridiculous high medical bills.
So in their mind it's:
Better be a homeless veteran or live in your car, because you can't afford an apartment, than having Universal healthcare since this would be considered communism.
When American politician John McCarthy said:
"better dead than red" he literally meant it.
Better die, than having something they would consider "communist"
(Even if >99% of the stuff are not even communist ideas, the real commies just addopted them as well because they saw them beneficial)
We’re not ok with it. The private insurance providers have purchased enough of our politicians with campaign donations to keep the system from ever changing.
@RainbowManification I'm not talking about politicians or the likes. But society allowing people to call themselves traditional medical professional names.
You ever had the pain of moving to another state, being rural and driving 4 hours to a "doctors" appointment for a legitimate long term medical condition only to find out its a bloody acupuncturist and unable to actually provide the prescriptions you need to live? Then get charged an arm and a leg because it's not an actual doctor?
In Australia, I used to live in a rural town, and by Australian standards, it wasnt even that rural. The nearest well equipped trauma center is the John Hunter Hospital in Newcastle and is about a 2 hour drive away, but for other towns it can be 3 or even 4. Our widely spaced population means that the local hospitals' plan for anything more than a broken arm is usually to keep them alive until they can be medevaced to John Hunter. This makes flying medical aid and transport essential in Australia.
For example, when my Mum fell off her horse and fractured her pelvis, the paramedics were worried it would shift and she would bleed out internally. They decided that they didn't want to risk a bumpy Ambulance ride to John Hunter so they drove her to the local hospital, which has a helipad, and got the Westpac helicopter to fly her to John Hunter. Turned a bumpy Ambulance ride that would probobly have been 90mins with minimal traffic to a 30 to 45min smooth trip with no traffic. She's made a full recovery and us back to riding horses.
"Unprofitable hospital" two words that should not be used in conjunction in any society
Was about to comment exactly this. Crazy concept.
It doesn't even make sense. Eventually, most of the people that these hospitals save end up generating wealth through their work. It's profitable to society as a whole, in the long run.
The same with prisons:/
Add prisons, schools and militarizes.
So it makes sense to have a fully stocked and staffed hospital to take care of a hand full of people?
Ahh, america, where "wE're TeChnicCaLLy an ARlIne" is a valid argument in court. Surprised no one is suing and telling that they didn't ask for an air ambulance.
Sure, you could try to sue, and they'll bury you on legal debt. If you've got money, and it's a civil suit, it's easier for them to just bankrupt you with legal fees and settle out of court. Then they aren't held accountable.
This sounds so insanely infuriating to me as a German, but most likely also to anyone not living in a socially backwater country like the USA. "buT wE sLapPed a CeRtAiN LaBlE oN it" seems like the dumbest way to get out of jail free - even though it's apparently the way to go in cases like these.
@@Handygamer While the rest of the world advances socially and fails economically, the USA will still be that socially backwater country makin' money.
@@CompleteDiscreteWolf How head in the sand of you. I have bad news... merica isnt #1 in just about anything anymore..... Yall still got #1 for school shooting's I think... so grats on that i guess? But all these "economically devoid" countries where the people living in them are for some bizarre reason, treated as more than just cannon fodder for the cooperate work floor, are actually doing just fine.
@@nuarius Dude, my head isnt in the sand. The united states makes almost more money than the next two world contenders combined for the most money. Do you know how much money this country makes compared to even the top 5?
I can just say being in the infantry. That the golden hour is extremely true.
Nah apparently some guy doing research on the internet is attempting to defy a unanimous medevac system used successfully in war time since Vietnam and in the civvy world
What does being an 11B have to do with this?
@@josephdawson8073 0311, and if you have to ask about why the golden hour is important as an infantryman, you're a boot.
