The coast and benefits of helicopter emergency medical services instead of the ground unit in traumatic patients: A cost-effectiveness analysis

Amin Shams Akhtari, Naghmeh Sadat Jafari, Hamid Kariman, Afshin Amini, Vahid Monsef, Mohamad Noorizadeh, Neda Gholizadeh

Department of Emergency Medicine, Gilan University of Medical Sceince, Rasht, Iran.
Department of Emergency Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran;.
Department of Forensic Medicine and Traumatic Pathology, Alborz University of Medical Science, Karaj, Iran.
Department of Radiation Medical Engineering, Isfahan University, Isfahan, Iran.
Research Committee of Medical Science, Jondishapour University of Medical Science, Ahvaz, Iran.

DOI: 10.4236/health.2013.55119                

Abstract

Study objective: Aero medical crews offer an advanced level of practice and rapid transport to definitive care; however, their efficacy remains unproven. Previous studies have used relatively small sample sizes or have been unable to adequately control the effect of other potentially influential variables. Here we explore the impact of aeromedical response in patients with moderate to severe traumatic brain injury. Methods: This was a cross-sectional study using our county trauma registry. All patients with trauma injury, who referred to our emergency department by helicopter or car, were included. The impact of aeromedical response was determined using logistic regression, adjusting for age, sex, mechanism, preadmissionGlasgowComa Scale score and Injury Severity Score. Finally, the aeromedical patients undergoing field intubation were compared with ground patients undergoing emergency department (ED) intubation. Results: A total of 243 patients meeting all inclusion and exclusion criteria and with complete data sets were identified. Overall mortality was 25% in the air- and ground-transported cohorts, but outcomes were not significantly better for the aeromedical patients when adjusted for age, sex, mechanism of injury, hypotension, Glasgow Coma Scale score, head Abbreviated Injury Score, and Injury Severity Score (adjusted odds ratio [OR] 1.90; 95% confidence interval [CI] 1.60 to 2.25; P: 0001). Good outcomes (discharge to home, jail, psychiatric facility, rehabilitation, or leaving against medical advice) were also higher in aeromedical patients (adjusted OR 1.36; 95% CI 1.18 to 1.58; P: 0001). Conclusion: Here we analyze a large database of patients with moderate to severe traumatic brain injury. Aeromedical response appears to yield no significantly improved outcomes after adjustment for multiple influential factors in patients with moderate to severe traumatic brain injury.

