Prehospital Trauma Care Provided by Helicopter Emergency Medical Service and Ground Emergency Medical Service: Does it Make a Difference?

Abstract

Background: The correlation between the quality of prehospital emergency care provided by ground ambulance and helicopter emergency medical services and outcome of major trauma patients was subject of many scientific papers. Yet there is no definitive proof for the superiority of HEMS. Methods: A retrospective cohort study on 276 multiple trauma patients admitted to the Department of Trauma Surgery of the Medical University Vienna (a level I trauma center in Austria) by ground ambulance (ground EMS, n = 172) or rescue helicopter (HEMS, n = 104), both physician staffed, has been performed. Prehospital and clinical documentation were analyzed. Demographics, time of rescue and of prehospital activities, medical condition of the patient on scene and upon admission (using MEES), type and severity of injuries (employing ISS), prehospital and early clinical treatment were analyzed in a comparative way, too. Results: Patients of helicopter (HEMS) and ground ambulance (ground EMS) were similar regarding age, sex and severity of injuries. Time from accident to admission was significantly shorter in HEMS patients. HEMS vs. ground EMS patients were considered to be in a more critical condition on scene, but judged significantly better at the time of admission. Early endotracheal intubation and chest tubing was performed more often in the HEMS group. HEMS patients received more fluid replacement and a more extensive pain management, especially significant regarding opioids. Time spent in the ER following the admission by HEMS was 2/3 in comparison to ground EMS admission. Intubation rate in the ER of HEMS patients was 50 % to ground EMS patients. Conclusions: Although on-scene advanced trauma life support by HEMS vs. ground EMS was more comprehensive, overall prehospital time was significantly shorter. The efficiency of HEMS vs. ground EMS is indicated by an improved emergency evaluation score (MEES) at hospital admission, lower likelihood of immediate airway management and chest tubing requirements, and therefore less time needed in the ED. The reasons for these findings are a more experienced HEMS crew and a therefore more invasive treatment in the field.