@@kojosmith1210 I would call this out as an ad hominem, but given you're a "0311" you probably don't know what that means
@@josephdawson8073 everything, that followed after he was trying debunk the "golden hour" was correct. I'm staunch advocate for universal healthcare, because, everything he described wrong with the helicopter ambulance industry could be simultaneously redirected as a critique of the entire American healthcare system. However, don't unnecessarily, critique the methodology that's been battle tested & proven by countless gunshot wounds & IED blasts. The narrator has no personal experience to draw from which could validate or invalidate this rule. Yes, there's price gouging occurring that should be illegal. Yes, I'm sure many flights are illegitimate and are just carried out in order to fatten someone's pockets. All true, but the rule itself is still valid & written in blood. Hence, why, EMS, personnel are extremely critical.
I will say, to critique some one, for the use an ad hominem while simultaneously, imploying the use of an ad hominem. Is either an ingenious joke only caught by the witty, or indeliberately done to validate your own self righteous ego. To infer that some one is intellectually inferior, because of a chosen job field in which honor, integrity, decisive action, loyalty, & grit are valued most. Is to show that like the narrator you personally don't know what you're talking about on this given subject & feel the need to overcompensate in order to discount real world experience. The problem is your just not that smart.
As an American EMT I think this is an amazing video, I wish it was taught in class. The argument that creating unessicary financial hardship for statistically uneccesary reasons absolutely violates the hypocratic oath is a really good one and I’m gonna use it
Only in the USA is that an issue.
Financial hardship that can be, and frequently is bankrupted... Or death... Tough choice.
its rather terrible because it doesn't tell the other side of the story. sad truth about media
"hospitals closed in rural areas cuz they were not profitable" "ambulance market" sums it up i guess
Some people get mad about regulating ambulances, forcing ambulance rides to be free to clients because they think people will game the system to use them to get free rides to wherever they want.
@@SkyWave32 Where I live, if your Ambulance Ride is deemed necessary by the doctor who ends up treating you, then it is free, if it is unnecessary, then you have to pay a fee of $250 for ground ambulance.
Look, this isn't some evil US capitalist exploitation. Healthcare costs skyrocket and become unaffordable in no time unless you make a concerted effort to keep costs down. We have a govt run system in the Netherlands but we've been closing or downsizing small hospitals as well. Hospitals are incredibly expensive, especially emergency care. Tradeoffs are inevitable. So yeah, the US system is awful but cost pressures are not to blame.
@@rolandxb3581 Yes, "cost pressures" are in fact literally responsible.
@@jadegrace1312 of course, I meant demands for profit.
I do like that the stock footage used for the line “the entire American air ambulance industry” is actually of an ambulance helicopter in the Australian state of Victoria. 😂
don't forget the two MI-8s and NHS helos
And the Wales UK.
Or a German DRF Luftrettung EC135
Australia, you mean the one that treats Japanese anime and manga as illegal goods?
Yeah, not much of an example.
@@Aereto Well, that's a lie.
Air ambulances save lives. It is an hour drive to the closest trauma center in parts of the county I work in. Without our air ambulances these patients dont stand a chance
I live in london and the only thing payed with tax in the HEMS program (Helicopter Emergency Medical Service) are the salaries of the crew on board but some times the doctors volunteer for the role in their spare time. Everything else is payed for via donations to the foundation including the helicopter. I believe Virgin was a major sponsor and had their logo on the side for a while. Not sure if that's still on the helicopter though.
Air Ambulances work...
*Or Do They?*
Vsauce Intro Plays
Air Ambulances work...
*But what if*
*They didn’t*
The doctors say I've lost my mind...
*Or did they?*
Vietnam vets:well yes but actually no but actually yes
Jake Chudnow - Moon Men btw
@@Monarch34 "RPG INBOUND!"
I was in a car crash about three months ago that broke my back and killed two of my friends. I was flown in an air ambulance and they billed me over $81,000. I guess the prices are much much higher in California. I was also flown about 90 miles.
At least you survived, a second chance. Have you paid that bill yet?
God, the flight alone is how much a european person would pay in 20 years of taxes
I'm sorry for your loss. I hope you'll recover fine.
