Emergency workers call it the "golden hour," that 60-minute period from the moment of an accident until hospital care is administered.
Because that hour can mean the difference between life and death, helicopter ambulances are called to virtually every serious injury accident that occurs in Douglas County.
While no one doubts a helicopter ride to a hospital in the Kansas City metropolitan area is quicker than a ride in the back of a ground ambulance, it can be as much as 10 times the expense of a trip in an ambulance.
That's led to some debate about when it's appropriate to call for such transport.
About two years ago, Nancy Childers' 14-year-old daughter, Sara, fell about 20 feet while rappelling. The Lawrence girl was taken to Kansas University Medical Center by LifeFlight Eagle helicopter.
Nancy Childers doesn't question the decision by emergency crews to call for the helicopter. It turned out her daughter had two fractured vertebrae. But she said the helicopter bill surprised her and her husband, David.
The medical bill for the helicopter service alone was $5,000.
"I remember hoping that our insurance would cover it," Nancy Childers said. "We happened to be fine, but there may be a lot of other people out there who may not be covered."
Seth Myers, president and chief executive of LifeFlight Eagle, said the average billing for LifeFlight is $6,000. LifeFlight has a provider contract with Blue Cross and Blue Shield. He advises people to check their insurance policies to find out whether air ambulances are covered.
"Some cover the entire bill," Myers said. "Others may put in just a ground ambulance rate."
Ambulance bills from Lawrence-Douglas County Fire & Medical for a road trip to Kansas City average about $550, said Mark Bradford, deputy chief with Fire & Medical.
Decisions to call for air transport at an accident scene are made by the senior Fire & Medical commanders, Bradford said. Fire & Medical follows a set of guidelines for determining when to summon helicopter help.
In addition to obvious serious injuries, the guidelines also consider the cause of injury. The factors include ejection from an automobile, removal from an overturned vehicle or the death of someone else in the same vehicle.
In those cases, Bradford said, there may be injuries that are not immediately obvious to paramedics arriving on the scene.
"If someone has injuries that could cause a lacerated liver, it may be a half hour or so before those symptoms start to show," Bradford said.
In addition to LifeFlight based at Downtown Airport in Kansas City, Mo., Fire & Medical can call on other helicopters. Life-Net is at Johnson County Executive Airport, and LifeStar is at Forbes Field Airport, Topeka. The one called depends on availability and the accident's location in the county.
Most of the injured are flown to Kansas University Medical Center or Overland Park Regional Medical Center.
KU Med Center is rated as a level-one trauma center by criteria verified by the American College of Surgeons. It is the only regional level-one center outside Wichita. Overland Park Regional is a level-two center.
A level-one trauma center must have a surgical team at the hospital 24 hours a day, said Dr. Dennis Allin, director of KU Med Center's emergency medical services. A level-two center must have a surgeon on call and within 20 minutes of the hospital.
All children 16 years old or younger are taken to Children's Mercy Hospital, Kansas City, Mo.
If a hospital's trauma center closes because it can't handle any more patients, Douglas County dispatchers receive a message via computer, Bradford said. Patients then would be flown to the nearest level-two trauma center, such as Stormont-Vail Regional Medical Center in Topeka.
The state of Kansas is in the process of setting up its own official trauma center rating but is expected to use the American College of Surgeons' standards and verification, said Allin, who is on the Kansas Advisory Committee on Trauma.
Lawrence Memorial Hospital officials say it may apply for level-two or level-three trauma center status.
A level-three center is primarily patient stabilization. A surgical team must be on call, but arrival time at the hospital is not monitored as closely as for level-two, Allin said.