Keywords

Emergency; Traumatic Patients; Aero Medical

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Warren, J., Fromm Jr., R.E., Orr, R.A., Rotello, L.C. and Horst, H.M. (2004) Guidelines for the inter- and intra- hospital transport of critically illpatients. Critical Care Medicine, 32, 256-262.
[2]	Alexander, R.H., Pons, P.T., Kriscuer, J. and Hunt, P. (1984) The effect of advance life support and sophisticated hospital on motor vehicles mortality. The Journal of Trauma, 24, 486-490. doi:10.1097/00005373-198406000-00005
[3]	Celli, P., Fruin, A. and Cervoni, L. (1997) Severe head trauma: Review of the factors influencing the prognosis. Minerva Chirurgica, 52, 1467-1480.
[4]	Boyd, D., Mains, K. and Flashner, B. (1973) A systems approach to statewide emergency medical care. The Journal of Trauma, 13, 267-284. doi:10.1097/00005373-197304000-00002
[5]	Thomas, F., Clemmer, T.P. and Orme, J.F. (1985) A survey of advance truma life support procedure being performance by physicians and nurses on hospital aeromedical evacuation services. Aviation, Space, and Environmental Medicine, 56, 1213-1215.
[6]	Finch, H.F., Nareff, M.J. and Watkins, P.B. (1967) Wings for wounded warriors. JAMA, 200, 391-398. doi:10.1001/jama.1967.03120180079012
[7]	McVey, J., Petrie, D.A. and Tallon, J.M. (2010) Air versus ground transport of the major trauma patient: A natural experiment. Prehospital Emergency Care, 14, 45-50.
[8]	Shatney, C.H., Homan, S.J., Sherck, J.P., et al. (2002) The utility of helicopter transport of trauma patients from the injury scene in an urban trauma system. The Journal of Trauma, 53, 817-822. doi:10.1097/00005373-200211000-00002
[9]	Talving, P., Teixeira, P.G.R., Barmparas, G., DuBose, J., Inaba, K., et al. (2009) Helicopter evacuation of trauma victims in Los Angeles: Does it improve survival? World Journal of Surgery, 33, 2469-2476. doi:10.1007/s00268-009-0185-1
[10]	Cunningham, P., Rutledge, R., Baker, C.C., et al. (1997) A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene. Journal of Trauma, 43, 940-946. doi:10.1097/00005373-199712000-00013
[11]	Evans, C., Howes, D., Pickett, W. and Dagnone, L. (2009) Audit filters for improving processes of care and clinical outcomes in trauma systems. Cochrane Database of Systematic Reviews, Article ID: CD007590.
[12]	Olson, C.M., Jastremski, M.S., Vilogi, J.P., Madden, C.M. and Beney, K.M. (1987) Stabilization of patients prior to interhospital transport. American Journal of Emergency Medicine, 5, 33-39. doi:10.1016/0735-6757(87)90285-3
[13]	Ehrenworth, J., Sorbo, S. and Hackel, A. (1986) Transport of critically ill adults. Critical Care Medicine, 14, 543547. doi:10.1097/00003246-198606000-00005
[14]	Kanter, R. and Tompkins, J. (1989) Adverse events during interhospital transport: Physiologic deterioration associated with pretransport severity of illness. Pediatrics, 84, 43-48.
[15]	Borlase, B.C., Baxter, J.K., Kennedy, P.R., Forse, R.A., Benotti, P.N. and Blackburn, G.L. (1991) Elective intra-hospital admissions versus acute interhospital transfers to a surgical intensive care unit: Cost and outcome prediction. Journal of Trauma, 31, 915-918. doi:10.1097/00005373-199107000-00006
[16]	Mackenzie, P.A., Smith, E.A. and Wallace, P.G.M. (1997) Transfer of adults between intensive care units in the UK. British Medical Journal, 314, 1455-1456. doi:10.1136/bmj.314.7092.1455
[17]	Emily, A., Bosk, M.S.W., Veinot, T. and Iwashyna, T.J. (2011) Which patients, and where: A qualitative study of patient transfers from community hospitals. Medical Care, 49, 592-598. doi:10.1097/MLR.0b013e31820fb71b
[18]	Chappell, V.L., Mileski, W.J., Wolf, S.E., et al. (2002) Impact of discontinuing a hospital-based air ambulance service on trauma patient outcomes. Journal of Trauma, 52, 486-491. doi:10.1097/00005373-200203000-00012
[19]	Gore, J.M. (1989) Feasibility and safety of emergency interhospital transport of patients during the early hours of acute myocardial infarction. Archives of Internal Medicine, 149, 353-355. doi:10.1001/archinte.1989.00390020075015