If I see that helicopter I'd just tell them to leave me to die lol
sorry bout your friends :/
I have revisited this video several times and it's only on my fourth watch thru that I'm noticing a critical missing element in both your essay and the studies it references. At 9:56 and again around 11:00 you talk about mortality rates & overtriage (being defined as surviving trauma that could have been handled by a lower-level hospital) "so the health outcome was the same". The outcome very well may NOT be the same. For example, if a patient suffers a severe head/neck injury in a car accident and gets flown to a Level 3 and then transferred to a Level 1 that has a maxillofacial & otolaryngologist on call 24/7 that can reconstruct their jaw and facial structure while the injury is fresh the patient will have a far BETTER outcome even if they would have 'survived' at the Level 3. Based on the study you referenced they were overtriaged and it was an unnecessary flight when in reality it caused an incredible amount of good for the patient. You are very right that this industry is long overdue for regulation but I think we need more detailed data to fully understand the affects of air ambulances on patient outcomes.
Hello, I thought I would add one nuance that I found to be missing from your video. You did not mention in your video that often [though not at every center], air medicine or the team using the air ambulances is made up of doctors, rather than EMTs or paramedics, as is typical of ground ambulances in the US.
This means that the times you are citing to first be seen by a doctor is dramatically reduced, as we can begin to assess and treat the patient right there on the scene and during the flight. As well, a patient who may not be stable enough to leave in the hands of EMTs or paramedics, can be [more] safely transferred while remaining in the care of doctors during an air ambulance transfer.
I have great respect to paramedics and EMTs who face tremendous situations on a daily basis. However, there is a great difference between a physician's ability to diagnose what's happening in a patient and stabilize the person on an air ambulance, versus what ground ambulance teams are trained and able to do.
These factors mean that air ambulances do not solely provide a more expedient means of transportation. They allow for stabilization of patients who, in ground ambulance teams, would not be stable as they make their way to hospital or between hospitals.
USA Healthcare be like: We think a human's life is priceless. But only if they have money to pay for it.
The ambulance will always pick you up and you will always be treated. They just bill you for it all afterwords.
@@rilyc2843 you will be “stabilized”
Reminds me of that one Onion headline.
"Health insurance companies reach record profits."
"'We did it by just not paying' says agent"
It's the same for any healthcare system. It's only as good as the funding. Free, poorly funded government healthcare is horrible. Well funded, privatized healthcare is superior. Free, highly funded government healthcare is great but not every country can pull it off.
@@patrickreynolds6270 that’s quite the oversimplification
Well this took a dark twist, started off with a really feel good story.
At 17:32 there is a romanian medical helicopter, Eastern Europe. It does not apply there because the entire medical emergency service is free in Romania, as well in many European Countries. All medical chopsers are operated by the State and no patient pays for medical service. Also its not all about how fast a victim arrives at the hospital but the fact that a helicopter brings a specialised trauma medic to the accident site very fast, giving the first aid and stabilising the patient.
Reads 'Romanian healtcare'
Gets "The Death of Mr Lazarescu" flashback
This is a great video and I wanted too mention that an air ambulance saved my cousins life! He had a brain tumour and he had a seizure and lived in a remote part of newzealnd and would have died if the air ambulance didint get him too the hospital in Auckland where he could be treated properly! Great respect too all air ambulance pilots out there
Land of the free
* Free not included out of network
* Free not inclusive of tax
Free to take desperate peoples moneys all day long.
Why do those networks even exist in the first place? It wasn't the topic of this video but it seems that those networks are also one of the worst ideas ever for citizens, and just exist to profit off the people.
Land of the free people as in they don't cost you anything
Land of the fee and home of the grave.
@@wormsblink2887 that makes me think how funerary businesses are preying on people too
I thought it was something about the health effects of being in a helicopter. Nope, just America's broken medical system.
I was picturing that vid of the woman spinning as she was being lifted up lol
I was expecting the problem to be that people would die in unececery transfers, not that a lifesaving helicopter ride is a 1 way ticket to poverty street.
@@adriannahowell2359 lelelel same XD
I was thinking it would be because the helicopters could struggle finding a spot to land...
