The helipad at Myrah Keating Smith Community Health Center (MKSCHC) is fully up to date and standardized with only one major component missing to make it fully operational a helicopter.
V.I. Senate President Lorraine Berry promised to reconsider an offer made by a part-time St. John resident more than a year ago to provide a helicopter for the island to assist in emergency transports which was turned down.
The unidentified resident offered to organize and fund a helicopter and staff it with a crew and pilot 24 hours a day for emergency transport in exchange for occasional personal use of the helipad, Sen. Berry told a the Senate Health and Human Services Committee meeting on St. John Wednesday, October 26.
Currently, everything on the helipad works, said Dr. Joseph DeJames, one of two physicians at the clinic. As part of MKSCHC maintenance, the helipad is painted properly, the lights and signals are functional and it has a windsock, added Dr. DeJames.
The bottom line is we want to save lives, and whoever is willing to do this, we ought to listen, said Senate President Berry, promising to follow up on the prior offer.
Transporting Patients Off Island
One of the critical concerns encountered with patient care at MKSCHC expressed at the senate hearing by Dr. DeJames involves transporting patients from the clinic to another off-island health care facility.
While patient transport during a critical emergency often takes an hour when traveling by ambulances via land and water due to logistics and staffing, a helicopter could do the job in a mere six minutes once it leaves the clinic.
That trip takes approximately six minutes via air and one hour by land and water, said Dr. DeJames. Although having a helicopter is a health priority, because St. John only has a population of 4,700, there is not a high enough volume of emergencies to make staffing and maintaining a helicopter full- time cost effective, according to Dr. DeJames. There is no helicopter in the territory to provide that transport, said Dr. DeJames. Such a low volume of emergencies accompanied by the high costs associated with maintenance, operations and 24-hour staffing would require a cost analysis to determine if it was a viable option, he added. We would need to do a cost analysis to see how many transports we have over a year or season and see what the local resources can afford to fund, Dr. DeJames added.
St. John Patients Paying More
One of the ways St. John patients feel they are over-paying for health care is when they are transported from St. John to the Schneider Regional Medical Center on St. Thomas and are charged multiple times for ambulance services.
St. John residents are constantly being penalized, Yvonne Wells told the committee meeting, speaking on behalf the St. John Business and Professional Womens Organization, the St. John Lions Club and the AARP Chapter 4777.
A patient is charged for an ambulance ride when picked up from his or her original location on St. John and taken to MKSCHC; when transported from the health center to the ambulance boat in Cruz Bay; again when transported on the ambulance boat to Red Hook and a final charge is tacked on for the ambulance ride from Red Hook to Schneider Regional Medical Center.
Each encounter or individual patient ride on an ambulance costs about $400, which would bring the total charge for a St. John patient being transported on four separate rides to RLS on St. Thomas to $1,600, according to Department of Healths Commissioner Darlene Carty.
Tell me, isnt that a bit too much for people on this island? asked Wells. What can be done to remedy this situation?
Replace Boat with Chopper
Senator at Large Craig Barshinger suggested researching the option of eliminating the ambulance boat and replacing it with helicopter emergency service.
Although the volume for emergency helicopter transport may be low, if we sent everyone by helicopter and abolished the four leg ride on land and water, sending every patient by air, the economy of scale might increase, said Sen. Barshinger. St. John deserves the best possible treatment and we cant get that when it takes four separate encounters on an ambulance to get to St. Thomas.
Once a patient is picked up in an ambulance and taken to MKSCHC for stabilization, doctors can make a determination as to where the best health care facility is located and then send the patient off island for treatment, according to Sen. Barshinger.
As medicine evolves and specialized care becomes more available, it can make the difference between life or death, said Sen. Barshinger, adding that patients could be air lifted to St. Croix for cardiac treatment or to Puerto Rico or Miami for burn treatment.
There are different kinds of emergencies and a boat can only get us to St. Thomas whereas a helicopter can get us to St. Thomas or Puerto Rico, said Sen. Barshinger. Our options are so much greater and the speed is so much faster when we fly.
I think air transportation for St. John is the way to go, said Sen. Barshinger, pointing out that when an ambulance boat is in use, there are no EMTs on the island and no method available for transporting patients to St. Thomas for at least an hour.
No Emergency Helicopters in Territory
There are no emergency helicopters operating in the territory, and the nearest air transport available is a plane that would have to fly from Puerto Rico to St. Thomas, which could take four or five hours, according to Dr. DeJames. Having an emergency services helicopter on St. John with additional EMS resources would be a huge benefit, both financially for patients and for additional emergency staffing, according to Dr. DeJames.
It would definitely help for two reasons cost wise, it would be less expensive than the different ambulance steps, and it also would not tie up any of the local EMS resources right now if EMTs are on the water, they arent on land to assist in another emergency, said Dr. DeJames.
Having a helicopter to assist with patient transports during an emergency would be a huge benefit to the island; however, the costs associated with maintaining and staffing a helicopter full time would be the main limiting factor, according to Catherine Taylor, treasurer of St. John EMS association.
The cost effectiveness of maintaining and staffing a helicopter on a 24-hour basis in the territory is the limiting factor, said Taylor. The cost of maintaining and keeping a crew on staff for the EMS ambulance boat in Cruz Bay is extremely costly, according to Taylor. And it costs much less to maintain and upkeep a boat in the water than it does to staff and maintain a helicopter full time, she added.
Health services on the island would positively benefit from the donation of a helicopter if it was fully staffed with pilots as well as emergency personnel, according to Dr. DeJames.
Because we are short staffed EMS wise, St. John may not be able to provide its own EMS staff, he said. The operation would have to be a collaboration between the Schneider Regional Medical Center, MKSCHC, the Department of Health and the private entity. Unless these entities come together to iron everything out, it may be a little confusing to fully implement, said Dr. DeJames.
Previous Air Service in V.I.
Wings of Life, a privately-run company which provided a territory-wide ambulance-run helicopter service, operated for a brief period in 2003, but due to the operation being very labor intensive and costly, the low volume of calls and issues with insurance collection, the company discontinued the service according to Dr. DeJames.
Lisle Evelyn, president of Wings of Life and a paramedic on St. Thomas, intends to take what he has learned from the first go around with the business and eventually provide the territory-wide service again.
I do intend to get the service up and running again, said Evelyn. It was a much needed service, especially for the St. John patients because the time frame is only six minutes from the St. John helipad to the helipad on St. Thomas. Wings of Life, which employed its own paramedics and respiratory therapists as well as pilots, operated for about a year, but ceased operations in 2004, according to Evelyn, who said the main problem encountered was the trouble collecting payments from Medicare- or Medicaid-insurance providers.
Running a helicopter service is very costly, and we tried to make our rates cheaper than the costs of the land and boat ambulances to make it easier for the patients, said the president of Wings of Life. This was our first time in the market so we encountered some problems, but we are trying to resolve the issues we encountered and move forward I want to clear those hurdles and get this thing going again for the sake of the patients on St. John.