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Speed is not everything: Identifying patients who may benefit from helicopter transport despite faster ground transport

Chen, Xilin, MPH; Gestring, Mark, L., MD; Rosengart, Matthew, R., MD, MPH; Billiar, Timothy, R., MD; Peitzman, Andrew, B., MD; Sperry, Jason, L., MD, MPH; Brown, Joshua, B., MD, MSc

Journal of Trauma and Acute Care Surgery: April 2018 - Volume 84 - Issue 4 - p 549–557
doi: 10.1097/TA.0000000000001769
AAST 2017 Podium Paper
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BACKGROUND Helicopter emergency medical services (HEMS) have demonstrated survival benefits over ground emergency medical services (GEMS) for trauma patient transport. While HEMS speed is often-cited, factors such as provider experience and level of care may also play a role. Our objective was to identify patient groups that may benefit from HEMS even when prehospital time for helicopter utilization is longer than GEMS transport.

METHODS Adult patients transported by HEMS or GEMS from the scene of injury in the Pennsylvania State Trauma Registry were included. Propensity score matching was used to match HEMS and GEMS patients for likelihood of HEMS, keeping only pairs in which the HEMS patient had longer total prehospital time than the matched GEMS patient. Mixed-effects logistic regression evaluated the effect of transport mode on survival while controlling for demographics, admission physiology, transfusions, and procedures. Interaction testing between transport mode and existing trauma triage criteria was conducted and models stratified across significant interactions to determine which criteria identify patients with a significant survival benefit when transported by HEMS even when slower than GEMS.

RESULTS From 153,729 eligible patients, 8,307 pairs were matched. Helicopter emergency medical services total prehospital time was a median of 13 minutes (interquartile range, 6–22) longer than GEMS. Patients with abnormal respiratory rate (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.26–4.55; p = 0.01), Glasgow Coma Scale score of 8 or less (OR, 1.61; 95% CI, 1.16–2.22; p < 0.01), and hemo/pneumothorax (OR, 2.25; 95% CI, 1.06–4.78; p = 0.03) had a significant survival advantage when transported by HEMS even with longer prehospital time than GEMS. Conversely, there was no association between transport mode and survival in patients without these factors (p > 0.05).

CONCLUSION Patients with abnormal respiratory rate, Glasgow Coma Scale score of 8 or less, and hemo/pneumothorax benefit from HEMS transport even when GEMS transport was faster. This may indicate that these patients benefit primarily from HEMS care, such as advanced airway and chest trauma management, rather than simply faster transport to a trauma center.

LEVEL OF EVIDENCE Therapeutic, level III.

From the Division of Trauma and General Surgery, Department of Surgery (X.C., M.R.R., T.R.B., A.B.P., J.L.S., J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and Division of Acute Care Surgery, Department of Surgery (M.L.G.), University of Rochester Medical Center, Rochester, New York.

Submitted: August 30, 2017, Revised: November 16, 2017, Accepted: November 27, 2017, Published online: December 15, 2017.

Address for reprints: Joshua B. Brown, MD, MSc, Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213; email: brownjb@upmc.edu.

This article was presented as an oral podium presentation at the 76th Annual Meeting of the American Association for the Surgery of Trauma, September 13-16th, 2017; Baltimore, MD.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

© 2018 Lippincott Williams & Wilkins, Inc.