@@iexist1300 Yeah I thought that like it was that perhaps a helicopter ride itself is dangerous because of the vibrations or something and in some instances a longer car ride could actually be safer for the patient because it would keep them still or something, or maybe they were dangerously overused in some way. Didn't realize that actually this was just a capitalism problem and the helicopters are perfectly fine.
An air ambulance saved my younger brothers life in rural Minnesota after a log splitting accident
In Switzerland, we use a sort of subscription service to the non-profit organization REGA, our air ambulance service. It costs 40$ a year and guarantees that they‘ll pick you up free of charge, wherever you are in the country, when it isn‘t directly accessible by road (as we have a lot of mountainous terrain, this accounts for a large portion of the country). Additionally, if you have an accident abroad, they will pick you up from the hospital in one of their jets and bring you back to Switzerland, also free of charge. If you don‘t have a subscription, you still don‘t have to pay the full price, as the company is heavily funded by independent sources.
You forgot the "in the USA" disclaimer.
As usual.
@@Statusinator damn he should make a video about wait time for surgery in Canada
@@alexander5662 I'd much rather wait 3 months for a non urgent surgery than having to pay a ridiculous amount of money.
@@joshuabowerman882 well that u but depends what is a urgent surgery right because small Symptoms usually are because of a bigger problem 🧐
@Mr. Turnip The second thing he said wasn't stupid, small symptoms can result from bigger problems. As a bit of an extreme example, people with cancer usually only start feeling pain when the cancer is so widespread that it is very hard to stop, making early treatment key. That said, doctors who refer patients to this or that waiting list are generally pretty good at determining what the cause of the symptom is, so I don't agree with the wait time for surgery in Canada being a dealbreaker, annoying as it is (one of my family members got put on a year long wait list for an X-ray once).
Another episode of what I like to call "What the heck America?!"
Right :)
As always, blame the government.
@@candyy9746 laughs in a comment section of an American company 🤔
@@matthew8153 how is this not the government's fault? Every other developed country doesn't have this issue because of government action.
@@Spongy656 Because the people support it and let them remain in power. Just try your luck on Twitter with a bait like "hey why don't our country has covid benefit?" or "why Bernie didn't run for presidency back then. I'm sure he'd do well?" And watch as the capitalist glorification flows like golden shower. Worth a popcorn.
"Unprofitable rural hospital" has to be the most American thing I've heard in a while
it sounds like this could all be solved by one thing: keeping the unprofitable hospitals open through socialized healthcare. Not subsidized. socialized.
terrible idea. forcing people to pay for something they may not want or may not use. holding a gun to their heads is terrible. thats what happens if you dont' pay taxes.... so its forced by violent threat of arrest. not compassionate and not freedom.
"closures of unprofitable rural hospitals"
*Confused British look*
*confused Canadian look*
Confused Sri Lankan look
*Confused Rest of the world look*
**Confused Malaysian look**
Confused Arubian look🤨
When profiting on other people's life is a business.
god bless the USA
You miss-spelled “healthcare industry”
@@stephefw7601 If you read a lot of the comments a lot of people are talking about how weird it is to pay for healthcare
thank god i don't live in america....
Britain is supirior in pretty much every single way.
@@davidty2006 Military?
The Golden Hour was established under combat conditions in Korea and Vietnam, and in the age of IED and terrorist attacks in the modern age of the Global War on Terrorism in Iraq and Afghanistan the principle has held up.
In London, HEMS brings surgeons and paramedics to you. They will even perform open heart surgery at the roadside if needed. If it was about patient care in the US, they would offer that level of service. Then it might excuse charging $30k.
Hearing about all the costs and how american hospitals need to be profitable moneymakers feels so sickening
Makes you wonder if they're being honest about COVID 😏
We're sickened too, but we can't afford to go to a doctor so...
Nah it's more about being sustainable than profitable
The insurance companies charge the hospitals tons
@@thismans1405 In all fairness hospitals in countries with universal healthcare are still sustainable. It's just kind of appalling how some people just don't have access or are forced to pay absolutely over-the-top bills just to stay healthy.
