Is the flight physician needed for helicopter emergency medical services?

The question of whether physicians are cost effective in helicopter emergency medical services (HEMS) transport remains an unresolved issue. During a four-month study period, all physician-specific contributions to medical care were recorded by means of a questionnaire that was completed by the flight physician and the flight nurse after each flight. In the judgment of the nurse, the flight physician made a unique and important contribution to the care of the patient in 38 of 174 flights (22%) completed during the study. Judgment, the most common contribution, was cited on 29 flights (17%). Both skill and judgment were contributed on seven additional flights (4%), and skill alone on only two flights (1%). Judgment was exercised most frequently in making diagnoses, initiating critical medical treatments, and determining destination. The cost to this program of providing physicians is approximately $85,000 per year, or 7% of an annual budget of approximately $1.2 million. Flight physicians make a substantial and important contribution to patient care in HEMS operations, exercising critical judgment regarding diagnosis, medical treatment, and disposition in 22% of transports. The benefits of this contribution far outweigh the 7% program cost.