Let’s assume, for argument’s sake, that helicopters indeed are helpful and make a difference in mortality. How many lives would you sacrifice in the process?

Let’s start with 35. That’s the number of people who died in medical helicopter crashes from December 2007 to November 2008. More were injured.

Is it okay to kill a few in an effort to save an unproven number of others? This seems like a discussion that should go on at the Pentagon, but we actually make these choices every day in medicine. We use drugs and treatments that we know carry significant risk, but choose to use them because of a favorable risk–benefit analysis. Some risk does exist, and a rare patient will die or suffer from a known adverse effect of our treatment.

The difference here is that not only are we putting patients at risk, we are putting their caregivers at risk as well. How many of you would give thrombolytics for stroke if, in giving it, YOU were subjected to a small but real chance of cerebral hemorrhage?

This brings us back to the question of whether helicopters are worth the risk to all involved. There will not be a universal answer, so it should be examined on a regional basis. In an era of soaring deficits and looming Medicare insolvency, we will be forced to do not only a risk–benefit analysis but a cost–benefit analysis as well.

I’ll admit that I’ve never flown on a helicopter. I had the chance to do this as a resident but declined. This decision was shaped by my experience as a medical student. When I was rotating on the infectious disease service at St. Vincent’s Hospital, Life Flight encountered unexpected fog on a fateful December evening and entered the woods of southern Michigan. The pilot and the emergency medicine resident, Dr. Jean Hollister, perished. The flight nurse survived with terrible injuries.

Every time I accept a transfer by air, I wonder if the risk taken by the crew is warranted for the particular problem of the patient. Should their lives be risked to fly a drunken person with minor injuries from one of the Lake Erie islands? (Yes, this happens.) Should their lives be risked to fly someone with ventricular arrhythmias that have been brought under control by medication?

Some will brand me a heretic for raising this question. Those that shout the loudest should probably be the first to put aside their parochial interests and consider the possibility that nothing would change if their helicopter was grounded.