That was easily the most depressing end to a video you've done so far.
It is comrade Sam coming to terms with his political opinions tbh.
We can expect a "why capitalism doesn't work" in 6-8 months on this pace
@@boe277 this is not the fault of free market capitalism, he literally went over this in the video. If it weren't for the fact that the air ambulance market isn't/can't be a free market then prices would be way lower.
@@boe277 Bruh even a lassiez-faire libertarian would agree this is disgusting
yeah
@@boe277 I mean it doesn't that much should be obvious to anyone with a pair of eyes and a brain. And even if you lack eyes you could probably read about it with braille.
5:48 I feel like you left out a big part there, the "...at least during the first hour after injury" part immediately following what you quoted. That feels like it still fits within the golden hour rule quite nicely.
I'm not American so can someone from the US explain how can a person be compelled to pay for a service that they did not consent to buy? 🤔⁉️
thats how it works OUTSIDE the U.S.. other countries are taxed more, forced by the government without their consent to buy something they didn't ask for. that is sick and wrong.
@@adamr8628 The USA is the only major economy and advanced country in the world that does not have universal healthcare in place for its citizens and workforce. Because of this lack of uniformity and access, the average American spends twice as much on healthcare as compared to their counterparts in other developed countries. Apart from this, the USA also has the highest number of hospitalizations and deaths from diseases that are considered to be easily preventable and the highest infant and maternal mortality rates. Compared to the other major economies in the world, the United States healthcare system ranks the worst and gives minimum to no coverage for its working classes.
I live in the UK and pay 20% tax and that includes my healthcare full coverage for myself and my family. I have 3 neurological conditions, a congenital heart defect, and a thyroid problem. Had a pregnancy with complications, and many other things along the way. I have had decades of treatment and have been under the care of many specialists and consultants including a cardiologist, neurologist, neurosurgeon, pain specialist, ENT consultant, audiologist, etc. Decades of MRI/MRA scans, echocardiograms, ECGs, 24-hour heart monitors, surgeries, procedures, blood tests, ambulance call-outs, doctor call-outs to my home day or night, hospital stays, physiotherapist, A&E visits, X-rays, broken bones, hearing tests, antenatal care, postnatal care, and a whole lot more. Not to mention all the healthcare from my primary care doctor, health checks, and annual screenings. The cost to me is £0.
I pick up my prescriptions from my pharmacy every month and pay £0. Medications are free for many health conditions. Medications are also free to Children under 18, People aged 60 and over, People in education, People who are unemployed, Pregnant women, and People who can't work due to illness and disability. For People who do pay for their medications, all prescriptions are £9.65. All forms of birth control are free as are all vaccinations. After being discharged from the hospital women and their newborn babies receive their first 2 weeks of postnatal care home midwives do daily home visits. I had COVID last year and recovered but still had chest symptoms. I called my primary care doctor in the morning who came out to see me that afternoon on his home visits. He examined me and prescribed me a 5-day course of Antibiotics to treat a chest infection. The cost to me was £0. If I stopped working tomorrow absolutely nothing regarding my healthcare would change. Healthcare is a human right that everyone has the same access to regardless of whether someone is in employment or not. Americans pay taxes and then they have to pay health insurance and even then they still have out-of-pocket expenses. The USA is the only country in the entire developed where people have to beg strangers for money on go-fund-me to help pay for their medical bills. Where people avoid seeing their doctor for fear of medical bills and ration or go without their medications simply because they can't afford them.
You can actually hear the anger in his voice towards the end, and I'm not surprised. Everyone should be angry at this
🤔?
Right!!! I started almost tearing up towards the end at how awful the owners of these companies are, thanks is to all the pilots/paramedics/doctors who work on these helicopters to save people’s lives but the executives can rot in hell. I’m not a very emotional person but this got me
U.S.A!
