Overuse of helicopter transport in the minimally injured

Vercruysse, Gary; Friese, Randall S.; Khalil, Mazhar; Ibrahim‐Zada, Irada; Zangbar, Bardiya; Hashmi, Ammar; Tang, Andrew; O'Keeffe, Terrence; Kulvatunyou, Narong; Green, Donald J.; Gries, Lynn; Joseph, Bellal; Rhee, Peter

doi:10.1097/ta.0000000000000553

Cited by 43 publications

(6 citation statements)

References 17 publications

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“…Minor injury patients may not be appropriate candidates for HEMS, because there may be limited scope for an improvement in outcome for such patients and greater expense related to HEMS [18–20]. However, it remains uncertain which types of patients are likely to benefit from HEMS.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort study

Tsuchiya

Tsutsumi

Yasunaga

2016

Scand J Trauma Resusc Emerg Med

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BackgroundBecause of a lack of randomized controlled trials and the methodological weakness of currently available observational studies, the benefits of helicopter emergency medical services (HEMS) over ground emergency medical services (GEMS) for major trauma patients remain uncertain. The aim of this retrospective nationwide cohort study was to compare the mortality of adults with serious traumatic injuries who were transported by HEMS and GEMS, and to analyze the effects of HEMS in various subpopulations.MethodsUsing the Japan Trauma Data Bank, we evaluated all adult patients who had an injury severity score ≥ 16 transported by HEMS or GEMS during the daytime between 2004 and 2014. We compared in-hospital mortality between patients transported by HEMS and GEMS using propensity score matching, inverse probability of treatment weighting and instrumental variable analyses to adjust for measured and unmeasured confounding factors.ResultsEligible patients (n = 21,286) from 192 hospitals included 4128 transported by HEMS and 17,158 transported by GEMS. In the propensity score-matched model, there was a significant difference in the in-hospital mortality between HEMS and GEMS groups (22.2 vs. 24.5%, risk difference −2.3% [95% confidence interval, −4.2 to −0.5]; number needed to treat, 43 [95% confidence interval, 24 to 220]). The inverse probability of treatment weighting (20.8% vs. 23.9%; risk difference, −3.9% [95% confidence interval, −5.7 to −2.1]; number needed to treat, 26 [95% confidence interval, 17 to 48]) and instrumental variable analyses showed similar results (risk difference, −6.5% [95% confidence interval, −9.2 to −3.8]; number needed to treat, 15 [95% confidence interval, 11 to 27]). HEMS transport was significantly associated with lower in-hospital mortality after falls, compression injuries, severe chest injuries, extremity (including pelvic) injuries, and traumatic arrest on arrival to the emergency department.ConclusionsHEMS was associated with a significantly lower mortality than GEMS in adult patients with major traumatic injuries after adjusting for measured and unmeasured confounders.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0335-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Outcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort study

Tsuchiya

Tsutsumi

Yasunaga

2016

Scand J Trauma Resusc Emerg Med

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“…[7,9,15,19] Several studies have highlighted the importance of reducing the helicopter transportation of near-hospital injuries and over-triage of minor injury patients for air transportation in order to achieve better costeffectiveness and practical mortality or disability reductions in HEMS. [7,8,20] In South Korea, 17 regional trauma centers have been evenly distributed across the country for the provision of superior medical services to patients with emergent and traumatic diseases. In these centers, several efforts have been made to utilize helicopter transport including a pilot project referred to as "Doctor Heli 2011"; [12] however, HEMS failed to be set-up such that only 237 patients of a total of 139,072 major medical emergency patients were airlifted by helicopters (0.001%).…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 , 10 , 15 , 19 ] Several studies have highlighted the importance of reducing the helicopter transportation of near-hospital injuries and over-triage of minor injury patients for air transportation to achieve better cost-effectiveness and practical mortality or disability reductions in HEMS. [ 5 , 9 , 21 ]…”

