Happy New Year, everyone! This story about a study last year is quickly making the rounds. Findings from the University of Rochester School of Medicine now show that trauma patients transported by helicopter ambulance are more likely to survive and be discharged home after treatment than patients transported by ground – despite typically being more seriously injured, in transport for a longer duration, and requiring more hospital resources than the average trauma patient transported by normal ambulance.
The six-page study, titled “Helicopters and the Civilian Trauma System: National Utilization Patterns Demonstrate Improved Outcomes After Traumatic Injury,” opened with the idea that the role helicopters should play in civilian trauma care is still controversial. The objective was to compare the outcomes of patients after being transported from the scene of injury by helicopter and ground ambulance respectively.
The researchers compared the results of 258,387 trauma patients transported by helicopter and ground ambulance using 2007 data from the National Trauma Databank.
They took into account twelve important variables, including mechanism of injury, intensive care unit admission, trauma center designation, and injury severity score (ISS). Using a stepwise logistic regression model, the study found helicopter transport to be a predictor of survival after adjusting for these variables.
Past studies on medical helicopter transport focused on specific regions of the country, or urban areas. These studies occasionally proposed that helicopters were overused in patient transport. However, the University of Rochester study is significant because it has a much wider scope, examining the role of helicopter ambulances on a national level rather than in one particular place — An important distinction, as helicopter ambulances are an increasingly common sight in the large rural expanses of the United States.
“The data confirms what we already know from our experience in the field,” said Dr. Daniel Hankins, MD, FACEP, and president of the Association of Air Medical Services (AAMS). He went on to say that air medical transport is a very effective form of medical intervention, and that in rural areas it is often the primary form of access to trauma care.
In addition, the study found that severely injured patients (those with an ISS higher than 15) were almost three times more likely to be transported by helicopter and were more likely to have severe head injuries and abnormal presenting physiology than patients transported on the ground – but distance and geography, not just the severity of the injury, can play a role in the decision to transport a patient by helicopter.
Due to the nature of this particular study, it is not possible to find a definitive reason for the difference. The study’s authors cited quicker transport to “definitive care,” the ability of air ambulance crews to provide patient therapies and utilize medical technologies that are not universally available to ground ambulance crews, and a helicopter’s better ability to access difficult terrain as possible explanations.
Mark Gestring, M.D., the Director of the Kessler Trauma Center who participated in the study, says that the study is limited, and that it is not possible to evaluate all the case-by-case factors that go into the decision to transport a patient by air.
These positive findings for helicopter ambulances came ironically during a time when the FAA has made it clear they are troubled by the number of medical helicopter crashes in past years. Only days ago, FAA Administrator Randy Babbitt announced the agency’s proposed tighter rules for medical helicopter pilots and air ambulance firms.
The full text of the study can be found in “Helicopters and the Civilian Trauma System: National Utilization Patterns Demonstrate Improved Outcomes After Traumatic Injury” was published in The Journal of Trauma, Injury, Infection, and Critical Care, November 2010 – Volume 69 – Issue 5 – pages 1030-1036.