No, this is fully interesting.
h
First
You sir are first
You sir are first
That’s why it’s not on the half as interesting Chanel LOL
Meanwhile, in the UK. Most if not all air ambulances are charities that need to fundraise to be able to operate (usually with government assistance) and the patient is never charged
Very interesting, as an EMT in rural America but within 45 minutes of a level 1 trauma center i see this decision frequently. We generally call if there is going to be a delay cutting through the car. We do have neighbors 20 minutes further from town that call a lot more frequently. I only called once which was for a lady 9 months pregnant and had head trauma. Turns out her placenta ruptured and they got the baby out just in time.
I understand the financial concerns but we (first responders) are also screwed because if we dont call and the patient dies it is our fault because we didnt call
Although your (potential) over-diagnosis saved the life of mother and baby, I’m sure the family was quite distressed that they had to skip family vacation that year because of the air ambulance bill. 😅
Great work out there, stay safe 👏
new title: How America Doesn't Work (air ambulance edition)
This ended like a second thought episode
this should be a new series XD
@@375-Gaming I'd watch that! ...and laugh. And then feel sorry for Americans.
@@375-Gaming thats basically second thoughts channel
@@jahajesper looks like after second thought, DHS has found a new youtuber to visit
"Closure of unprofitable rural hospitals"
What in the American hell?
The economy allocates scarce resources. Believe it or not it wouldn't make any sense to put any hospitals in a place with a couple hundred people or along a long Desert stretch of road where they literally use airplanes to catch people speeding because it's such a desolate area. Hospitals have to have expensive machines and expensive staff. 90% of the country is covered in that map and the only places that aren't are desolate as hell and somehow you don't understand how markets work. People also live in these areas on their own free will and I bet you if you asked whether they would prefer a hospital or lower taxes they would choose the taxes every time.
People weren’t getting sick enough
@@deuscoromat742 because Americans enjoy the delusion that nothing bad will happen to them. Many rural communities are complaining about the lack of local healthcare.
In the rest of the world rural hospitals don't exist in the first place.
@@brittgayle467 Where are these complaints? I'm curious because I haven't heard any and I've lived in rural communities with less than a thousand people indefinitely. What I do hear rural individuals complaining about are the Trashy under-equipped hospitals that have killed their kin because the staff seriously lacked experience and how they would tell all their friends and family to avoid them like the plague if they ever had an emergency. I think that people that live in rural areas are under no delusions that they have a higher likelihood of dying then someone in the city. If a part of life here, you don't move to a city for the peace and quiet. Is actually astonishing that there are people in the world that can't wrap their head around the fact that america is the wealthiest country in the world Because we don't put a hospital on every corner lol.
I'm curious if American's are aware of travel insurance often works.
Many 'worldwide' policies have two options: excluding US or including US. The including US is more expensive. No other countries are on the exclusion list. Just the US. It's not related to the danger level - just the cost of treatment.
I think that's a really illustration of just how expensive the system is.
In my country (India) health insurance companies include Canada on the list too, the company I interened at at least did.
My brother was airlifted at least 5 times in his 10 years (extreme, intractable epilepsy and Cystic Fibrosis). Not because he was too fat to a hospital but because he needed to be at a CHILDRENS hospital asap or he’d die.
Between those flights and his hospital stays, we owed over $100,000 in bills when he died. He’d lived less than 10 years from his brain injury. This was in ‘99. My dad made good money, mom had to be a SAHM due to my brothers care.
Every other country: we got you, we'll get you out of this you'll be alright
America: Yeah so, you wanna put this whole survival thing on your credit card or?
You do realize that if you spent more then 10% of your income on healthcare it’s a tax refund right?
@@Andy-ow4gt sounds great, spend 10% of your income on medical bills and you get to claim it on your tax. I’ll take free healthcare over that haha. Plus if we get private health insurance we can claim it on tax regardless of the amount
@@Andy-ow4gt You realize you cannot get a tax refund larger than you paid tax, right?
Credit card? What credit card? Do you take my food stamps?
