> So, part of that is that even when an ambulance gets there, what happens next? […] Out in the boondocks, the golden hour is laughable.

In the province in Ontario, where we have a few density populated communities often surrounded by large stretches of wilderness, folks are transported by helicopter in emergencies:

* https://en.wikipedia.org/wiki/Air_ambulance

* https://en.wikipedia.org/wiki/Air_medical_services

* https://sunnybrook.ca/content/?page=rooftop-helipad

If you look at the list of heliports in the province, you'll see quite a number of them are at hospitals:

* https://en.wikipedia.org/wiki/Category:Heliports_in_Ontario

Including ones, like St. Mike's and Sick Kids, in high density areas where they're often at the top of high-rise towers:

* https://www.youtube.com/watch?v=-OtDwkg-jGI

There are also non-emergency patient transportation services:

* https://en.wikipedia.org/wiki/Ornge

We have air ambulances in the US. With it being the US and the community being largely rural and poor, it's more economic to die than be flown to help. Most families can't swing a $40,000 cost for a life flight, and insurance in some cases won't cover it.

https://www.washingtonpost.com/business/economy/why-the-flig...

Weird, the article talks about air ambulances being billed as out of network. I thought that after Obamacare passed insurance companies were required to treat all emergency care as if it were in-network. Does that not apply to transportation? Or are helicopters being used in situations that insurance doesn't think are emergencies?

The point is that nobody knows the answer to this. Good luck fighting the insurance company in court.

In Ontario (and Canada) the majority of healthcare costs are done via taxes through our single-payer systems (health is provincial jurisdiction, hence plural; though there are federal equalization payments).

That's fine. Just don't tell them you're poor until after the flight.

That depends on the nature of the ambulance service. In the US/Canada, ambulances cover basic stabilization and transport the nearest trauma center. We in NA have a culture whereby minimally-equipped ambulances are tasked to deliver patients to hospitals asap. That approach isn't universal, nor is it necessarily the best. In France, some ambulances bring docs with them to do things beside the road that in the US would only be attempted at a trauma center. That could mean stopping the ambulance by the road so the doc can work. Helicopters also act differently, often taking the patient not to the nearest hospital but to the one that is best equipped for the case (ie the one with an MRI for suspected stroke).

My first time through first aid training was just after princess Diana died. The trainers from the local level one hospital were convinced that if the accident had happened in the US she would have lived. They even had a local case of a very similar accident just a month before where those involved lived, in large part because it wasn't on doctor in the ambulance trying to do things it was over a dozen doctors specializing in different things working on their part at the same time.

Of course the point of all the above is call 911 (or the local emergency number) ASAP, the faster you can get experts involved the better.

There are plenty of stories/opinions one way or the other. What occasionally comes up are situations where doctors unexpectedly arrive at accident scenes, take over, and apply procedures that the ambulance crews are totally untrained for.

"Dr. Mark Forrest knew he had to act fast to save the life of a man he watched go into cardiac arrest after a motorcycle accident — so he opened up the man's chest right there on the road and brought him back from the dead."

https://www.cbc.ca/news/canada/british-columbia/doctor-who-s...

Which is great if you have the right training for what is needed. If you are a great heart surgeon and arrive at the scene of a stroke you don't have the right training to do anything useful other than basic first aid.

That’s a fascinating story. I wonder what procedure was actually performed.