Should Helicopters Dispatched for EMS Trauma Response Be Grounded?

Abstract

A persistent debate in emergency medicine is the utility of helicopter transport for trauma victims from the scene of an accident to an appropriate receiving hospital. The topic is polarizing, with many advocates intensely for or against emergency medical services (EMS) helicopter dispatch. Much of the controversy centers around the cost of helicopter transport compared with ground transport. With respect to trauma, discussion of helicopter dispatch is made more interesting by the theoretical concept of the “golden hour” and the assumption that trauma victims require the most rapid method of transport. The article by Delgado et al published in this issue of Annals presents a sophisticated cost-effectiveness study of helicopter scene to hospital transports for trauma victims. The economic model used for the study shows that at a minimum, a 15% reduction in mortality must be accomplished for a helicopter to be cost-effective (threshold of $100,000/quality-adjusted lifeyears gained) relative to EMS ground transport. The study assumes a base rate for serious trauma mortality of 7.6%, such that a 17% reduction in mortality is equal to a 1.3% reduction in absolute mortality. The trauma mortality rate of 7.6% used for the analysis may be liberal compared with that of another recent publication using data from the US National Trauma Data Bank, which reported a crude US trauma mortality rate of 4.7%. The cost-effectiveness analysis presented by Delgado et al implies that EMS helicopter transport of trauma victims from the scene is costly and futile compared with ground transport. Although there are gaps in trauma center coverage throughout the United States, current trauma care programs represent a mature and sophisticated health delivery model for which attaining a 15% reduction in mortality based solely on transport method is unrealistic. Therefore, the data presented are strong evidence against dispatch of helicopters for transport of trauma victims from the field. But before grounding EMS trauma response helicopters, the limitations of cost-effectiveness research should be considered. There are 2 areas of cost-effectiveness research methodology that deserve discussion with respect to acute trauma management. First is the use of mortality as a primary outcome measure; F