Transportation to hospital for major trauma: helicopter or ground transportation?
For me, at least, the hospital’s helicopter looks impressive. We’re able to view it from one of the hallways leading to the OR. Patients like looking at it as they are wheeled into the operating room. Though perhaps an additional benefit is that it feeds into the hospital’s marketing, an important reason the helicopter is there is to transport traumatically injured patients. Does this make a difference? Indeed, transport by helicopter is expensive and its availability is limited. Is ground transportation just as good? In the study “Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma,” published in the 18 April 2012 issue of JAMA, Dr. Samuel M. Galvagno Jr, DO, PhD, (Division of Trauma Anesthesiology, Shock Trauma Center, Program in Trauma, Department of Anesthesiology, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD) and colleagues retrospectively compared patients older than 15 years of age who were transported by helicopter or ground emergency services to a level I or II trauma center.
The authors compiled data from the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank. Patients transported by other means were not included. They used the Injury Severity Score (ISS) to quantify the severity of trauma and included only those patients whose score was greater than 15. The primary outcome of interest was survival to discharge from hospital. The authors analyzed 61,909 patients who were transported by helicopter and 161,566 who were transported by ground. Unadjusted mortality was significantly higher for patients transported by helicopter, though more patients who were transported by helicopter had ISS scores higher than 24. However, based on regression analysis, helicopter transportation was associated with a greater change with regard to odds of survival. Data suggested that patients in the helicopter group had higher injury severity compared to patients transported by ground since more patients transported by helicopter were discharged to rehabilitation and to intermediate facilities. More patients in the ground transportation group were discharged from a level I center to a nursing home.
Who was caring for patients while they were in the helicopter and the intervention they provided is not known. This was a retrospective study and missing data was high for some variables. It is unlikely, though, that a randomized clinical trial comparing the two types of transport will be undertaken. If providers have the option, this study would favor helicopter use.