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Helicopter, other "air ambulances": time to assess effectiveness?

A sheaf of news releases on expanded or new hospital-based "air ambulance" services has gone out in recent months as this type of service enters a high growth phase. Now that dedicated hospital-based programs have been in operation in this country a dozen years, some observers suggest, it may be possible to begin to assess their effectiveness. The main question is whether these programs— which at a starting cost of about $500,000 a year admittedly are very expensive to maintain—upgrade the delivery of emergency services enough to be worth the tab. Also to be answered is whether helicopter transport itself may, at least on occasion, put patients at increased risk of further injury. What appears to be the progenitor of all programs in the United States is at St Anthony's Hospital in Denver. Henry Cleveland, MD, one of its founders, is forthright in his assessment of air transportation for medical