Helicopter trauma transport: An overview of recent outcomes and triage literature

Current Opinion in Anaesthesiology

Volumn 16, Issue 2, 2003, Pages 153-158

  Thomas, Stephen H ^a,b,c   Biddinger, Paul D ^a  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b Boston MedFlight Critical Care T   (United States)

^c Clinics Building ^*  (United States)

Author keywords

EMS; Helicopter transport; Outcomes studies; Prehospital transport

Indexed keywords

BLUNT TRAUMA; EMERGENCY HEALTH SERVICE; HEAD INJURY; HEALTH CARE UTILIZATION; HELICOPTER; HUMAN; MORTALITY; OUTCOMES RESEARCH; PATIENT CARE; PATIENT TRANSPORT; PRIORITY JOURNAL; REVIEW;

EID: 0037399390     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-200304000-00008     Document Type: Review

References (32)

1. Thomas SH, Cheema F, Wedel SK, Thomson D. Trauma helicopter EMS transport: annotated review of selected outcomes-related literature. Prehosp Emerg Care 2002; 6:359-371. An annotated review of HEMS trauma-related outcomes literature, covering 1980-2000 (the the time period before the commencement of the current article's focus).
2. Dick WF, Mauritz W. Prehospital trauma care. Curr Opin Anaesthesiol 2000; 13:175-179.
3. DiBartolomeo S, Sanson G, Nardi G, et al. Effects of 2 patterns of prehospital care on the outcome of patients with severe head injury. Arch Surg 2001; 136:1293-1300. A well-written study assessing severe head injury outcome for patients receiving 'basic' (e.g. basic life support plus intravenous access) versus 'advanced' (i.e. anesthesiologist-staffed HEMS) prehospitat care. The authors' discussion of possible confounders and explanations for their findings is particularly thoughtful.
4. Eckstein M, Jantos T, Kelly N, Cardillo A. Helicopter transport of pediatric trauma patients in an urban emergency medical services system: a critical analysis. J Trauma 2002; 53:340-344. A well-conducted study assessing the magnitude of HEMS evertriage for pediatric trauma. The authors include an assessment of factors that specifically affect helicopter dispatch and transport interventions for pediatric patients.
5. Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993; 34:216-222.
6. Baxt WG, Moody P. The impact of advanced prehospital emergency care on the mortality of severely brain injured patients. J Trauma 1987; 27:365-368.
7. Celli P, Fruin A, Cervoni L. Severe head trauma. Review of the factors influencing the prognosis. Minerv Chir 1997; 52:1467-1480.
8. Malacrida RL, Anselmi LC, Genoni M, et al. Helicopter mountain rescue of patients with head injury and/or multiple injuries in southern Switzerland 1980-1990. Injury 1993; 24:451-453.
9. Dardis R, Roberts G, Phillips J. A cost-benefit evaluation of helicopter transfers to the Beaumont neurosurgical unit. Ir Med J 2000; 93:50-51.
10. Coats TJ, Kirk CJ, Dawson M. Outcome after severe head injury treated by an integrated trauma system. J Accid Emerg Med 1999; 16:182-185.
11. Nardi G, Massarutti D, Muzzi R, et al. Impact of emergency medical helicopter service on mortality for trauma in north-east Italy: a regional prospective audit. Eur J Emerg Med 1994; 1:69-77.
12. Thomas SH, Orf J, Wedel SK, Conn A. Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice. J Trauma 2002; 52:47-53. The use of the HEMS service as an agent for observing critical care practices in a wide catchment area; with their high level of training and frequent exposure to critically injured patients. HEMS crews are ideal observers of prehospital and community hospital practices.
13. Thomas SH, Harrison TH, Buras WR, et al. Helicopter transport and blunt trauma outcome. J Trauma 2002; 52:136-145. One of the few large-scale (n=16 999) studies that did not employ TRISS (an outcomes assessment tool based on calculated 'expected' mortality from the US Multiple Trauma Outcome Study database). This study, which employed ISS for acuity control between ground and air transported patients, was characterized by an evaluation of independent variables (e.g. prehospital level of care) usually not considered in other studies.
14. Brathwaite CE, Rosko M, McDowell R, et al. A critical analysis of on-scene helicopter transport on survival in a statewide trauma system. J Trauma 1998; 45:140-146.
15. Chappell VL, Mileski WJ, Wolf SE, Gore DC. Impact of discontinuing a hospital-based air ambulance service on trauma patient outcomes. J Trauma 2002; 52:486-491. The first study published in full-length form, which addressed the effects of the discontinuation of HEMS availability on trauma outcomes. On a close read, methodological issues slightly diminish the impact of the authors' results, but the authors are to be congratulated on tackling a complex topic and setting the stage for further work in a situation (i.e. HEMS service discontinuation as a result of financial issues) that is likely to be repeated elsewhere.
