An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients

Abstract

Background. Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. Objective. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. Methods. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on

Description of Medication Administration by Emergency Medical Services during Mass-casualty Incidents in the United States

“…13 The types of medications used also reflect airway management procedures with higher frequencies of sedatives and paralytics reported than in the other EMS level of care activations.…”

Helicopter transport improves survival following injury in the absence of a time-saving advantage

“…37, 38 Recently, multiple stakeholder agencies developed guidelines for air medical transport of trauma patients using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. 9 This effort was hampered by very low quality evidence, but recommended HEMS transport in patients meeting any physiologic or anatomic triage criteria from the National Field Triage Guidelines only when a significant time savings is present over GEMS transport. 9, 20 However, it is unclear from these guidelines what length of time would constitute a significant time savings.…”

“…9 This effort was hampered by very low quality evidence, but recommended HEMS transport in patients meeting any physiologic or anatomic triage criteria from the National Field Triage Guidelines only when a significant time savings is present over GEMS transport. 9, 20 However, it is unclear from these guidelines what length of time would constitute a significant time savings. Further, our group has shown that only a subset of the physiologic and anatomic triage criteria are useful for HEMS triage, based on improved survival for HEMS transport.…”

“…7, 8 Recent guidelines recommend HEMS transport only if a significant time savings is present over GEMS transport; however no definition of a significant time savings was suggested. 9 …”

Evidence-based Guidelines for Prehospital Practice: A Process Whose Time Has Come

“…The specific results of this cooperative agreement effort are detailed in the remaining three EBG-related articles published in this issue. 5,6,7 The scientific contribution of these papers is without question. Although the application of evidence-based principles to prehospital protocol development is not new, never before has there been a uniform attempt to systematically incorporate such rigorous methodology as part of the initiation of a national process.…”