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Helicopter Emergency Medical Services for Trauma: An Update

  • Trauma Surgery (J. Diaz, Section Editor)
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Abstract

Purpose of Review

Helicopter emergency medical services (HEMS) have become a well-established component of most contemporary trauma systems throughout the world. HEMS is associated with significant costs, safety concerns, and potential inappropriate use. In this update, we briefly review the historical context, evidence for clinical effectiveness, and methods for ensuring proper utilization of HEMS.

Recent Findings

A recently validated prehospital triage score—the Air Medical Prehospital Triage (AMPT)—is reviewed. Examples of system improvements using evidence-based practices and adherence to both national and local utilization guidelines are also discussed.

Summary

Appropriate triage for HEMS use remains an important goal for developed trauma systems. Although associated with significant costs and safety concerns, recent literature has highlighted the association of HEMS with improved outcomes for trauma patients.

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References

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  1. Florence CST. Estimated lifetime medical and work loss costs of fatal injury: united States. MMWR. 2013;64:38.

    Google Scholar 

  2. Disease and injury country estimates. 2004. http://apps.who.int/ghodata/). Accessed 26 Jun 2011.

  3. Centers for Disease Control and Prevention. 10 leading causes of death, United States. 2016, all races, both sexes. Centers for Disease Control and Prevention. 2017. (http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html)–(http://webappa.cdc.gov/sasweb/ncipc/leadcaus.html).

  4. Davidoff JB, Pakiela J. History of air medical transport. In: Blumen IJ, editor. Principles and direction of air medical transport. Salt Lake City: Air Medical Physician Association; 2015. p. 3–9.

    Google Scholar 

  5. McNabney WK. Vietnam in context. Ann Emerg Med. 1981;10:659–61.

    Article  CAS  Google Scholar 

  6. • Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden hour policy on the morbidity and mortality of combat casualties. JAMA Surg. 2016;151:15–24. This paper is a descriptive analysis of over 21,000 US casualties analyzed before and after a mandate to transport critically injured casualties in 60 minutes or less. Following the mandate, a significant reduction in time between injury and definitive care was realized with an attendant decrease in mortality.

    Article  Google Scholar 

  7. Eastridge B, Mabry R, Seguin P, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73:S431–7.

    Article  Google Scholar 

  8. Howard JT, Kotwal B, Santos-Lazada AR, Martin MJ, Stockinger ZT. Reexamination of a battlefield trauma golden hour policy. J Trauma Acute Care Surg. 2018;84:11–8.

    Article  Google Scholar 

  9. Cowley R, Hudson F, Scanlan E, et al. An economical and proved helicopter program for transporting the emergency. J Trauma. 1973;13:1029–38.

    Article  CAS  Google Scholar 

  10. Lerner E, Moscati R. The golden hour: scientific fact or medical ‘urban legend?’. Acad Emerg Med. 2001;8:758–60.

    Article  CAS  Google Scholar 

  11. Shatney C, Homan S, Sherck J, Ho C. The utility of helicopter transport of trauma patients from the injury scene in. J Trauma. 2002;53:817–22.

    Article  Google Scholar 

  12. Eckstein M, Jantos T, Kelly N, Cardillo A. Helicopter transport of pediatric trauma patients in an urban emergency medical. J Trauma. 2002;53:340–4.

    Article  Google Scholar 

  13. Hotvedt R, Kristiansen I, Forde O, et al. Which groups of patients benefit from helicopter evacuation? Lancet. 1996;347:1362–6.

    Article  CAS  Google Scholar 

  14. Chappell V, Mileski W, Wolf S, Gore D. Impact of discontinuing a hospital-based air ambulance service on trauma patient. J Trauma. 2002;52:486–91.

    PubMed  Google Scholar 

  15. Schiller WR, Knox R, Zinnecker H, et al. Effect of helicopter transport of trauma victims on survival in an urban trauma center. J Trauma Inj Infect Crit Care. 1988;28:1127–33.

