Few aeromedical programs feature a physician aboard the aircraft. But should they? And is this worth the extra cost?

Several studies have been done on the subject both in the U.S. and Europe. In the U.S., the percentage of aeromedical flights with physicians aboard has declined from 13 percent in 1984 to about 5 percent today. The typical helicopter EMS flight dispatches with one pilot, one nurse and one paramedic (or a pair of nurse/paramedics).

There is no question that physicians who receive the appropriate HEMS training can enhance patient outcomes, according to a study in the Internet Journal of Aeromedical Transportation.

The study noted that a "physician's judgment and skills are needed in about 25 percent of flights and that the flight physicians perform more procedures without altering the scene time compare to nurses or paramedics. These factors have shown to improve trauma patients' outcome and mortality."

However, the study issued the following cautionary proviso: "Residency training does not provide adequate preparation for physicians practicing as flight physicians, and EM residents need special HEMS training before flying." In other words, snagging a warm body out of the ER and throwing him/her in the back of the chopper is not going to cut it.

A common slam on having docs ride in the back is that they diddle on the scene and actual delay patient transport. However, a study of data from the United Kingdom, where physicians on helicopters is a more common practice, suggests this is not the case. Having a doc aboard increased the standard of patient care provided and did not necessarily produce transport delays.

U.K. data also showed that almost 70 percent of trauma patients needed scene care beyond the capabilities of a ground ambulance paramedic. Swiss/German HEMS operations tend to fly with anesthesiologists aboard skilled in airway management, while physicians flying in the U.S. have a more generalized background in emergency medicine.

What U.S. data there is on the presence of physicians aboard and patient outcomes is sparse and old. A 1986 Michigan survey showed that the flight physician "made a unique and important contribution to the care of the patient in 22 percent of flights" via superior diagnosis skills, quickly initiating treatment and directing the helicopter to the facility with the most appropriate level of care.

While flight paramedic training has improved over the last two decades, the absence of a national standard is seen as retarding continued progress. Flight paramedics need physician-level skills to make a difference when it comes to acute trauma patient care.

Absent that, strap in a doc in back.