Seabrook Island is a rural residential community on the coast of South Carolina. The island is approximately 20 miles from any of the area’s emergency-capable hospitals in Charleston so with traffic considered, access to emergent health care for the island town has been an issue since it was founded. There are few direct paths in to the city and its hospitals from the island, most of which are two lane roads, and as a result they are riddled with consistent traffic jams. Any similarly equipped urgent care facility is also more than two-thirds of the distance in to the city, and even then, such clinics cannot provide the diagnostics or treatments needed for life-threatening illness or injury. Apart from those urgent care clinics, the only other ancillary services in the surrounding area are non-emergent practices such as chiropractors and dermatologists. Knowing that substantial medical issues require immediate access to emergent triage, it is imperative that access to such healthcare be consistent. A simple solution to efficient care is rapid transportation to suitable medical facilities via air ambulance, but unfortunately cost makes the service unattainable for many. An option that could protect Seabrook Island residents would be city-wide air ambulance insurance coverage.
The permanent resident population of Seabrook Island is approximately 1,700, of whom 98% are white, and the median resident age is 67 years. 93% of residents are US born, and there is a median annual income of $95,114 (Data USA 2016).
With Seabrook’s “closest hospitals many miles away and added congestion from summer visitors, [the] beach community is looking to the skies for help with medical emergencies.” (Findlay 2017). Because summer traffic and poor road infrastructure make a commute to the city an hour-long journey, ground ambulances are a poor choice for life-threatening medical issues. If roads are impassable due to visiting tourists and tired commuters, a clear alternative is travel by flight. In fact, a study by Johns Hopkins’ Bloomberg School of Public Health found that “patients transported to the hospital by air were 16 percent more likely to survive than similarly injured patients transported by ground” (Johns 2012). Knowing the likelihood of survival in an air transport as opposed to ground, it is clear that the service should be strongly considered by the rural town of Seabrook. When there is a life-threatening issue, the quality of service provided “can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care” (Barber 2017), including the differences between ground and air ambulances.
Jeffrey Lubin, MD, MPH, gave a presentation about why a HEMS (helicopter emergency medical service) would be used as opposed to a GEMS (ground emergency medical service). He evaluated patient transport methods against mortality rates and found that in almost every variable he studied that helicopter transport resulted in better outcomes. To start, the overall mortality rate of GEMS is 25.3%, while HEMS is only 25.2%. Furthermore, patients with an AIS score1 of four or more taken on GEMS have a mortality rate of 36.7% while HEMS is only 34.9%. Finally, a patient with a Glasgow Coma Scale from three to eight faces a mortality rate of 48.9% on GEMS as opposed to just 43.6% on HEMS. The data he shared can be found in Figure II of the appendix (Lubin n.d.).
To clarify why HEMS have better outcomes than GEMS, Lubin explained the inverse relationship between average time until treatment and mortality rate, as shown in Figure III in the appendix. “The county said that its average response time to Seabrook is about 13 minutes, and the average transport time to a hospital is about 40 minutes” (Findlay 2015). To clarify, that is a total GEMS transport time of 53 minutes not counting triage at the site of pickup. Knowing the risk of GEMS, an MD resident of Seabrook Island, J. Reves, said that “if on Seabrook, a
1An AIS score refers to the Abbreviated Injury Scale, which classifies an injury on a scale from one to six. The scale is defined as shown in Figure I in the appendix.
helicopter should be considered as the travel time is markedly reduced by this form of transport. The most important thing is to recognize a [medical emergency] is happening and get help immediately” (Reves 2015). Dr. Lubin suggests that EMS services strongly consider HEMS if a GEMS ambulance dispatched is beyond 20-30 minutes from the patient. With Seabrook transports being the average of 40 minutes from emergency care via GEMS, it puts every patient there at risk.
Fortunately, HEMS service is available almost everywhere in the United States as to date, but the issue is cost to the patient. A Seabrook Island “resident who had medical insurance was hit with a $25,000 bill for air ambulance transport” (Findlay 2016) because their policy did not cover HEMS. The decision to take the life-saving transport resulted in a crippling debt for this person. Not every EMS response needs to be via helicopter, and usually “doctors, firefighters and paramedics make the call on whether air transport is medically necessary. Air ambulances most commonly carry patients with traumatic injuries, pregnancy complications, heart attacks, strokes and respiratory diseases” (Findlay 2017). The service would not need to be used by every resident with a call to EMS, but for any urgent cases HEMS would be the best choice if not for cost.
To avoid residents of rural areas acquiring substantial and life changing debt, most HEMS providers offer insurance coverage to municipalities. If Seabrook Island’s city pays for $18,000 annually in city-wide coverage to provide the benefit for the city's 1,700 residents, any medically insured island resident is flown by air and covered because the HEMS provider then “works with [their] benefits provider to secure a payment for the flight. Whatever the patient’s benefits provider pays is considered payment in full” (Findlay 2017). If the patient turns out to not be covered by any medical insurance, the HEMS provider “will bill the covered person at the ‘Medicare Allowable Rate’ for the transport,” which is approximately a third of the cost that is charged by the HEMS provider (Islands 2017). Many see the solution of HEMS insurance coverage as “an innovative solution to address the needs of rural populations and to give residents peace of mind” (Findlay 2016).
Considering Seabrook Island’s geographical separation from adequate health care for life-threatening issues, it is clear that a plan needs to be enacted to protect the population’s well-being medically and financially. HEMS are the clear choice for efficient transportation, but with health care costs already so high, concerns of traveling to emergency services should not be another looming concern. Island-wide air ambulance insurance coverage is the community’s best option to protect itself as a whole.