B. N. Taylor1, N. Rasnake1, K. McNutt1, B. J. Daley1 1University Of Tennessee Medical Center,Surgical Critical Care,Knoxville, TENNESSEE, USA
Introduction: There is debate within the EMS community over the value of calling a helicopter for trauma patients within a moderate distance/< 45 minutes, from a trauma center. Helicopter EMS (HEMS) generally have a wider scope and more advanced training than the ground EMS (GEMS). GEMS, on the other hand, have the benefit of being able to immediately initiate rapid ground transport to the center without having to wait for the HEMS to fly to the scene, land, and assume patient care.
Methods: We retrospectively analyzed patients brought to a level I trauma center that were admitted with blunt traumatic injuries between 2010 and 2015 in the Trauma Quality Improvement Program (TQIP) database. Two analyses were performed, one in which the patient’s reported initial scene vitals met criteria for step one of the CDC’s 2011 National Field Triage Guidelines (NFTG), and the other in which the patient’s initial scene vitals met those same guidelines and/or had a pulse greater than 110 beats per minute. Patients were categorized on scene to ED transport mode, either HEMS or GEMS. Inclusion criteria were a HEMS response time to the scene that was between 15 and 45 minutes with a transport time from the scene to the ED that was between 10 and 35 minutes, or a GEMS transport time from the scene to the ED that was between 15 and 45 minutes. Statistical significance (p< 0.05) was established through logit regression. Mortality rates were then calculated within each transport mode based population.
Results: 400 subjects were included in the analysis of patients meeting the first step of the NFTG, with 212 HEMS patients and 188 in the GEMS group. HEMS had a higher mortality rate at 0.184 and GEMS at 0.101 which was statistically significant (p=0.019). When 606 subjects meeting the first step of the NFTG or with a pulse greater than 110 beats per minute were analyzed, the results were statistically significant again (p=0.000), with the HEMS category having a higher mortality rate at 0.154 and the GEMS category having a lower mortality at 0.056.
Conclusion: This data demonstrates that scene to ED time is paramount and rapid ground transport should be used in blunt trauma patients when the scene is a up to a moderate ground distance away from the trauma center and there is a moderate to prolonged HEMS response time. In both analyses, hemodynamically unstable trauma patients had a lower rate of mortality following ground transport. We recognize that there may be a subset of patients at these distances who could benefit from HEMS response, particularly if the flight crew can offer more advanced and specialized techniques, however every effort should be made to minimize the scene to ED time, and HEMS response, scene, and transport time must be considered. This study only analyzed the patients within a moderate distance of the trauma center, and at longer distances or in different environments; HEMS transport may indeed minimize the scene to ED time.