MARATHON -- TraumaStar, the life-saving medical helicopter run by the Monroe County Sheriff's Office, is fighting for its own survival.

Monroe County voters will decide Nov. 4, in a nonbinding special referendum, whether they favor legislation to pay higher property taxes -- about $45 per year on a $300,000 home -- to keep TraumaStar running.

The Florida Keys have three community hospitals, but none of them is capable of treating most life-threatening emergencies, including trauma, heart attacks, strokes, severe burns and high-risk pregnancies. Victims must be transported quickly to hospitals in Miami-Dade County.

The island chain starts 20 miles from the mainland and runs 120 miles on a single road from North Key Largo to Key West.

Some residents believe the air ambulance service should continue to be provided by the county, like fire and police protection, to ensure equal availability to all. Others believe that paying millions in tax dollars for a service that a private company will provide to the county at no charge -- patients and insurance companies foot the bill -- makes no sense.

''We hope citizens of Monroe County understand we're part of your whole public safety,'' said Susie Martenson, a former certified emergency nurse at two Keys hospitals and now Monroe County's air medical services chief. ``I've had patients die waiting for private helicopters coming from Miami. It's really sad holding their hands.''

Monroe County Commissioner Sylvia Murphy, a former emergency medical technician, countered: ``We are facing such a severe budget crunch. There is no point in paying for something when a private helicopter is sitting at the hospital pad in Key West at no cost to the county. This referendum is the Sheriff's Office's attempt to hang onto their favorite toy.''

TraumaStar, a program that Sheriff Rick Roth began in 2002 with money forfeited by drug dealers, costs the county about $1.8 million annually.

Debate about TraumaStar began at the July County Commission meeting when new County Administrator Roman Gastesi recommended its elimination to reduce a $9 million budget shortfall.

Gastesi reasoned that private company LifeNet already has a helicopter in Key West and another in Miami to serve the Keys hospitals. The Upper Keys also has an agreement with Miami-Dade County Air Rescue for emergencies. The cost to the county for the service from both entities: nothing.

Larry Keys of Cudjoe Key pleaded to the commissioners to keep TraumaStar after relating his own experience: an emergency helicopter trip to Miami while suffering severe chest pains that his doctor called ``a heart attack waiting to happen.''

''I was on a gurney, more like an ironing board, for 45 minutes at Lower Keys Medical Center while waiting for a LifeNet helicopter to come,'' Keys said last week. ``I found out later that TraumaStar was available to go right away. My nightmare continued when I got my bill of over $19,000. It would have been thousands less with TraumaStar.''

The commissioners decided in July not to immediately pull the plug on TraumaStar, which is based in Marathon in the Middle Keys.

Commissioners extended TraumaStar's funding six more months, through March, deciding to let voters have a say in the program's ultimate fate.

The special referendum calls for an increase in property taxes to maintain the service.

For anyone who lives below mile marker 95 on U.S. 1, the tax would be up to 15 cents per $1,000 of taxable value. The tax is 7 ½ cents per $1,000 of taxable value for those living above mile marker 95, because it's quicker for Miami-based helicopters to get to them.

Monroe County Mayor Mario DiGennaro and Key West Mayor Morgan McPherson are both concerned that LifeNet is a for-profit company that could leave the county if profits fell.

Bari Conte, business development director of LifeNet Miami and LifeNet Key West, subsidiaries of Air Methods Corp., said the companies are willing to sign a seven-year contract with the county.

''Whatever happens with the referendum, we are not going anywhere,'' she said, adding that the firms have contracts with all three Keys hospitals.

Monroe County voters' decision could affect Miami daytrippers, business people and tourists -- anyone who travels to the island chain and suffers a major medical emergency.

Emergency air transportation is not cheap. Only Miami-Dade's air rescue does not charge the patient. TraumaStar costs $5,500 plus $80 per mile from the lift-off area to the hospital. LifeNet charges about $10,000 plus $100 per mile.

Currently, Monroe patients are billed whatever insurance doesn't cover for both LifeNet and TraumaStar.

If the referendum passes, Martenson said the plan is to pass a new ordinance that would exempt county residents transported by TraumaStar from being billed a balance, but would continue billing tourists and out-of-county residents for their balances. With LifeNet, all patients are billed the balance.

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