Population Coverage of Trauma Systems: What Do Helicopters Add?

Abstract

Trauma is a time-critical condition. Helicopters are thought to enhance the accessibility to trauma centers, but this benefit is poorly quantified. The aim of this study was to conduct a geographical analysis of the added benefit provided by helicopters, over ground transport. This study uses geospatial analysis. Helicopter bases and Level I and II designated trauma centers were geocoded. 60-minute drive-time and elliptical flight-time isochrones were mapped with ArcGIS™ (Esri, Redlands, CA). Calculations included allowance for mission ground time (MGT). We compared the proportion of the population that could be taken to Level I and II trauma centers, within 60 minutes, by road and by air. Using a 30-minute MGT model, helicopters permit 279,317 additional residents (5.8%) access to a Level I trauma center within 60 minutes. Using the 20-minute MGT model, 1,089,177 more residents (22.8%) would have access to Level I trauma center care. The benefits were marginally greater for access to Level I and II trauma center care. Helicopters enhance access to specialist trauma center care, but the benefit is small and dependent on MGT. Consideration should be given to the siting of helicopters, particularly in relation to trauma patients, MGT, and the timely response of EMS when determining the triage for helicopter transport.

Predictors of Inappropriate Helicopter Transport

“…16 Similarly, a recent (2013-2018) 5-year retrospective study of trauma registry data found that one-third of the patients only had minor injuries, and the majority was in relatively close proximity to a hospital. 3 As such, there is a need to deploy HT only as necessary. Critical to this end is identifying HT-specific triage criteria.…”

“…As such, SI was converted to a dichotomous variable ≥0.9 or <0.9. GCS alteration was analyzed as the nominal variable of mild (12)(13)(14)(15), moderate (9-11), and severe (3)(4)(5)(6)(7)(8), and the dichotomous variable of GCS ≤8 or GCS ≥8. The age cut point was set at age ≥55.…”

“…Currently, there are 1000 medical helicopters in the United States that make 400 000 annual flights. 3 A recent analysis showed that the average cost of HT is $6800, which when compared with $1100 for GT translates into $2.72 billion differential costs annually for the US health care system. 3 Consequently, it is imperative that HT is deployed with discretion.…”

“…3 A recent analysis showed that the average cost of HT is $6800, which when compared with $1100 for GT translates into $2.72 billion differential costs annually for the US health care system. 3 Consequently, it is imperative that HT is deployed with discretion. This poses a challenge for prehospital ground personnel, who must use real-time information to decide if they should proceed with HT.…”

“…3 A recent analysis showed that the average cost of HT is $6800, which when compared with $1100 for GT translates into $2.72 billion differential costs annually for the US health care system. 3…”