Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Abstract

Context-Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted.Objective-To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Online-Only Material:The eFigure, eTables 1-3, and the Author Video Interview are available at http://www.jama.com.Author Contributions: Dr Galvagno had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Galvagno, Haut, Millin, Efron, Koenig, Pronovost, Haider. Acquisition of data: Galvagno, Haut, Zafar, Haider. Analysis and interpretation of data: Galvagno, Zafar, Baker, Bowman, Haider. Drafting of the manuscript: Galvagno, Haut, Milllin, Efron, Baker, Bowman, Pronovost, Haider. Critical revision of the manuscript for important intellectual content: Galvagno, Koenig, Baker, Bowman, Pronovost, Haider. Statistical expertise: Galvagno, Zafar, Bowman, Haider.Administrative, technical, or material support: Galvagno, Haut, Efron, Pronovost, Haider. Study supervision: Galvagno, Haut, Haider. Conclusion-Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders. NIH Public AccessTrauma remains the leading cause of death and disability among young people around the world. In the United States, more than 50 million people are injured per year, resulting in approximately 169 000 annual deaths and a lifetime cost of $406 billion. 1,2Over the past several years, significant improvements in survival after trauma have been achieved. One reason for this has been improvements in emergency medical services (EMS) and life-saving transport of trauma patients to a center capable of providing definitive care. The utility of helicopter EMS and its possible effect on outcomes for traumatically injured patients remains the subject of debate. [3][4][5][6][7][8] Because helicopter transport is a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground EMS is warranted.Several studies have used the National Trauma Data Bank (NTDB) to assess outcomes for traumatically injured adultstransportedbyeitheroption. [9][10][11] Although each of these studies concluded that helicopter transport was associated with improved odds of survival, they also reported limitations to their conclusions because of the lack of testing for the assumptions of a regression model, and none was able to account for the differences in how patients were assigned treatments (helicopter or ground transport). Additionally, the high proportio...

Activation Intervals for a Helicopter Emergency Medical Service in Japan

“…These conditions were analyzed because the sample number and uniformity were assured and because numerous reports mentioned the utility of HEMS under such conditions. [3][4][5][6][7][8][9][10] The statistical analyses were performed using SPSS 17.0 (Japan Inc.). The differences amongst these 5 conditions were assessed using one-way analysis of variance (ANOVA).…”

“…HEMS have played an increasingly important role in prehospital emergency medical care in Japan. 1,2 Many studies have commented on the usefulness of HEMS for managing acute conditions, such as trauma, [3][4][5] burns, 6 intoxication 7 , acute coronary syndrome (ACS) 8 and stroke. 9,10 Immediate definitive treatment and specialized care are necessary for such patients, and the actions taken during prehospital time are crucial.…”

Falls and peripheral nerve injuries: an age-dependent relationship

“…values and used multiple imputation techniques to estimate the rest of the missing values, as previously established for NTDB. 10 However, this is still inferior to utilizing real data. Fifth, the NTDB is lacking information on the longterm functional status of the patients.…”

Intervenções de emergência realizadas nas vítimas de trauma de um serviço aeromédico

“…Probably the combination of air rescue elements along with the high level of professional care is decisive in the survival of patients treated using this modality. Another study (23) points out that research studies that evaluated the survival of patients assisted by the air service had limitations in their samples and methods; however, invariably, to obtain any beneficial effect of aeromedical transport, a combination of speed, crew expertise, and willingness of reference centers to immediately refer patients is required.…”