The impact of multiple patient transport on patient care in helicopter emergency medical services

Abstract

Introduction: Many helicopter emergency medical services can transport either one (singles) or two (doubles) patients. The purpose of this study was to investigate whether the additional patient in the doubles flight had an adverse impact on patient care because of the decreased provider-to-patient ratio. Setting: Patients were flown by a Level 1 trauma center-based helicopter emergency medical service staffed by a nurse and paramedic. Method: A retrospective record and trauma registry review comparing 124 randomly selected scene trauma singles frequency-matched to 100 doubles ( 1 89 through 6 92 ) was performed. Data collected included patient demographics, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, mechanism of injury, scene time, and ground ALS and helicopter emergency medical services procedures performed. Results: Doubles accounted for 6.5% of all on-scene helicopter emergency medical service trauma patient transports. Paired comparison of Glasgow Coma Scale, Revised Trauma Score, and Injury Severity Score revealed that only one of the doubles patients had a field Glasgow Coma Scale as low, or an Injury Severity Score as high as the average singles. Revised trauma scores were equivalent. Although more procedures were performed during doubles missions, no procedures were performed in most singles missions (58%) and a substantial minority of doubles missions (41%). No differences were found between the groups in change in Glasgow Coma Scale during flight. Conclusions: Only one of the two patients during doubles missions was as severely injured as the average patient in a singles transport. The decreased ratio of helicopter emergency medical service crew to patients in doubles missions does not jeopardize patient care because few procedures were performed during either singles or doubles missions.