Rapid test may save money by allowing quicker emergency flights

CMAJ 2000;162:1031

Dr. Andrew McNab, director of the pediatric air ambulance program at the BC Children's Hospital, and Kyle Stevens, a paramedic and third-year medical student, are comparing results from the use of an iStat monitor, a point-of-care diagnostic tool, with conventional laboratory testing of blood gases prior to airlifting patients to hospital. Analysis of the gases is a key factor in determining whether a patient is stable enough to fly. If this determination can be made faster it will save money, because it costs $3000 an hour to have the ambulance helicopter standing by, and it takes about 2 hours to stabilize most patients.

The iStat monitor, which uses a tiny amount of blood, takes 2 minutes to produce results and can be used by paramedical personnel; the tests cost $15-$20 each. (The waiting time for conventional lab results ranges from 10 to 20 minutes, depending on the size of the hospital. McNab says that in a study he conducted involving 46 patients, the average wait for conventional results was 11 minutes.) The iStat units, which have been on the market for about 4 years, cost about $8000. McNab predicts that using them routinely could result in significant savings because of reduced overtime for ambulance staff and less callback time for laboratory technicians. One in 4 flights results in overtime payments to paramedics, who carry out about 50% of the calls without an accompanying physician.

To provide a comparison, McNab said that an oximeter, which is now used heavily on these flights, paid for itself in less than a year. About 1000 children use the air ambulance service each year, and McNab estimates about half of them could benefit from iStat testing. Apart from the cost savings, children who are stabilized speedily will arrive at hospital in superior condition. "The better condition you are in when you arrive in the intensive care unit, the less likely you are to need overall hospital care," says McNab. The researchers plan to extend the project to head-injured children, a move that McNab says will result in "an even greater reduction in morbidity" and help optimize care during the transfer to the Children's Hospital.

Stevens began the project as part of a summer program in pediatrics that is offered to first- and second-year medical students, and he will continue the work throughout this academic year. — Heather Kent, Vancouver

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