Helicopter Scene Transport of Trauma Patients with Nonlife-Threatening Injuries: A Meta-Analysis

Bledsoe, Bryan E; Wesley, A. G.; Eckstein, Marc; Dunn, Thomas M.; O’Keefe, Michael F.

doi:10.1097/01.ta.0000196489.19928.c0

Cited by 131 publications

(86 citation statements)

References 64 publications

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“…22 This ISS was much lower than the mean ISS for the patients transported by helicopter in the present study and was more comparable to that of the patients transported by ground ambulance. A large meta-analysis of 22 studies with 37 350 patients by Bledsoe and colleagues 23 noted that 60% of patients had an ISS of 15 or less and that 24% were discharged within 24 hours. As a result, 73% of aeromedical transports in the metaanalysis were described as "nonbeneficial."…”

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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“…Both trauma triage guidelines and compliance with those guidelines have been shown to vary by region, [33][34][35][36] and most previous studies of HEMS transport noted a significant number of patients transported by helicopter with minor to moderate injuries. 5 We too identified a large number of HEMS-transported patients who would seem at low risk of dying. Among all the HEMStransported patients, 43% had an ISS of less than or equal to 14, and of these, 83% had normal prehospital and initial hospital RTS values.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, they are a limited resource, and their use results in a substantially higher financial cost for the patient compared to ground EMS transport. [5][6][7] Ground ambulances are generally more regionally distributed and can be at the scene of an accident quickly. However, ground personnel vary in their level of expertise and experience, and travel by ground may delay treatment if the scene of injury is far from the appropriate trauma center.…”

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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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“…Enhanced availability of HEMS has resulted in its use when the severity of injuries sustained may not have warranted it. [44][45][46] As competition in the health care industry has heightened, there have been increasing concerns about the costs and necessity of HEMS. 47 Even after the large initial investment for a HEMS aircraft, non-inflation-adjusted estimated annual operating costs from 1997 exceeded $2 million.…”

Section: Discussionmentioning

confidence: 99%

Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services

Sullivent

Faul

Wald

2011

Prehospital Emergency Care

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Background. Some studies have shown improved outcomes with helicopter emergency medical services (HEMS) transport, while others have not. Safety concerns and cost have prompted reevaluation of the widespread use of HEMS. Objective. To determine whether the mode of transport of trauma patients affects mortality. Methods. Data for 56,744 injured adults aged ≥18 years transported to 62 U.S. trauma centers by helicopter or ground ambulance were obtained from the National Sample Program of the 2007 National Trauma Data Bank. In-hospital mortality was calculated for different demographic and injury severity groups. Adjusted odds ratios (AOR) were produced by utilizing a logistic regression model measuring the association of mortality and type of transport, controlling for age, gender, and injury severity (Injury Severity Score [ISS] and Revised Trauma Score [RTS]). Results. The odds of death were 39% lower in those transported by HEMS compared with those transported by ground ambulance (AOR = 0.61, 95% confidence interval [CI] = 0.54-0.69). Among those aged ≥55 years, the odds of death were not significantly different (AOR = 0.92, 95% CI = 0.74-1.13). Among all transports, male patients had a higher odds of death (AOR = 1.23, 95% CI = 1.10-1.38) than female patients. The odds of death increased with each year

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Helicopter Scene Transport of Trauma Patients with Nonlife-Threatening Injuries: A Meta-Analysis

Cited by 131 publications

References 64 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

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

Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services

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