Impact of Discontinuing a Hospital-Based Air Ambulance Service on Trauma Patient Outcomes
Texas A&M University - Galveston, Galveston, Texas, United States The Journal of trauma
(Impact Factor: 2.96).
04/2002; 52(3):486-91. DOI: 10.1097/00005373-200203000-00012
The clinical benefit of aeromedical transportation of injured patients in the civilian population has been debated. The purpose of this study was to examine the effects of discontinuing a hospital-based helicopter transport program on trauma patient outcomes, with the hypothesis that the loss of an air ambulance would result in increased transport time and increased mortality among severely injured patients.
Data on injury severity and patient outcomes were collected prospectively for the 12 months immediately preceding and 24 months following discontinuation of the helicopter ambulance service. Transport time, mortality rate, and hospital length of stay was compared.
The number of trauma patient admissions decreased 12%, with a 17% decrease in admissions of severely injured patients. Transport time decreased, with no change in mortality.
Discontinuation of a hospital-based air ambulance service did not increase transport time or increase mortality for trauma patients.
Available from: cctcore.org
- "As the authors themselves are quick to note, their methodology benefits from the availability of a single trauma database covering the entire province. All of the system's trauma patients are thus captured in the analysis, and the authors thus avoid the selection bias that cripples some HEMS studies . In essence, the authors have conducted a population-based study, with minimization of confounding variables, in a setting ideal for detecting a HEMS benefit (a rural, maritime province with a single tertiary trauma center). "
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ABSTRACT: Helicopter EMS (HEMS) and its possible association with outcomes improvement continues to be a subject of discussion. As is the case with other scientific discourse, debate over HEMS usefulness should be framed around an evidence-based assessment of the relevant literature. In an effort to facilitate the academic pursuit of assessment of HEMS utility, in late 2000 the National Association of EMS Physicians' (NAEMSP) Air Medical Task Force prepared annotated bibliographies of the HEMS-related outcomes literature. As a result of that work, two review articles, one covering HEMS use in nontrauma and the other in trauma, published in 2002 in Prehospital Emergency Care surveyed HEMS outcomes-related literature published between 1980 and mid-2000. The project was extended with two subsequent reviews covering the literature through 2006. This review continues the series, outlining outcomes-associated HEMS literature for the three-year period 2007 through the first half of 2011.
Available from: Brian P Walcott
- "In one study, helicopter transport was faster than ground transport for interfacility transfer of patients from all hospitals studied in a regional referral system, however the time difference was miniscule.  In another study using historical controls, a hospital system that removed a hospital based air ambulance service did not demonstrate increased transport time or mortality for trauma patients. It should be noted that while helicopter transport may or may not be faster than ground transport overall, there is evidence that ground dispatch times and “set up” times are shorter for ground transportation. "
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ABSTRACT: The clinical benefit of helicopter transport over ground transportation for interfacility transport is unproven. We sought to determine actual practice patterns, utilization, and outcomes of patients undergoing interfacility transport for neurosurgical conditions.
We retrospectively examined all interfacility helicopter transfers to a single trauma center during 2008. We restricted our analysis to those transfers leading either to admission to the neurosurgical service or to formal consultation upon arrival. Major exclusion criteria included transport from the scene, death during transport, and transport to any area of the hospital other than the emergency department. The primary outcome was time interval to invasive intervention. Secondary outcomes were estimated ground transportation times from the referring hospital, admitting disposition, and discharge disposition. Of 526 candidate interfacility helicopter transfers to our emergency department in 2008, we identified 167 meeting study criteria. Seventy-five (45%) of these patients underwent neurosurgical intervention. The median time to neurosurgical intervention ranged from 1.0 to 117.8 hours, varying depending on the diagnosis. For 101 (60%) of the patients, estimated driving time from the referring institution was less than one hour. Four patients (2%) expired in the emergency department, and 34 patients (20%) were admitted to a non-ICU setting. Six patients were discharged home within 24 hours. For those admitted, in-hospital mortality was 28%.
Many patients undergoing interfacility transfer for neurosurgical evaluation are inappropriately triaged to helicopter transport, as evidenced by actual times to intervention at the accepting institution and estimated ground transportation times from the referring institution. In a time when there is growing interest in health care cost containment, practitioners must exercise discretion in the selection of patients for air ambulance transport--particularly when it may not bear influence on clinical outcome. Neurosurgical evaluation via telemedicine may be one strategy for improving air transport triage.
Available from: challenger.library.pitt.edu
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