Mode of Transport and Clinical Outcome in Rural Trauma: A Helicopter versus Ambulance Comparison

Abstract

Helicopter Emergency Medical Services (HEMS) is presumably an effective way of patient transport in rural trauma, yet the literature addressing its effectiveness is scarce. In this study, we compared the clinical outcome of rural trauma patients between Ground Emergency Medical Services (GEMS) and HEMS transportation from the beginning of 2006 to the end of 2012. Focus was placed on identifying factors associated with survival to discharge in these patients. Over the seven-year study period, 4492 patients met the inclusion criteria with 2414 patients (54%) being transferred by GEMS and 2078 patients (46%) being transferred by HEMS. In comparison with GEMS, patients transferred by HEMS were younger men who were admitted with a higher mean Injury Severity Score and a lower mean Glasgow Coma Score (all Ps < 0.0001). HEMS patients were more frequently intubated before arrival at the trauma center (32% vs 9%, P < 0.0001) and were more frequently transferred to the operating room from the emergency department (11% vs 5%, P < 0.0001). In multivariate analysis, transfer by HEMS was associated with a significant increase in survival to discharge (odds ratio: 1.57, 95% confidence interval: 1.03–2.40, P = 0.036). Blunt injury, no intubation, and Glasgow Coma Score >8 were also associated with significantly improved odds of survival to discharge (all P < 0.0001). These findings show that although patients transferred by HEMS arrived in less favorable clinical conditions, HEMS transfer was associated with significantly higher odds of survival in rural trauma.

The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

“…Similarly to other systems, trauma formed the largest subset of patients. Trauma is indeed the most common cause of preventable death in the previously healthy [33]., and several studies have found HEMS to provide benefit to this specific patient group [34][35][36]. The second most common medical problem was OHCA, representing a large proportion compared to other systems [7,8,21].…”

A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

“…Injury severity scoring measures were used in 73 (76%) articles to risk stratify and cohort similarly injured sub-groups of trauma patients, of which 54 (74%) used anatomic severity measures (injury severity score [ISS], abbreviated injury score [AIS], new injury severity score [NISS]); 3 (3%) used physiologic or hybrid scores (e.g., trauma injury severity score [TRISS]); and 17 (18%) used a combination of anatomic, physiologic, and/or hybrid scores (e.g., revised trauma score [RTS]). There were only a few studies that measured organ failure as a secondary outcome—four (4%) articles used multiple organ failure as a secondary outcome [ 27 , 63 , 64 , 85 ] assessed by the Sequential Organ Failure Assessment (SOFA) score, and two (2%) studies specified acute renal failure as the organ failure outcome [ 69 , 81 ].…”

“…). There were only a few studies that measured organ failure as a secondary outcome-four (4%) articles used multiple organ failure as a secondary outcome [27,63,64,85] assessed by the Sequential Organ Failure Assessment (SOFA) score, and two (2%) studies specified acute renal failure as the organ failure outcome [69,81].…”

Primarily Successful Resuscitation of Traumatic Aortic Rupture after high- Energy Car Accident: A Case Report

“…The injury severity and major internal bleeding was misjudged by the primary EP, leading to delayed alert of HEMS. Beside the time benefit of air rescue regarding transportation to level 1 trauma centers in rural areas, HEMS also provides survival benefit for trauma patients [8][9][10]. Studies have shown that survival time is also being improved by usage of a correct emergency tactic.…”

“…Studies have shown that survival time is also being improved by usage of a correct emergency tactic. Especially in rural areas patients admitted to hospital via HEMS tend to have a better outcome, even if initially presented with a worse overall condition [8,9,11]. In order to identify cases in which HEMS should be considered different scoring systems have been developed to help the emergency responder.…”