@@Andy-ow4gt It's a 7.5% floor, and that's when it STARTS counting towards your itemized deductions. Itemized deductions do you no good until you hit the standard deduction amount, which is $12,550-$27,800 depending on age and marital status. That also requires that you have paid the bill, so it cannot be outstanding as of 12/31, or no deduction for you. If you try to use an HSA, you have a cap of annual funding, and many health insurance plans (all of the marketplace plans in my area) have a maximum out of pocket that far exceeds the annual contribution amount.
“...the private equity firms that now own the majority of them...”
Ah, well, there goes any hope of regulating them at all.
Probably. However there's still a chance the U.S. government could force them to break up and split into several smaller companies
Private equity companies only exist to get rich off of making the lives of others miserable.
Indeed. The lobbying by those PE firms of members of congress will halt any proposed legislation.
@@SurprisinglyDeep which goverment? Democrats? Republicans? They're all in the same pockets. Or do you think that by some miracle Bernie or someone like him is going to be allowed in office? No chance buddy, The interested parties' profits are far too great for them to allow such a thing.
welcome to America. Where everyone has a price
I still remember Steven King in his book On Writing describing being moved via air ambulance when he got hit by a van and how the air paramedic asked him enthusiastically "Is this your first time riding in a helicopter?"
4:16 - though you'd be surprised at how few Mi-8s are used in the US as air ambulances.
0:00 : *Ooo, Wendover uploaded!*
20:52 : *Well thank fucking god this is over.*
good old america, even saving life is a business
Which is why we support Medicare for All.
@@BoogsterSU2 or some of you do... There's still a lot of idiots calling it sheepish and what not.
Not really. Videos like this usually have a narrative. You would be surprised at the amount of not for profit facilities in the US.
@@BoogsterSU2 so you want to go to a hospital run by the same people that run a driver’s license office? No thanks.
The more you need it, the more they can drive up the profits
Cost of Air Transport is complicated. Most good have a 40-60% markup so something that costs 12K being sold for 25K is kind of on point. The cost of the pilots, EMT staff, medical equipment, chopper maintenance adds up. I think there should be more control but it will end up with the government just subsidizing the industry if there is too much regulation. Everyone complains about government healthcare but it seems to be more favorable than public stock market company healthcare and can be better regulated.
You may not be accounting for the fact that high care level vehicles, ie air ambulances and critical care ambulances, now provide services on arrival that possibly rival or exceed the care provided on arrival at hospital when the "golden hour" theory was formed. Really, survival in most cases relies on "time to stabilization" rather than "time to hospital care", as once stabilized time to further treatment makes little difference to survival. However, I also totally agree with the damage to quality of life that financial burden of that magnitude can cause. And a loss of a year's income isn't recovered in a year, it probably impacts a life for more than 5 years, during which only basic survival might be possible. "Saving lives" at a price too high does eventually reach a point of diminishing returns when it's also creating years of financial slavery to debt in so many
I’m glad more people are hearing this now. It’s insane.
As long as not every single American will send this video to every single politician (in us) nothing will change🙄
And I'm glad you're glad
Well tbh the efficacy of the air ambulance system is not my top concern right now
@@Jesse-2531 US leftist politicians (but not limited to them only...) are dump as F... most off them I know about, to be clear. But if you want to make it even worse, let it be :D
This feels like an episode of Last Week Tonight
Omg trueee
should we spam John Oliver with this so we get an episode?
@@jpfidalgo7 yes do it
the news never seems to tell the other side of the story.
A lot of air ambulance bases are closed each year because it costs too much to operate. Lets say that it costs $ 2 million per year to have one helicopter base in operation. And some bases only get 50 flights for the entire year because of bad weather and not having enough pilots to cover shifts because the airline industry is taking all the pilots because they can afford to pay more. Insurance doesn't pay for a lot of those flights. When the patient can't afford to pay, the bill gets forgiven. Now you have bases that cost $2 million per year and they aren't even making that much per year and they close. Do a google search on air ambulance bases closing . there are a lot that are closing.
Here in Kuwait I do see the red helicopter flying from gov hospital near me. It's done for when they need to transfer but notably when you're afar in the desert.
They don't charge you anything and the gov is the one operating those emergency methods.