    Article  CAS  Google Scholar 

  16. •• Galvagno SM Jr, Haut ER, Zafar SN, et al. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA. 2012;307:1602–10. Using the National Trauma Databank (NTDB), this cohort study analyzed over 223,000 adults with serious injuries. This study is the largest study examining the effectiveness of helicopter emergency medical services to date. Using a variety of techniques to control for known confounders, including propensity scores, patients transported by helicopter had improved odds of survival with an absolute risk reduction of 1.4–1.5%.

    Article  Google Scholar 

  17. Galvagno SM Jr. Comparative effectiveness of helicopter emergency medical services compared to ground emergency medical services. Crit Care. 2013;17:169.

    Article  Google Scholar 

  18. Andruszkow H, Lefering R, Frink M, et al. Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients. Critical Care. 2013;17(3):R124.

    Article  Google Scholar 

  19. Pakkanen T, Kamarainen A, Huhtala H, et al. Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury. Scand J Trauma Resusc Emerg Med. 2017;25:94.

    Article  Google Scholar 

  20. Gellerfors M, Fevang E, Backman A, et al. Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations. Br J Anaesth. 2018;120:1103–9.

    Article  CAS  Google Scholar 

  21. Chen X, Gestring ML, Rosengart MR, et al. Speed is not everything: identifying patients who may benefit from helicopter transport despite faster ground transport. J Trauma Acute Care Surg. 2018;84:549–57.

    Article  Google Scholar 

  22. Thomas SH, Blumen I. helicopter emergency medical services literature 2014 to 2016: lessons and perspectives, part 1-helicopter transport for Trauma. Air Med J. 2018;37:54–63.

    Article  Google Scholar 

  23. Thomas S. Helicopter emergency medical services transport outcomes literature: annotated review of articles published 2000–2003. Prehosp Emerg Care. 2004;8:322–33.

    PubMed  Google Scholar 

  24. Thomas S, Cheema F, Wedel S, Thomson D. Trauma helicopter emergency medical services transport: annotated review of selected outcomes-related literature. Prehosp Emerg Care. 2002;2002:359–71.

    Article  Google Scholar 

  25. Galvagno S, Thomas S, Stephens C, et al. Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev. 2013;2015:12.

    Google Scholar 

  26. Galvagno SM Jr. Assessing health-related quality of life with the EQ-5D: is this the best instrument to assess trauma outcomes? Air Med J. 2011;30:258–63.

    Article  Google Scholar 

  27. Galvagno SM, Sikorski R, Hirshon JM, et al. Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev. 2015;12:CD009228.

    Google Scholar 

  28. Di Rocco D, Pasquier M, Albrecht E, Carron PN, Dami F. HEMS inter-facility transfer: a case-mix analysis. BMC Emerg Med. 2018;18:13.

    Article  Google Scholar 

  29. Brown JB, Stassen NA, Bankey PE, Sangosanya AT, Cheng JD, Gestring ML. Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury. J Trauma. 2010;69:1030–4.

    Article  Google Scholar 

  30. Baker S, Grabowski J, Dodd R, Shanahan D, Lamb M, Li G. EMS helicopter crashes: what influences fatal outcome? Ann Emerg Med. 2006;47:351–6.

    Article  Google Scholar 

  31. Federal Aviation Administration. 14 CFR parts 91, 120, and 135 helicopter air ambulance, commercial helicopter, and part 91 helicopter operations. Washington, D.C.: Final Rule; 2017.

    Google Scholar 

  32. •• Brown JB, Forsythe RM, Stassen NA, Gestring ML. The national trauma triage protocol: can this tool predict which patients with trauma will benefit from helicopter transport? J Trauma Acute Care Surg. 2012;73:319–25. Analyzing over 158,000 patients transported by helicopter (16%) or ground (84%), the following triage criteria were found to have a survival benefit when transported by helicopter: penetrating injury, Glasgow Coma Scale < 14, respiratory rate < 10 or > 29, and age > 55. This tool was later validated in a subsequent study.

  33. Sasser SM, Hunt RC, Faul M, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61:1–20.

    PubMed  Google Scholar 

  34. Galvagno SM Jr, Massey M, Bouzat P, et al. Correlation between the revised trauma score and injury severity score: implications for prehospital trauma triage. Prehosp Emerg Care. 2018;23:1–8.