Section: Discussionmentioning

confidence: 99%

Time-saving effects using helicopter transportation: comparison to a ground transportation time predicted using a social navigation software

et al. 2021

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BackgroundPrevious comparison studies regarding two types of transportation, helicopter (HEMS) versus ground emergency medical services (GEMS), have shown underlying heterogeneity as these options have completely different routes and consequent times with reference to one patient. To compare the two types of transportation on a case-by-case basis, we analyzed the retrospectively reviewed HEMS and predicted GEMS data using an open-source navigation software. MethodsPatients transferred by military HEMS from 2016 to 2019 were retrospectively enrolled. The HEMS records on the time of noti cation, injury point and destination addresses, and time required were reviewed. The GEMS data on distance and the predicted time required were acquired using open-source social navigation systems. Comparison analyses between the two types of transportation were conducted. Further, linear logistic regression analyses were performed on the distance and time of the two options. ResultsA total of 183 patients were enrolled. There was no statistical difference (p=0.3021) in the distance between the two types of transportation, and the HEMS time was signi cantly shorter than that of GEMS (61.31 vs. 116.92 minutes, p<0.001). The simple linear curves for HEMS and GEMS were separately secured, and two graphs presented the statistical signi cance (p) as well as reasonable goodness-of-t (R 2 ). In general, the HEMS graph demonstrates a more gradual slope and narrow distribution compared to that of GEMS. ConclusionIdeally, HEMS is identi ed as a better transportation modality because it has a shorter transportation time (56 minutes saved) and a low possibility of potential time delays (larger R 2 ). With a strict patient selection, HEMS can rescue injured or emergent patients who are "out of the golden hour."

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“…When the incident scene is inaccessible, helicopters may be the only way to transfer personnel, equipment, and patients [6][7][8]. The first recorded use of a helicopter dates back to 1945, when it was used to quickly transport wounded soldiers of the Battle in Burma [9,10]. After the first use of helicopters for military purposes in the Korean War to evacuate soldiers from the battlefield, helicopters were introduced in the USA medical emergencies in the early 1970s for civilian use, and then entered high-income countries and became a Helicopter Emergency Medical Service (HEMS) [11].…”

Section: Introductionmentioning

confidence: 99%

Dispatcher Criteria and Therapeutic Measurement by Air Emergency Ambulance of Kurdistan Province, Iran, 2017

Abdi

Ghaderi

Nuri

et al. 2019

HDQ

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How to manage patients, transmission times, and therapeutic measurement executed during air transmission can improve training, protocols, and management decisions. The current study aimed at investigating the dispatch criteria and the way of handling patients during transport by air emergency medical services of Kurdistan Province, Iran, in 2017. Materials and Methods: In the current study, information of patients transported by air emergency ambulance of Kurdistan Province in 2017 was collected from the recorded mission forms. To analyze the information, version 12 of STATA software was employed. Descriptive statistics was used to analyze the qualitative variables and draw frequency distribution table and mean and standard deviation to utilize quantitative variables. Results: Out of 50 transported patients, trauma caused by traffic accidents was the most important cause of patient transport (38%). In terms of clinical symptoms, weakness and lethargy and decreased consciousness were the most common symptoms. The most important therapeutic measures executed during transport were oxygen therapy, various body fixations, and serum therapy, respectively. The average time spent at scene was 10.7 minutes and the mean total mission time was 93.72 minutes with a standard deviation of 45.53. Conclusion: The results of the study indicated that the air emergency performance of Kurdistan Province was desirable in terms of dispatch criteria, time of transport and treatment during transportation, but there were weaknesses in the administration of medications during transportation and recording missions and measures in the specific sheets (forms).

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Overuse of helicopter transport in the minimally injured

Abstract: Epidemiologic study, level III. Therapeutic study, level IV.

Cited by 43 publications

References 17 publications

Outcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort study

Outcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort study

Time-saving effects using helicopter transportation: comparison to a ground transportation time predicted using a social navigation software

Dispatcher Criteria and Therapeutic Measurement by Air Emergency Ambulance of Kurdistan Province, Iran, 2017

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