Helicopter transport: Help or hindrance?

Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Current opinion in critical care (Impact Factor: 2.62). 12/2011; 17(6):596-600. DOI: 10.1097/MCC.0b013e32834c5655
Source: PubMed


Traumatic injury continues to be a significant cause of morbidity and mortality in the year 2011. In addition, the healthcare expenditures and lost years of productivity represent significant economic cost to the affected individuals and their communities. Helicopters have been used to transport trauma patients for the past 40 years, but there are conflicting data on the benefits of helicopter emergency medical service (HEMS) in civilian trauma systems. Debate persists regarding the mortality benefit, cost-effectiveness, and safety of helicopter usage, largely because the studies to date vary widely in design and generalizability to trauma systems serving heterogeneous populations and geography. Strict criteria should be established to determine when HEMS transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate helicopter transport into their triage model.
Research suggests that HEMS improves mortality in certain subgroups of trauma patients, both after transport from the scene of injury and following interfacility transport. Studies examining the cost-effectiveness of HEMS had mixed results, but the majority found that it is a cost-effective tool. Safety remains an issue of contention with HEMS transport, as helicopters are associated with significant safety risk to the crew and patient. However, this risk may be justified provided there is a substantial mortality benefit to be gained.
Recent studies suggest that strict criteria should be established to determine when helicopter transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate HEMS into their triage model. This will enable regional hospitals to determine if the costs and safety risks associated with HEMS are worthwhile given the potential benefits to patient morbidity and mortality.

