Is it the H or the EMS in HEMS that has an impact on trauma patient mortality? A systematic review of the evidence

Abstract

Background and aim Prehospital care of trauma patients is a matter of great debate. The optimal transport method remains undecided, with conflicting data comparing helicopter and ground emergency medical transfer. This study systematically reviews the evidence comparing helicopter and ground transfer of trauma patients from the scene of injury. Methods A systematic literature review of all population-based studies evaluating the impact on mortality of helicopter transfer of trauma patients from the scene of injury. We searched MEDLINE, CINAHL and EMBASE from January 1980 to December 2008 and selected and reviewed potentially relevant studies. Results A search of the literature revealed 23 eligible studies. 14 of these studies demonstrated a significant improvement in trauma patient mortality when transported by helicopter from the scene. 5 of the 23 studies were of level II evidence with the remainder being of level III evidence. Data were then entered into an evidence table and reference made to transport staffing, intubation rate, time at scene and time/distance of transfer. Conclusions The role and structure of HEMS in a modern trauma service is a debate that is likely to continue. Prehospital care design should be specific to critical incident frequency, geographical arrangements of hospital facilities and travel times within each trauma network. It is also important to consider the benefits and capabilities of the emergency medical team separately from the transport method being considered. An effective helicopter EMS will ultimately depend on effective operating procedures and tasking protocols, clinical governance, and auditing of the helicopter EMS activity.

An analysis of patients transported by a private helicopter emergency medical service in South Africa

“…[2] When comparing the mean on-scene times of both the Netcare 911 HEMS operations with other similarly staffed operations, the mean on-scene times for the Netcare operations were often shorter. [7,20,21] An interesting finding was the similarity between the interfacility transfer and primary transfer on-scene times. The transfer times from scene to hospital for both the Netcare 911 HEMS operations were similar to another SA study.…”

Emergency Medical Service in Rural Mountain Areas in Taiwan: A Nantou Mountain Areas Based Study

“…16 The feasibility and demand of air ambulance medical service is also worth of consideration. 17 An Australian study has shown that if the distance of EMS is in the range of 100 km with accessible land traffic, there is no apparent advantage of using the air ambulance transport to improve time to definite care. 18 In our study, the mean distance from the fire station to the most nearby hospital was 34.5 km.…”

Prehospital Triage and Emergency Room Care in TBI

“…Applying liberal policy for the use of civil helicopters to transport patients failed to demonstrate clear benefits [13,14]. On the other hand, a number of reports have provided evidence of positive impact in patients' outcomes [15][16][17]. Some investigators advocated that helicopter evacuations have a considerable influence on the survival of the more severely injured patients but does not demonstrate significant impact on the less injured [16].…”