    Google Scholar 

  35. Brown JB, Gestring ML, Guyette FX, et al. Development and validation of the air medical prehospital triage score for helicopter transport of trauma patients. Ann Surg. 2016;264:378–85.

    Article  Google Scholar 

  36. Brown JB, Gestring ML, Guyette FX, et al. External validation of the air medical prehospital triage score for identifying trauma patients likely to benefit from scene helicopter transport. J Trauma Acute Care Surg. 2017;82:270–9.

    Article  Google Scholar 

  37. Vasilyeva K, Widener MJ, Galvagno SM Jr, Ginsberg Z. Spatial methods for evaluating critical care and trauma transport: a scoping review. J Crit Care. 2018;43:265–70.

    Article  Google Scholar 

  38. Hirshon JM, Galvagno SM Jr, Comer A, et al. Maryland’s helicopter emergency medical services experience from 2001 to 2011: system improvements and patients’ outcomes. Ann Emerg Med. 2016;67(332–40):e3.

    Google Scholar 

  39. Brown JB, Smith KJ, Gestring ML, et al. Comparing the air medical prehospital triage score with current practice for triage of injured patients to helicopter emergency medical services: a cost-effectiveness analysis. JAMA Surg. 2018;153:261–8.

    Article  Google Scholar 

  40. Floccare DJ, Stuhlmiller DF, Braithwaite SA, et al. Appropriate and safe utilization of helicopter emergency medical services: a joint position statement with resource document. Prehosp Emerg Care. 2013;17:521–5.

    Article  Google Scholar 

  41. Englum BR, Rialon KL, Kim J, et al. Current use and outcomes of helicopter transport in pediatric trauma: a review of 18,291 transports. J Pediatr Surg. 2017;52:140–4.

    Article  Google Scholar 

  42. Michailidou M, Goldstein SD, Salazar J, et al. Helicopter overtriage in pediatric trauma. J Pediatr Surg. 2014;49:1673–7.

    Article  Google Scholar 

  43. Brown J, Stassen N, Bankey P, Sangosanya A, Cheng J. Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes following traumatic injury. Annual Scientific Assembly: Eastern Association for the Surgery of Trauma; 2010. Phoenix: EAST; 2010.

    Google Scholar 

  44. Bulger EM, Guffey D, Guyette FX, et al. Impact of prehospital mode of transport after severe injury: a multicenter evaluation from the Resuscitation Outcomes Consortium. J Trauma Acute Care Surg. 2012;72:567–73.

    Article  Google Scholar 

  45. Desmettre T, Yeguiayan JM, Coadou H, et al. Impact of emergency medical helicopter transport directly to a university hospital trauma center on mortality of severe blunt trauma patients until discharge. Crit Care. 2012;16:R170.

    Article  Google Scholar 

  46. Koury SI, Moorer L, Stone K, Stapczynski JS, Thomas SH. Air vs ground transport and outcome in trauma patients requiring urgent operative interventions. Prehosp Emerg Med Care. 1998;2:289–92.

    Article  CAS  Google Scholar 

  47. Ryb G, Dischinger P, Braver E, Burch C, Ho S, Kufera J. Expected differences and unexpected commonalities in mortality, injury severity, and injury patterns between near versus far occupants of side impact crashes. J Trauma. 2009;66:499–503.

    Article  Google Scholar 

  48. Zhu TH, Hollister L, Opoku D, Galvagno SM Jr. Improved survival for rural trauma patients transported by helicopter to a verified trauma center: a propensity score analysis. Acad Emerg Med. 2018;25:44–53.

    Article  Google Scholar 

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Funding

Samuel M. Galvagno Jr. has received a grant from the Department of Defense and non-financial support from the United States Air Force.

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Authors and Affiliations

  1. Department of Anesthesiology, Program in Trauma, Maryland Critical Care Network, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene Street, T3N08, Baltimore, MD, 21201, USA

    Benjamin Fedeles & Samuel M. Galvagno

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Correspondence to Samuel M. Galvagno.

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Benjamin Fedeles declares no potential conflicts of interest.

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Fedeles, B., Galvagno, S.M. Helicopter Emergency Medical Services for Trauma: An Update. Curr Surg Rep 7, 17 (2019). https://doi.org/10.1007/s40137-019-0239-8

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