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. Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank. Interventions Transport by helicopter or ground emergency services to level I or level II trauma centers. Main Outcome Measures Survival to hospital discharge and discharge disposition. Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14-1.17; P  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.

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

Introduction Helicopter emergency medical services (HEMS) are popular in first world health systems despite inconsistent evidence in the scientific literature to support their use. The aim of the current study was to perform a systematic review of economic evaluations of HEMS, in order to determine the economic cost of HEMS and the associated patient-centered benefits. Method A systematic review was performed of studies that provided a cost estimate of HEMS. The inclusion criteria consisted of English language articles that estimated both the costs and outcomes of a HEMS and fulfilled pre-specified criteria in relation to a cost analysis, cost–minimisation, cost–effectiveness or cost–benefit evaluation. Identified studies were synthesised according to the patient diagnosis (trauma, non-trauma or non-specific) and the type of HEMS transport under review (primary scene retrieval or secondary inter-facility transport). All costs were converted to US dollars and indexed for inflation. Results Fifteen studies met the inclusion criteria. Among all studies the annual cost of HEMS ranged from $115,777 to $5,571,578. Five studies showed HEMS to be a more expensive transport alternative without an associated benefit while eight studies provided cost–effectiveness ratios of $3292 and $2227 per life year saved for trauma, $3258 per life saved and $7138 and $12,022 per quality adjusted life year for non-trauma and $30,365 and $91,478 per beneficial mission for non-specific patient populations. One study also evaluated the cost of HEMS to societal benefit, producing a ratio of 1:6. Interpretation The cost and effectiveness of HEMS varied considerably between studies. Despite generally being more expensive than ground transport, a number of studies found HEMS to be cost-effective. However, given the variation in the intervention design, context and study methods between studies it was not possible to assess the cost–effectiveness of HEMS in general. Given the variation inherent in the health systems in which HEMS operate, synthesis and extrapolation of study findings across differing health environments is difficult. To address economic and clinical evidence in relation to HEMS, future research that is tailored to account for local system factors is required.

A systematic review of the costs and benefits of helicopter emergency medical services.

Although the need and benefit of prehospital interventions has been controversial for quite some time, an increasing amount of evidence has stirred both sides into more frequent debate. Proponents of the traditional "scoop-and-run" technique argue that this approach allows a more timely transfer to definitive care facilities and limits unnecessary (and potentially harmful) procedures. However, advocates of the "stay-and-play" method point to improvement in survival to reach the hospital and better neurologic outcomes after brain injury. Given the lack of consensus, the Eastern Association for the Surgery of Trauma convened a Practice Management Guideline committee to answer the following questions regarding prehospital resuscitation: (1) should injured patients have vascular access attempted in the prehospital setting? (2) if so, what location is preferred for access? (3) if access is achieved, should intravenous fluids be administered? (4) if fluids are to be administered, which solution is preferred? and (5) if fluids are to be administered, what volume and rate should be infused?

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Guidelines for Prehospital Fluid Resuscitation in the Injured Patient

BACKGROUND: In Rotterdam, the Netherlands, a helicopter-transported medical team (HMT), staffed with a trauma physician, provides additional therapeutic options at the scene of injury. This study evaluated the influence of the HMT on the chance of survival of severely injured trauma victims. METHODS: This was a 2-year prospective observational study of consecutive adults who suffered multiple trauma (Injury Severity Score (ISS) 16 or more) and presented to the Erasmus Medical Centre emergency ward. The effect of the HMT was quantified by an odds ratio (OR), adjusted for confounding variables in logistic regression models. RESULTS: Complete data for a total of 346 patients were available for analysis. Two hundred and thirty-nine patients were treated by ambulance personnel alone and 107 received additional HMT assistance. Patients in the HMT group had significantly lower Glasgow Coma Scale scores (mean 8.9 versus 10.6; P = 0.001) and a higher ISS (mean 30.9 versus 25.3; P < 0.001). The unadjusted OR for death was 1.7 in favour of the group treated by ambulance staff only (OR for survival 0.61 (95 per cent confidence interval (c.i.) 0.37 to 1.0, P = 0.048)). After adjustment, however, patients in the HMT group had an approximately twofold better chance of survival (all injuries: OR 2.2 (95 per cent c.i. 0.92 to 5.9), P = 0.076; blunt injuries: OR 2.8 (95 per cent c.i. 1.07 to 7.52), P = 0.036). CONCLUSION: The presence of the HMT may increase chances of survival for patients suffering multiple trauma, especially for those with blunt trauma.

Beneficial effect of helicopter emergency medical services on survival of severely injured patients.

https://www.michigan.gov/documents/mdch/AirAmbCost_433276_7.pdf

David P. Thomson

Papers

Nontrauma helicopter emergency medical services transport: annotated review of selected outcomes-related literature.

Unnecessary intravenous access in the emergency setting

Rocuronium versus Succinylcholine in Air Medical Rapid-Sequence Intubation

Effect of a ground critical care transport service on air medical helicopter utilization.

An instrument approach to airway management.