HEMS Guidelines Utilization

Abstract

Introduction Debates exist on the benefits of Helicopter EMS (HEMS) with safety, cost, and outcome implications often cited. The decision to utilize HEMS is a complex process that involves many considerations. Professional associations and agencies have published guidelines to assist providers with decision making for the utilization of helicopter transport. Study Objective The goal of this project is to determine if requests for HEMS align with recently published utilization guidelines. Methods A retrospective chart review was performed during a six month period. Reviewers versed in Wisconsin HEMS Utilization, NAEMSP, and CAMTS guidelines determined if criteria were met for each transport. Charts were categorized according to whether they did or did not follow the criteria for each set of recommendations. Percentage of total cases was calculated for each group and compared between groups. Results 514 charts were reviewed, 439 of which consisted of completed patient transports. 42.8% of transports were for trauma, 9.3% STEMI, 8.0% stroke, 4.1% sepsis, and 35.8% for other medical conditions. Pediatric patients comprised 15.9% of all HEMS transports and met the trauma, sepsis, and other medical condition subgroup criteria 20.2%, 11.1%, and 19.1% of the time, respectively. CAMTS, NAEMSP, and WI HEMS guidelines satisfied 85.4%, 83.4%, and 53.1% of requests, respectively. There were statistically significant differences when comparing rates meeting criteria between WI HEMS and CAMTS and between WI HEMS and NAEMSP guidelines (p-value < 0.0001). This was true in all subgroups except STEMI, which did not show significant difference among the three guidelines. There was no difference between rates for CAMTS and NAEMSP guidelines in any group. Conclusion We detected a significant difference between the number of cases meeting Wisconsin HEMS utilization versus NAEMSP guidelines, and between Wisconsin HEMS utilization and CAMTS guidelines in all subgroups except STEMI patients. No statistically significant difference existed between the NAEMSP guidelines and the CAMTS guidelines. Further study is required to examine the lack of agreement between guidelines to clearly identify patients that should be transported by HEMS. Debates exist on the benefits of Helicopter EMS (HEMS) with safety, cost, and outcome implications often cited. The decision to utilize HEMS is a complex process that involves many considerations. Professional associations and agencies have published guidelines to assist providers with decision making for the utilization of helicopter transport. The goal of this project is to determine if requests for HEMS align with recently published utilization guidelines. A retrospective chart review was performed during a six month period. Reviewers versed in Wisconsin HEMS Utilization, NAEMSP, and CAMTS guidelines determined if criteria were met for each transport. Charts were categorized according to whether they did or did not follow the criteria for each set of recommendations. Percentage of total cases was calculated for each group and compared between groups. 514 charts were reviewed, 439 of which consisted of completed patient transports. 42.8% of transports were for trauma, 9.3% STEMI, 8.0% stroke, 4.1% sepsis, and 35.8% for other medical conditions. Pediatric patients comprised 15.9% of all HEMS transports and met the trauma, sepsis, and other medical condition subgroup criteria 20.2%, 11.1%, and 19.1% of the time, respectively. CAMTS, NAEMSP, and WI HEMS guidelines satisfied 85.4%, 83.4%, and 53.1% of requests, respectively. There were statistically significant differences when comparing rates meeting criteria between WI HEMS and CAMTS and between WI HEMS and NAEMSP guidelines (p-value < 0.0001). This was true in all subgroups except STEMI, which did not show significant difference among the three guidelines. There was no difference between rates for CAMTS and NAEMSP guidelines in any group. We detected a significant difference between the number of cases meeting Wisconsin HEMS utilization versus NAEMSP guidelines, and between Wisconsin HEMS utilization and CAMTS guidelines in all subgroups except STEMI patients. No statistically significant difference existed between the NAEMSP guidelines and the CAMTS guidelines. Further study is required to examine the lack of agreement between guidelines to clearly identify patients that should be transported by HEMS.