Download full-text


Available from: Heather L Evans,
1 Follower
63 Reads
  • Source
    • "Secondly, HEMS medical crew members are supposed to be more experienced in trauma management improving preclinical treatment of traumatised patients [8] [9]. At least, improved triaging is suggested to result in transportation to a specialist trauma centre avoiding inter-hospital transfers [10]. Despite these expected beneficial aspects, the effects of HEMS transport on posttraumatic outcome also revealed varying results [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Helicopter emergency medical service (HEMS) has been established in the preclinical treatment of multiple traumatised patients despite an ongoing controversy towards the potential benefit. Celebrating the 20th anniversary of TraumaRegister DGU® of the German Trauma Society (DGU) the presented study intended to provide an overview of HEMS rescue in Germany over the last 10 years analysing the potential beneficial impact of a nationwide helicopter rescue in multiple traumatised patients. Patients and methods We analysed TraumaRegister DGU® including multiple traumatised patients (ISS ≥16) between 2002 and 2012. In-hospital mortality was defined as main outcome. An adjusted, multivariate regression with 13 confounders was performed to evaluate the potential survival benefit. Results 42,788 patients were included in the present study. 14,275 (33.4%) patients were rescued by HEMS and 28,513 (66.6%) by GEMS. Overall, 66.8% (n = 28,569) patients were transported to a level I trauma centre and 28.2% (n = 12,052) to a level II trauma centre. Patients rescued by HEMS sustained a higher injury severity compared to GEMS (ISS HEMS: 29.5 ± 12.6 vs. ISS GEMS: 27.5 ± 11.8). Helicopter rescue teams performed more on-scene interventions, and mission times were increased in HEMS rescue (HEMS: 77.2 ± 28.7 min. vs. GEMS: 60.9 ± 26.9 min.). Linear regression analysis revealed that the frequency of HEMS rescue has decreased significantly between 2002 and 2012. In case of transportation to level I trauma centres a decrease of 1.7% per year was noted (p < 0.001) while a decline of 1.6% per year (p < 0.001) was measured for level II trauma centre admissions. According to multivariate logistic regression HEMS was proven a positive independent survival predictor between 2002 and 2012 (OR 0.863; 95%-CI 0.800–0.930; Nagelkerkes-R2 0.539) with only little differences between each year. Conclusions This study was able to prove an independent survival benefit of HEMS in multiple traumatised patients during the last 10 years. Despite this fact, a constant decline of HEMS rescue missions was found in multiple trauma patients due to unknown reasons. We concluded that HEMS should be used more often in case of trauma in order to guarantee the proven benefit for multiple traumatised patients.
    Injury 10/2014; 45:S53–S58. DOI:10.1016/j.injury.2014.08.018 · 2.14 Impact Factor
  • Source
    • "In the present study, we also find that the impact of aging population on National Health Insurance is underestimated. Therefore, appropriate selection of patients by referring physicians and maintenance of good physician-patient rapport are important when the projected outcome is an issue [13, 14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: EAMT in Taiwan has experienced increasing demand in the past few years. The objective is to analyze the trend of EAMT in the past six years and mortality rate within three days of patients undergoing interfacility transport in Taiwan. Material and method: We conducted a retrospective review of patients who were airlifted from remote islands to main island between 2006 and 2011. Main outcome measures are EAMT number (EAMT-N), EAMT per thousand population (EAMT frequency, EAMT-F), number of mortality (Mor-N), and mortality rate within three days after EAMT (Mor-R). Results and discussion: Overall mortality rate is 7.54% in 1684 airlifted patients. Acute myocardial infarction (AMI, 26.3%) and traumatic brain injury (TBI, 25.8%) comprise the majority in diagnosis (52.1%). However, Mor-R in these two categories is significantly low in AMI (3.5%) and TBI (5.1%). Conclusion: The present study demonstrates that physician density is not related to EAMT-N but to physician number. As general population ages (10%), the average age of patient who underwent EAMT doubled (21%). This study also leaves room for discussion regarding futile medical care. The results can be used as a reference for increasing utilization of EAMT in current National Health Care Scheme.
    BioMed Research International 08/2014; 2014:767402. DOI:10.1155/2014/767402 · 3.17 Impact Factor
  • Source
    • "Improved triaging of traumatized patients has been mentioned as a third benefit. As HEMS has the ability to travel greater distances, HEMS might be suggested to transport patients directly to a specialist trauma center where definitive treatment can be guaranteed and secondary transfers are avoided [1,2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Physician staffed helicopter emergency medical services (HEMS) are a well-established component of pre-hospital trauma care in Germany. Reduced rescue times and increased catchment area represent presumable specific advantages of HEMS. In contrast, the availability of HEMS is connected to a high financial burden and depends on the weather, time of day and controlled visual flight rules. To date, clear evidence regarding beneficial effects of HEMS in terms of improved clinical outcome has remained elusive. Traumatized patients (Injury Severity Score, ISS 9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using the TraumaRegister DGU(R) of the German Society for Trauma Surgery. Only patients treated in German level I and II trauma centers with complete data referring the transportation mode were included. Complications during hospital treatment included sepsis and organ failure according to the criteria of the ACCP/SCCM consensus conference committee and the Sequential Organ Failure Assessment (SOFA) score. 13,220 patients with traumatic injuries were included in the present study. 62.3% (n=8,231) were transported by GEMS and 37.7% (n=4,989) by HEMS. Patients treated by HEMS were more seriously injured compared to GEMS (ISS 26.0 vs. 23.7, P<0.001) with more severe chest and abdominal injuries. The extent of medical treatment on-scene, which involved intubation, chest and treatment with vasopressors, was more extensive in HEMS (P<0.001) resulting in prolonged on-scene time (39.5 vs. 28.9 minutes, P<0.001). During their clinical course, HEMS patients more frequently developed multiple organ dysfunction syndrome (MODS) (HEMS: 33.4% vs. GEMS: 25.0%; P<0.001) and sepsis (HEMS: 8.9% vs. GEMS: 6.6%, P<0.001) resulting in an increased length of ICU treatment and in-hospital time (P<0.001). Multivariate logistic regression analysis found that after adjustment by eleven other variables the odds ratio for mortality in HEMS was 0.75 (95%-CI 0.636 - 862). Afterwards, a subgroup analysis was performed on patients transported to level I trauma centers during the daytime intending to investigate a possible correlation between the level of the treating trauma center and posttraumatic outcome. According to this analysis, the Standardized Mortality Ratio (SMR) was significantly decreased following the Trauma and Injury Severity Score (TRISS) method (HEMS: 0.647 vs. GEMS: 0.815; P=0.002) as well as the Revised Injury Severity Classification (RISC) score (HEMS: 0.772 vs. GEMS: 0.864; p=0.045) in the HEMS group. Although HEMS patients were more seriously injured and had a significantly higher incidence of MODS and sepsis, these patients demonstrated a survival benefit compared to GEMS.
    Critical care (London, England) 06/2013; 17(3):R124. DOI:10.1186/cc12796 · 4.48 Impact Factor
Show more