Emergency medical personnel work hard to get patients to the Hospital of the University of Pennsylvania. In a race against time, seriously injured patients are rushed to the medical center from around the area, over land by ambulance -- and through the air by helicopter.

Dispatchers call air ambulances when an emergency is severe enough to require a top trauma center like HUP and every second is of the essence. Like all such centers, the hospital is always staffed by trauma specialists and has specialized equipment for difficult cases.

Because they are spread out in bases outside of Philadelphia, Penn's helicopters can arrive at accidents outside the city much more quickly than if they were based in the city. When Penn's second helicopter ambulance, named PennSTAR2, moved from HUP to Brandywine Airport west of the city, the helicopter started to get more calls from dispatchers in that area who were looking for the fastest way to get patients to care, said Kevin Thomas, a PennSTAR administrator.

Being closer is not the only way to decrease response times, though.

Two more Penn helicopters are located near Allentown, Pa., and Reading, Pa., further from the city -- bringing the Penn vehicles into competition with a greater number of health-care providers. So to keep up with its rivals in the area, instead of flying Eurocopter BK117 helicopters, Penn flies the faster Agusta A109 model.

But speed doesn't just matter for competing. It can also save lives.

Helicopters typically get patients to the hospital just over an hour after the call was received, past the so-called "Golden Hour," or the first 60 minutes after an emergency occurs, during which chances of survival are greatest. Epidemiology professor Charles Branas downplays the importance of that window, though. A sharp increase in mortality among patients who miss the one-hour cutoff has never been documented, he said, adding that the Golden Hour is "just another way of saying that time matters."

A ride in a helicopter ambulance may be safer as well. Emergency Medicine professor Zachary Meisel said that the cramped conditions of helicopters require a degree of organization and standardization not seen in ground ambulances, reducing mistakes in the confusion of an emergency.

Those advantages come with a hefty price tag, though. To keep its $4

million aircraft running with a complete crew, Penn charges the insurance of each patient transported by helicopter about $7,000. To someone miles from a hospital with a heart problem or mangled limb, however, that may just be the bargain of a lifetime.

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