HEMS transport may be predictor of survival

Helicopters are controversial in EMS circles, particularly in the United States, which seems to have a high number of Helicopter Emergency Medical Services (HEMS) crashes. Although this may in part be a reflection of a large increase in HEMS missions, and the factors contributing to crash fatalities have been studied, it makes sense to limit HEMS missions to those that are likely to make a difference to the patient. Advantages of HEMS services may include the ability to deliver a patient more rapidly to the most appropriate facility, as well as being able to convey a highly skilled team more rapidly to the scene.

Analysis of patients from the National Trauma Databank identified 258,387 subjects transported by either helicopter (HT) (16%) or ground ambulance (GT) (84%). HT subjects were younger (36 years ± 19 years vs. 42 years ± 22 years; p < 0.01), more likely to be male (70% vs. 65%; < 0.01), and more likely to have a blunt mechanism (93% vs. 88%; < 0.01) when compared with GT subjects.

For every dead-on-arrival (DOA) subject in the HT group, there were 498 survivors compared with 395 survivors for every DOA subject in the GT group. When comparing indicators of injury severity, patients transported by helicopter were more severely injured (mean ISS and percentage with ISS > 15), were more likely to have a severe head injury, and were more likely to have documented hypotension or abnormal respiratory when compared with those transported by ground ambulance. Furthermore, HT subjects also had longer length of stay, higher rates for ICU admission, and mechanical ventilation, as well as an increased requirement for emergent surgical intervention.

interestingly, this study shows that <15% of HT patients nationally are discharged within 24 hours. This is much lower than the 24.1% reported previously, suggesting that the degree of over-triage may not be as significant on the national level as reported in smaller studies.

Overall survival was lower in HT subjects versus GT subjects on univariate analysis (92.5% vs. 95.6%; < 0.01). Stepwise univariate analysis identified all covariates for inclusion in the regression model. HT became an independent predictor of survival when compared with GT after adjustment for covariates (OR, 1.22; 95% CI, 1.18– 1.27; < 0.01).

Helicopters and the Civilian Trauma System: National Utilization Patterns Demonstrate Improved Outcomes After Traumatic Injury
J Trauma. 2010 Nov;69(5):1030-4

National Transportation Safety Board HEMS data

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