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

Galvagno, Samuel M.; Haut, Elliott R.; Zafar, Syed Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George; Baker, Susan Pardee; Bowman, Stephen M.; Pronovost, Peter J.; Haider, Adil H.

doi:10.1001/jama.2012.467

Cited by 283 publications

(133 citation statements)

References 40 publications

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“…It has been shown that HEMS improves outcomes over ground emergency medical services (GEMS) in both scene and transfer patients. 44–46 Thus, this represents a potential confounder on mortality that cannot be accounted for in the current analysis. Despite this, we do not believe that the results seen here are likely explained solely by the effect of HEMS on survival in the PTC RBC group.…”

Section: Discussionmentioning

confidence: 99%

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Brown¹,

Cohen

Minei

et al. 2015

Annals of Surgery

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Objective To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01–0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15–0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02–0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01–0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03–0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01–0.95; P = 0.05). Conclusions PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

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Section: Discussionmentioning

confidence: 99%

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Brown¹,

Cohen

Minei

et al. 2015

Annals of Surgery

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“…In patients with TBI, we demonstrated that helicopter transport was associated with increased survival in comparison with ground EMS. Although the beneficial effect of helicopter transport has been described for patients with severe trauma, 14 its significance in TBI is under debate. 28 Patients with TBI are some of the most severely injured patients, in need of timely, efficient, and specialized care.…”

Section: Discussionmentioning

confidence: 99%

“…In a carefully designed study, using the NTDB data from 2007 to 2009, Galvagno et al 14 demonstrated an association of helicopter transport with improved survival in patients with severe trauma. We followed a similar methodology in the present analysis and demonstrated that the magnitude of the association is higher when only patients with head injury are considered.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Helicopter Transport and Survival of Patients With Traumatic Brain Injury

2015

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Objective To investigate the association of helicopter transport with survival of patients with traumatic brain injury (TBI), in comparison with ground emergency medical services (EMS). Background Helicopter utilization and its effect on the outcomes of TBI remain controversial. Methods We performed a retrospective cohort study involving patients with TBI who were registered in the National Trauma Data Bank between 2009 and 2011. Regression techniques with propensity score matching were used to investigate the association of helicopter transport with survival of patients with TBI, in comparison with ground EMS. Results During the study period, there were 209,529 patients with TBI who were registered in the National Trauma Data Bank and met the inclusion criteria. Of these patients, 35,334 were transported via helicopters and 174,195 via ground EMS. For patients transported to level I trauma centers, 2797 deaths (12%) were recorded after helicopter transport and 8161 (7.8%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival [OR (odds ratio), 1.95; 95% confidence interval (CI), 1.81–2.10; absolute risk reduction (ARR), 6.37%]. This persisted after propensity score matching (OR, 1.88; 95% CI, 1.74–2.03; ARR, 5.93%). For patients transported to level II trauma centers, 1282 deaths (10.6%) were recorded after helicopter transport and 5097 (7.3%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival (OR, 1.81; 95% CI, 1.64–2.00; ARR 5.17%). This again persisted after propensity score matching (OR, 1.73; 95% CI, 1.55–1.94; ARR, 4.69). Conclusions Helicopter transport of patients with TBI to level I and II trauma centers was associated with improved survival, in comparison with ground EMS.

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“…Limited data exist to suggest that patients benefit when transferred by helicopter 6 as compared to ground. Most research conducted on transported patients focuses on time-sensitive patients where time of transfer has been the primary outcome.…”

Section: Balancing Risk With Benefitmentioning

confidence: 99%

“…Yet, the effect of the transfer itself on patients both during and after transfer remains poorly understood. Recent studies support the transport of patients who are experiencing time-sensitive emergencies such as trauma 6 and myocardial infarction 7,8 . For these patients, use of the shortest transfer time to definitive care, which frequently is air transport, is non-controversial.…”

Section: Introductionmentioning

confidence: 99%

Ethical Considerations for Conducting a Randomized Controlled Trial in Transport

Reimer¹,

Daly²

2014

Air Medical Journal

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Although recent studies support the rapid transfer of patients experiencing time-sensitive emergencies, limited data exist to support the use of air transport for non-urgent patient transfers. The nature of medical transport and the heterogeneity of patients who are transferred present unique challenges in designing and conducting clinical research trials that could contribute to the evidence-based decision-making for patient care and transport. The current regulatory framework presents several barriers to conducting such research in the medical transport setting. We present a hypothetical study that randomizes patients to either ground or air transport as an exemplar. We discuss informed consent, risk, and the impracticality of conducting community consultations in a medical transport setting. Finally, recommendations for potential changes to current regulations are presented. These are directed at facilitating the conduct of emergency research through a system of oversight that integrates characteristics of quality improvement and health services research.

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

Cited by 283 publications

References 40 publications

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Prehospital Helicopter Transport and Survival of Patients With Traumatic Brain Injury

Ethical Considerations for Conducting a Randomized Controlled Trial in Transport

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