Comparing the Air Medical Prehospital Triage Score With Current Practice for Triage of Injured Patients to Helicopter Emergency Medical Services

Abstract

IMPORTANCE Little evidence exists to guide helicopter emergency medical services (HEMS) triage, and current practice is inefficient. The Air Medical Prehospital Triage (AMPT) score was developed to identify patients most likely to benefit from HEMS compared with ground EMS. To our knowledge, no studies have evaluated the potential effect on costs and outcomes of a more targeted HEMS triage strategy, such as the AMPT score. OBJECTIVE To evaluate the cost-effectiveness of current practice compared with the AMPT score for HEMS scene triage of trauma patients. DESIGN, SETTING, AND PARTICIPANTS A cost-effectiveness Markov model was developed for the US health care system to compare current practice with the AMPT score as HEMS scene triage strategies from the health care system perspective over a patient lifetime horizon. A base case was estimated using national data of patient characteristics from the National Trauma Databank from 2007 to 2012. Model inputs, including demographic information, health care costs, survival, and utility estimates, were derived from literature and national registries. Triage strategies were modeled as probability of HEMS transport. Multilevel logistic regression was used to evaluate survival probability between HEMS and ground EMS under the triage strategies. Costs considered included transport reimbursements, hospitalization, cost of health care in the first year postinjury, and annual cost of health care after the first year postinjury. Several sensitivity analyses were performed to evaluate robustness of model assumptions. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio, with a threshold of $100 000 or less per quality-adjusted life-year defining cost-effectiveness. RESULTS The base case had an incremental cost-effectiveness ratio of $255 333 per quality-adjusted life-year for current practice compared with the AMPT score. Assuming 20% of patients have severe injuries and assuming HEMS only benefits these patients, current practice had an incremental cost-effectiveness ratio of $176 686 per quality-adjusted life-year. Probabilistic sensitivity analysis demonstrated that current practice is inferior in 85% of iterations, only becoming favored when the cost-effectiveness threshold is greater than $310 000 per quality-adjusted life-year. CONCLUSIONS AND RELEVANCE Current practice is not cost-effective compared with the AMPT score for HEMS scene triage. The AMPT score was the preferred strategy across a range of model input values in sensitivity analyses. The AMPT score identifies patients most likely to benefit from HEMS while potentially reducing costs to the health care system and should be considered in air medical transport protocols for trauma patients.

A Comparison of Injury Severity Score and Disposition Between Pediatric and Adult Patients Transported to a Rural Trauma Center Via Helicopter

“…Rural trauma care presents distinct challenges to the tered and travel distance to a trauma center ultimately utilization have to be weighed against the risk 1 and cost. 4 We hope this data supplement the leverage toward the utilization of standardized prehospital triage among all trauma patients.…”

“…1,2 For these reasons, the rate of overtriage, and thus the potential for inappropriate utilization of HAA, has been explored in the trauma literature. 3 There is evidence pointing toward the ben- 4 Knowing that the literature shows the pediatric population is at a higher risk of overtriage in the urban setting, 3 our team aimed to explore this risk in a rural setting. We hope to add awareness of possible overtriage to HAA and therefore support the need to stanof the Injury Severity Score (ISS) and disposition between pediatric and adult trauma patients in a rural Level 1 trauma center who were transported from the scene of the accident by HAA.…”

“…3 There is evidence pointing toward the benefit of standardized triage to HAA in the field. 4 Knowing that the literature shows the pediatric population is at a higher risk of overtriage in the urban setting, 3 our team aimed to explore this risk in a rural setting. We hope to add awareness of possible overtriage to HAA and therefore support the need to standardize triage within the field.…”

Risk factors for cancellation after dispatch of rapid response cars for prehospital emergency care: a single‐center, case–control study

“…Several studies have estimated the cost-effectiveness of HEMS as the cost per life-year saved. [18][19][20] However, most of these studies did not focus on the additional costs of cancelled cases. One exception is Giannakopoulos et al, who calculated that the mean additional costs of HEMS and the mean additional working time were €239.2 and 5.98 minutes per cancelled flight, respectively.…”

Field-Triage, Hospital-Triage and Triage-Assessment: A Literature Review of the Current Phases of Adult Trauma Triage

“…The score and identifies patients most likely to benefit from helicopter emergency medical services while reducing costs. 37 Studies are confounded by selection of patients for type of transport (helicopter vs. ground transport), regional differences in transport distances, and skill sets of local EMS ground transport. A Cochrane review of 29 studies comparing helicopter versus ground transport found considerable heterogeneity in study methodologies, making comparisons difficult.…”