Study Measures Survival for Trauma Patients Based on Mode of Transport

[Arctickat]

Is a helicopter actually better than a ground unit for patient outcomes?

http://www.jems.com/article/patient-care/helicopters-don-t-affect-survival-trauma?utm_source=bm23&utm_medium=email&utm_term=Image+-+http%3A%2F%2Fwww.jems.com%2Farticle%2Fpatient-care%2Fhelicopters-don-t-affect-survival-trauma&utm_content=lowe%40sasktel.net&utm_campaign=Jems+eNews+06-19-12

The Science

This study is a retrospective analysis of prospectively collected data from the Resuscitation Outcomes Consortium on the survival of patients with hypovolemic shock and/or a traumatic brain injury (TBI), comparing their mode of transport: ground vs. helicopter. More than 2,000 patients qualified for the study, with approximately 700 patients being transported by helicopter. The investigators found the patients that were transported by helicopter tended to be more seriously injured and many suffered from blunt force trauma. Survival was analyzed at 28 days and 6 months in both groups; however, six-month follow up was reserved for patients with TBI. The analysis of the data showed no statistical difference in survival between the modes of transport in either the hypovolemic shock group or the TBI group. The only conclusion was that helicopter mode of transport was associated with longer prehospital times, more advanced life support procedures and more severely injured patients.

[BEorP]

I haven't taken a thorough look through this paper, but on the surface it does not seem terribly useful. This was done based on ROC data that was really focused on things other than evaluating air ambulance efficacy. If we really want to know, then we need a study designed specifically to evaluate this in a certain type of system and area. One of the problems is that unlike testing a medical device or something similar, the setup of the system and the local geography will impact the efficacy of air ambulances a whole lot more.

With this current paper, they say they found no difference in survival between the two groups, but the patients transported by air had more severe injuries. It seems to be like some could actually take this as being supportive of air ambulance transport from scene. Regardless of this, my first impression is that this doesn't really tell us anything new. (Still appreciate you sharing it!)

[mobey]

This post comes at a curious time for you

If I may inject a little HEMS experience here: Perhaps if the helo crew just "Load and fly" rather than sit around excersizing thier extensive adanced life support treatments on the ground, they would have better justification.

In these parts, a great way to delay transport of the patient of a critical patient, is to rendezvous with fixed wing or Helo.

**EDIT to add:

Dying trauma patients tend to die.

I am more interested to see if Helo's reduce morbidity. That I would definatly agree with!

I believe that will be the real effect in Arctic's area, not so much mortality reduction, but definatly a reduction in morbidity and increase in patient comfort.

Edited June 20, 2012 by mobey

[rock_shoes]

While I would agree HEMS is over used in many jurisdictions, this particular study is flawed. The authors themselves put forward the greatest flaw. HEMS patients tend to be more severely injured putting them at increased risk for all cause mortality right from the start. It becomes an apples to oranges comparison without accounting for differences in trauma severity scores.

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