Association between Helicopter Versus Ground Emergency Medical Services in Inter-Hospital Transport of Trauma Patients

The characteristics and clinical outcomes of trauma patients transferred by a physician-staffed helicopter emergency medical service in Korea: a retrospective study

Purpose

Helicopter transport with medical teams has been proven to be effective, with improvements in patient survival rates. This study compared and analyzed the clinical characteristics and treatment outcomes of trauma patients transported by doctor helicopters according to whether patients were transferred after a clinical evaluation or without a clinical evaluation.

Methods

This study retrospectively reviewed data from the Korean Trauma Data Bank of trauma patients who arrived at a regional trauma center through doctor helicopters from January 1, 2014, to December 31, 2022. The patients were divided into two groups: doctor helicopter transport before evaluation (DHTBE) and doctor helicopter transport after evaluation (DHTAE). These groups were compared.

Results

The study population included 351 cases. At the time of arrival at the trauma center, the systolic blood pressure was significantly lower in the DHTAE group than in the DHTBE group (P=0.018). The Injury Severity Score was significantly higher in the DHTAE group (P<0.001), and the accident to trauma center arrival time was significantly shorter in the DHTBE group (P<0.001). Mortality did not show a statistically significant between-group difference (P=0.094). Surgical cases in the DHTAE group had a longer time from the accident scene to trauma center arrival (P=0.002). The time from the accident to the operation room or from the accident to angioembolization showed no statistically significant differences.

Conclusions

DHTAE was associated with significantly longer transport times to the trauma center, as well as nonstatistically significant trends for delays in receiving surgery and procedures, as well as higher mortality. If severe trauma is suspected, air transport to a trauma center should be requested immediately after a simple screening test (e.g., mechanism of injury, Glasgow Coma Scale, or Focused Assessment with Sonography in Trauma), which may help reduce the time to definitive treatment.

Reduced Mortality in Severely Injured Patients Using Hospital-based Helicopter Emergency Medical Services in Interhospital Transport

Recent evidence has demonstrated the survival benefits of helicopter transport for trauma patients. The purpose of this study was to evaluate the effectiveness of hospital-based helicopter emergency medical services (H-HEMS) in comparison with ground ambulance transport in improving mortality outcomes in patients with major trauma. Study participants were divided into 2 groups according to type of transport to the trauma center; that is, either via ground emergency medical services (GEMS) or via H-HEMS. The study was conducted from October 2013 to July 2015. Mortality outcomes in the H-HEMS group were compared with those in the GEMS group by using the Trauma and Injury Severity Score (TRISS) analysis. The number of participants finally included in the study was 312. Among these patients, 63 were adult major trauma patients transported via H-HEMS, and 47.6% were involved in traffic accidents. For interhospital transport, the Z and W statistics revealed significantly higher scores in the H-HEMS group than in the GEMS group (Z statistic, 2.02 vs. 1.16; P = 0.043 vs. 0.246; W statistic, 8.87 vs. 2.85), and 6.02 more patients could be saved per 100 patients when H-HEMS was used for transportation. TRISS analysis revealed that the use of H-HEMS for transporting adult major trauma patients was associated with significantly improved survival compared to the use of GEMS.