Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: A multicenter study

Baxt, William G.; Moody, Peggy; Cleveland, Henry C.; Fischer, Ronald P.; Kyes, Ford N.; Leicht, Michael; Rouch, Faith; Wiest, Philip W.

doi:10.1016/s0196-0644(85)80634-x

Cited by 151 publications

(39 citation statements)

References 16 publications

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“…5 While the debate over outcome differences between patients transported by helicopter versus ground transport has continu ed for 25 years, the general consensus indicates that severely injured patients transported by air ambulance have better survival. [6][7][8][9][10][11][12][13][14] Controversy remains, however, regarding the injury severity and necessity of helicopter transport for particular cohorts of patients. [15][16][17][18][19][20][21] A study from a single institution in Great Britain of 156 injured patients with a mean ISS of 12 transported by helicopter reported that 45 patients were discharged within 24 hours.…”

Section: Discussionmentioning

confidence: 99%

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

et al. 2014

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“…Although a helicopter can travel much faster than ground ambulance, 2 the mobilisation and preparation times for helicopter ambulances are clearly more lengthy and previous studies have failed to show a consistently faster total transfer time from accident to arrival in casualty if the distances involved are less than 45 miles. 7 Studies from the US and Europe have provided evidence both supporting [9][10][11] and disputing 12,13 the outcome benefit and cost benefit of helicopter transfer of patients in a civilian setting with doctor-staffed aircrews and non-doctor crews. Although data to support the use of medically staffed helicopter transfer service in Greater London have been published, there is very little data regarding patient outcomes following initial transfer with non-medical HEAS transfer in the UK.…”

Section: Discussionmentioning

confidence: 99%

Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

Melton

Jain

Kendrick

et al. 2007

annals

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Ann R Coll Surg Engl 2007; 89: [513][514][515][516] 513 Helicopters were used very successfully for the transfer of wounded soldiers from the battlefields in the Korean and Vietnam wars and this model of patient transfer was then put into use in a civilian setting, initially in the US. In 1987, the first helicopter-based ambulance service in the UK was introduced in the Greater London region. 1Although this service carries an emergency physician as crew, it is unique in that respect. All other 15 dedicated HEAS providers in the UK are usually manned by one pilot and two paramedics. Advanced trauma and life-support (ATLS) teaching is that there are three peaks of mortality following major trauma. An early peak is due to patients who will die immediately with fatal injuries, a second peak of patients who will die in the 60 min following trauma and a third peak representing patients who will die of delayed complications of their injuries such as organ failure and sepsis. The second peak of mortality within 60 min of injury (the so-called 'golden hour' in ATLS teaching) represents the patients for whom rapid transfer to an emergency medical care facility from the scene of injury is potentially life-saving. 3The perceived benefit of helicopter transfer is the faster speed of transfer to hospital. This will maximise the proportion of the 'golden hour' spent in a hospital setting where potentially reversible conditions such as tension pneumothorax or cardiac tamponade can be treated. The most commonly used helicopter for HEAS in the UK is the Eurocopter 'Bolkow' 105, 2 which has a maximum speed of 252 km/h, clearly faster than ground ambulance. However, when factors such as mobilisation time, weather conditions, ease of access and the availability of helipad for landing at destination hospitals is considered, quicker transfer by helicopter is not always guaranteed. Many studies have found that patient transfer by helicopter is often not faster than by ground ambulance transfer overall except when large distances (over 45 km) are involved or when roads are poor or traffic conditions bad. These studies have questioned which

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“…Despite numerous studies of the association of trauma mortality and helicopter transport of trauma patients [6][7][8][9][10][11][12][13][14][15][16][17][18] spanning some 25 years, the topic continues to be the subject of debate. 4,19 The settings, patients, training level of HEMS crews, and study methodologies vary considerably among these studies, making it difficult to compare and generalize results.…”

mentioning

confidence: 99%

Association of Direct Helicopter Versus Ground Transport and In-hospital Mortality in Trauma Patients: A Propensity Score Analysis

Stewart

Cowan

Thompson

et al. 2011

Academic Emergency Medicine

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Objectives: Helicopter emergency medical services (HEMS) transport of trauma patients has been used for decades. Its use, however, is still a subject of debate, including issues such as high costs, increasing numbers of crashes, and conflicting results regarding effectiveness in reducing mortality. The aim of this study was to examine whether mode of transport (HEMS vs. ground EMS) is independently associated with mortality among trauma patients transported directly from the scene of injury to definitive care.Methods: All trauma patients transported directly to a Level I or Level II trauma center by either air or ground EMS over a 4-year period were selected from the Oklahoma State Trauma Registry. Multivariable logistic regression was used to develop propensity scores based on variables measured at the scene of injury. The propensity scores represented the predicted probabilities of a patient being transported by HEMS given a specific set of characteristics and were used as a composite confounding variable in subsequent models of the association of mortality and mode of transport. Along with the propensity scores, Injury Severity Scores (ISS), initial Revised Trauma Score (RTS), and distance from the trauma center were included in a Cox proportional hazards model of the association of mode of transport and 24-hour and 2-week mortality.Results: Overall, the hazard ratio (HR) for 2-week mortality in patients transported by HEMS was 33% lower (HR = 0.67, 95% confidence interval [CI] = 0.54 to 0.84) than in patients transported by ground EMS from the scene of injury, after adjustment for the propensity score and other covariates. In subanalyses, the apparent association of a reduction in the hazard of early mortality among patients transported by HEMS was most evident for patients with an RTS based on injury scene vital signs of 3 to 7 (HR = 0.61, 95% CI = 0.46 to 0.82). The point estimate of the HR was similar (HR = 0.65 95% CI = 0.34 to 1.2) in the 75% of cases who had normal vital signs at the scene of injury, although it was no longer statistically significant because crude mortality was very low (1.7%) in this group. Among those with a RTS of 3 or less at the scene, crude mortality was 58%, and mode of transport was not associated with mortality (HR = 1.02, 95% CI = 0.68 to 1.6).Conclusions: Helicopter EMS transport was associated with a decreased hazard of mortality among certain patients transported from the scene of injury directly to definitive care. Refinements in scene triage and transport guidelines are needed to more effectively select patients that may benefit from HEMS transport from those unlikely to benefit.

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Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: A multicenter study

Cited by 151 publications

References 16 publications

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

Association of Direct Helicopter Versus Ground Transport and In-hospital Mortality in Trauma Patients: A Propensity Score Analysis

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