[20]	Thomas, S.H., Harrison, T.H., Buras, W.R., et al. (2002) Helicopter transport and blunt trauma mortality: A multicenter trial. Journal of Trauma, 52, 136-145. doi:10.1097/00005373-200201000-00023
[21]	Harrahil, M. and Bartkus, E. (1990) Preparing the trauma patient for transfer. Journal of Emergency Nursing, 16, 25-28.
[22]	Lambert, S.M. and Willett, K. (1993) Transfer of multiply-injured patients for neurosurgical opinion: A study of the adequacy of assessment and resuscitation. Injury, 24, 333-336. doi:10.1016/0020-1383(93)90058-E
[23]	Henderson, A., Coyne, T., Wall, D. and Miller, B. (1992) A survey on interhospital transfer of head-injured patients with inadequately treated life-threatening extracranial injuries. Australian and New Zealand Journal of Surgery, 62, 759-762. doi:10.1111/j.1445-2197.1992.tb06913.x
[24]	Jacobs, L.M., Gabram, S.G., Sztajnkrycer, M.D., et al. (1999) Helicopter air medical transport: Ten-year outcomes for trauma patients in a New England program. Connecticut Medicine, 63, 677-682.
[25]	Garner, A., Rashford, S., Lee, A., et al. (1999) Addition of physicians to paramedic helicopter services decreases blunt trauma mortality. Australian and New Zealand Journal of Surgery, 69, 697-701. doi:10.1046/j.1440-1622.1999.01688.x
[26]	Dragsted, L., Jorgensen, J., Jensen, N.H., Bonsing, E., Jacobsen, E., Knaus, W.A. and Qvist. J. (1989) Interhospital comparisons of patient outcomes from intensive care: Importance of lead-time bias. Critical Care Medicine, 17, 418-422. doi:10.1097/00003246-198905000-00008
[27]	Gearhart, P., Wuerz, R. and Localio, A. (1997) Cost-effectiveness analysis ofhelicopter EMS for trauma patients. Annals of Emergency Medicine, 30, 500-506. doi:10.1016/S0196-0644(97)70010-6
[28]	Silbergleit, R., Scott, P.A., Lowell, M.J. and Silbergleit, R. (2003) Cost-effectiveness of helicopter transport of stroke patients for thrombolysis. Academic Emergency Medicine, 10, 966-972.
[29]	Fan, E., MacDonald, R.D., Adhikari, N.K.J., Scales, D.C., et al. (2006) Outcomes of interfacility critical care adult patient transport: A systematic review. Critical Care, 10, R6. doi:10.1186/cc3924
[30]	Durairaj, L., Will, J.G., Torner, J.C. and Doebbeling, B.N. (2003) Prognostic factors for mortality following interhospital transfers to the medical intensive care unit of a tertiary referral center. Critical Care Medicine, 31, 1981- 1986. doi:10.1097/01.CCM.0000069730.02769.16
[31]	Nardi, G., Massarutti, D., Muzzi, R., et al. (1994) Impact of emergency medical helicopter service on mortality for trauma in North-East Italy: A regional prospective audit. European Journal of Emergency Medicine, 1, 69. doi:10.1097/00063110-199406000-00004
[32]	Martin, G., Cogbill, T., Landercasper, J. and Strutt, P.J. (1990) Prospective analysis of rural interhospital transfer of injured patients to a referral trauma center. Journal of Trauma, 30, 1014-1020. doi:10.1097/00005373-199008000-00011
[33]	Valenzuela, T., Criss, E., Copass, M., Luna, G.K. and Rice, C.L. (1990) Critical care air transportation of the severely injured: Does long distance transport adversely affect survival? Annals of Emergency Medicine, 19, 169-172. doi:10.1016/S0196-0644(05)81803-7
[34]	Grieve, C.F., Ferguson, N.D., Adhikari, N., Singh, J.M., Moneta, S.L., DeMajo, W., Stewart, T.E. and Scales, D.C. (2005) Utilization pattern of Ontario’s critical care referral and transfer facilitation program [abstract]. Proceedings of the American Thoracic Society, 2, A597.
[35]	Kerr, H.D. and Byrd, J.C. (1989) Community hospital transfers to a VA Medical Center. Journal of the American Medical Association, 262, 70-73. doi:10.1001/jama.1989.03430010082035
[36]	Durairaj, L., Will, J.G., Torner, J.C. and Doebbeling, B.N. (2003) Prognostic factors for mortality following inter- hospital transfers to the medical intensive care unit of a tertiary referral center. 31, 1981-1986.