Speed isn’t everything: Identifying patients who may benefit from helicopter transport despite faster ground transport

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. HEMS total prehospital time was a median of 13minutes (IQR 6, 22) longer than GEMS. Patients with abnormal respiratory rate (OR 2.39; 95%CI 1.26-4.55, p=0.01), GCS≤8 (OR 1.61; 95%CI 1.16-2.22, p0.05). Conclusions Patients with abnormal respiratory rate, GCS≤8, and hemo/pneumothorax benefit from HEMS transport even when GEMS transport was faster. This may indicate 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: III, Therapeutic Correspondence and Reprints: Joshua B. Brown, MD, MSc, Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213. Email: brownjb@upmc.edu No funding or support was directly received to perform the current study. There are no conflicts of interest for the current study This paper 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. © 2017 Lippincott Williams & Wilkins, Inc.

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