16. Mann NC, Pinkney KA, Price DD, et al. Injury mortality following the loss of air medical support for rural interhospital transport. Acad Emerg Med 2002; 9:694-698. With their well-designed analysis and cogent discussion, these authors covered all of the bases. The barriers to performance of the 'natural experiment' research project were handled quite effectively, and the authors' discussion includes detailed handling of potential study flaws.
17. Slater H, O'Mara MS, Goldfarb IW. Helicopter transportation of burn patients. Burns 2002; 28:70-72. An overview of 437 burn transports, 98 by air, to the Western Pennsylvania Hospital. The article includes a balanced discussion of the facts that HEMS probably benefits some patients but is also overutilized. The authors' approach of discussing the real reasons for HEMS triage (with local ground ambulance providers) represents an important contribution to the triage literature.
18. Wijngaarden MV, Kortbeek J, Lafreniere R, et al. Air ambulance trauma transport: a quality review. J Trauma 1996; 41:26-31.
19. Kotch SJ, Burgess BE. Helicopter transport of pediatric vs. adult trauma patients. Prehosp Emerg Care 2002; 6:306-308. This straightforward paper simply compared ISSs, RTSs, and survival probability between adult and pediatric patients, to test the hypothesis that younger patients transported by air were of less acuity than adults.
20. Moront M, Gotschall CS, Eichelberger MR. Helicopter transport of injured children: system effectiveness and triage criteria. J Pediatr Surg 1996; 31:1183-1188.
21. Harrison T, Thomas SH, Wedel SK. Interhospital aeromedical transports: delayed air medical activation in adult and pediatric trauma patients. Am J Emerg Med 1997; 15:122-124.
22. Hotvedt R, Kristiansen IS, Forde OH, et al. Which groups of patients benefit from helicopter transport? Lancet 1996; 347:1362-1366.
23. Melanson SW, McCarthy J, Stromski CJ, et al. Aeromedical trauma sonography by flight crews with a miniature ultrasound unit. Prehosp Emerg Care 2001; 5:399-402. An early report of the use of portable ultrasound by flight physicians, to assist in prehospital diagnosis.
24. Thomas SH, Harrison T, Wedel SK. Flight crew airway management in four settings: a six-year review. Prehosp Emerg Care 1999; 3:310-315.
25. Coats TJ, Keogh S, Clark H, Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma 2001; 50:670-673. This study, set in London, demonstrated that the unusual occurrence of the need for resuscitative thoracotomy was actually associated with reasonably good outcomes (10% survival).
26. Oppe S, DeCharro FT. The effect of medical care by a helicopter trauma team on the probability of survival and the quality of life of hospitalised victims. Accid Anal Prevent 2001; 33:129-138. A well-written treatise providing a relatively detailed analysis of quality of life and HEMS transports, with the goal (successfully achieved) of demonstrating that air transport benefits those in the mid-range of iniury acuity.
27. Gearhart PA, Wuerz RW, Localio AR. Cost-effectiveness analysis of helicopter EMS for trauma patients. Ann Emerg Med 1997; 30:500-506.
28. Bruhn JD, Williams KA, Aghababian R. True costs of air medical vs. ground ambulance systems. Air Med J 1993; 12:262-268.
29. Schoettker P, Ravussin P, Moeschler O. Ejection as a key word for dispatch of a physician staffed helicopter: the Swiss experience. Resuscitation 2001; 169-173. A critical analysis of whether ejection was a useful criterion, on retrospective assessment, for triage to helicopter transport. The authors found that it was reliably predictive of the need for advanced levels of care.
30. Cunningham P, Rutledge R, Baker CC, Clancy TV. A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene. J Trauma 1997; 43:940-946.
31. Moylan JA, Fitzpatrick KT, Beyer AJ, Georgiade GS. Factors improving survival in multisystem trauma patients. Ann Surg 1988; 207:679-685.
32. Grines CL, Westerhausen DR, Grines LL, et al. A randomized trial of transfer for primary angioplasty versus on-site thrombolysis in patients with high-risk myocardial infarction. J Am Coll Cardiol 2002; 39:1713-1719. Arguably the first study to address directly the mortality benefit associated with HEMS transport (for percutaneous coronary intervention).