Helicopter Transports Research Articles

Feasibility of 10-Minute Arrival Time to Departure Time Metric for STEMI Patients

Objectives Delays in reperfusion treatment in ST-elevation myocardial infarction (STEMI) patients leads to higher morbidity and mortality. Previous reports for Helicopter Emergency Medical Services (HEMS) suggests a 10-minute skid-to-skid (arrival to departure) time to achieve appropriate reperfusion times. However, there is no published data on whether this goal is achievable for a HEMS service. This study aims to see if a midwestern critical care service can consistently achieve a 10-minute helicopter skid-to-skid time or ground critical care service arrival to departure time. Further, comparing this metric between ground and helicopter transportations will help evaluate the ideal transportation method to optimize time to percutaneous intervention (PCI). Methods This was a retrospective chart review utilizing 10 years of data from our ground and HEMS program to assess whether a 10-minute arrival to departure time for STEMI patients could be achieved. Patients included were at least 18 years of age and were transported from the referring facility for further STEMI management. Wilcoxon rank sum test and Chi-square tests were used to evaluate data between helicopter and ground services. Results Included in the study were 686 patients, 608 by helicopter transport and 78 by ground transport. The median arrival to departure time was 14 min (IQR = 5) for helicopter patients and 13 min (IQR = 6) for ground patients. There was not a statistically significant difference in this metric for STEMI patients transported by helicopter versus ground. A statistically significant difference, though, existed between helicopter and ground transports among percent with times less than or equal to 10 min versus percent times greater than 10 min, X2 = 5.46, df = 1, p = 0.02. Two referring facilities had statistically significant differences in median arrival to departure times. Conclusions Our study found that a median EMS arrival to departure time of 10 min to transport STEMI patients was not consistently achieved via either helicopter or ground transportation.

Helicopter versus ground ambulance transport for interfacility transfer of critically ill children

BackgroundFollowing initial stabilization, critically ill children often require transfer to a specialized pediatric hospital. While the use of specialized pediatric transport teams has been associated with improved outcomes for these patients, the additional influence of transfer mode (helicopter or ground ambulance) on clinical outcomes remains unknown. MethodsWe investigated the association between transport mode and outcomes among critically ill children transferred to a single pediatric hospital via a specialized pediatric transport team. We designed a retrospective cohort study to reduce indication bias by limiting analysis to patients for whom a helicopter transport was initially requested. We compared outcomes for those who ultimately traveled via helicopter, and for those who ultimately traveled via ground ambulance due to non-clinical factors. ResultsWe compared transport times, in-hospital mortality, and hospital length of stay by transport mode. Transport time in minutes was shorter for helicopter transports (median = 143, interquartile range [IQR]: 118–184) compared to ground ambulance transports (median = 289, IQR: 213–258; difference in medians = 146, 95% CI: 12 to 168, p < 0.001). In unadjusted analysis, helicopter transport was not associated with a difference in in-hospital mortality (helicopter = 6.0%, ground ambulance = 7.0%; 95% CI for difference: −6.6% to 3.3%; p = 0.64) but was associated with a statistically significant reduction in median hospital days (helicopter = 4, ground ambulance = 5; 95% CI -3 to 0; p = 0.04). In adjusted analyses, there were no statistically significant associations. These results were consistent across sensitivity analyses. ConclusionsAmong critically ill pediatric patients without traumatic injuries transported by a specialty team, those patients who would have been transferred by helicopter if available but were instead transferred by ground ambulance reached their site of definitive care approximately 2.5 h later. Helicopter transport for these patients was not associated with in-hospital mortality, but was potentially associated with reduced hospital length of stay.

The Helicopter Transports of Patients Critically ill with COVID-19.

ObjectiveThe aim of our study was to describe specialist nurses’ experiences with the helicopter transport of patients critically ill with COVID-19.MethodOur study followed a descriptive qualitative design anchored in the naturalistic paradigm and was based on qualitative content analysis. The study followed the consolidated criteria for reporting qualitative research.ResultsSix semi-structured interviews were conducted with specialist nurses who have cared for patients critically ill with COVID-19 during helicopter transport. The analysis of the interviews resulted in three themes—designing new routines before transport, working under new conditions and post-transport and reflections—with 11 categories. The goal of the intensive care transport of patients with COVID-19 was twofold: to prevent the spread of infection by using personal protective equipment and to prevent the contamination of the helicopter.ConclusionFor the nurses, working in personal protective equipment created a feeling of distance from patients that compromised patient–nurse intimacy. Our results suggest that ensuring the sufficiency of equipment required in the event of major accidents and pandemics is critical.

Pediatric interfacility transport effects on mortality and length of stay

BackgroundWe aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS.MethodsRetrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission.ResultsFour hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4–2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59–5.90) than ambulance transports (P = 0.017).ConclusionsThese results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.

Simulation-based medical education for Ambulance Jet and Helicopter Emergency Medical Services: A program description and evaluation.

This article was migrated. The article was marked as recommended. Introduction: In aviation, crew resource management trainings are established methods to enhance safety, a method that also gained popularity in medicine. In 2015, the Swiss Air Rescue (Rega) Helicopter Emergency Medical Services decided to start a simulation-based medical education program for its helicopter and ambulance jet crews (emergency physicians, paramedics/flight nurses and pilots). The aim of this program was to improve technical skills and the application of human factors during rescue missions. This report shows a five-year summary of the participants' course evaluation. Methods: A 1-day high-fidelity simulation on crisis resource management with video-assisted debriefing took place at 3 centres, two in Switzerland; one in Germany. Crew members participated once per year. Simulation covered critical situations in the helicopter or jet, during handovers at an intensive care unit or in ambulances. Extra Corporeal Membrane Oxygenation and Intra-Aortic Balloon Pump use was simulated during helicopter transports. Additionally, four times per year flight crews rehearsed basic and advanced life support skills using low-fidelity equipment between missions. Participants answered an anonymized course evaluation survey. Answers were rated on a Numeric Rating Scale ranging from 1=no agreement to 5=total agreement. Results: 329 participated and answered the questionnaire; 50% were emergency physicians, 40% paramedics, 9% flight nurses, and 1% pilots. Participants agreed that the course taught competencies that were useful for their clinical practice. However, confidence to apply Extra Corporeal Membrane Oxygenation or Intra-Aortic Balloon Pump skills was significantly lower compared to other emergency competencies. Instructors were rated as experienced, engaged and motivated, as well as responsive to course participants. Conclusions: This simulation-based medical education program, with the goal to increase patient's safety and outcome, was launched successfully. Participants especially valued the time to reflect on clinical performance as well as on crew interaction and ways to apply human factors to improve their team performance and task management.

Cabin temperature during prehospital patient transport \u2013 a prospective observational study

BackgroundFew studies have investigated the patient compartment temperatures during ambulance missions or its relation to admission hypothermia. Still hypothermia is a known risk factor for increased mortality and morbidity in both trauma and disease. This has special relevance to our sub-arctic region’s pre-hospital services, and we prospectively studied the environmental temperature in the patient transport compartment in both ground and air ambulances.MethodsWe recorded cabin temperature during patient transport in two ground ambulances and one ambulance helicopter in the catchment area of the University Hospital of North Norway using automatic temperature loggers. The data were collected for one month in each of the four seasons. We calculated the sum of degrees Celsius below 18 min by minute to describe the patient exposure to unfavourably low cabin temperature, and present the data as box plots. The statistical differences between transport mode and season were analysed with ANCOVA.ResultsThe recorded cabin temperatures were higher during the summer than the other three seasons. However, we also found that helicopter transports were performed at lower cabin temperatures and with significantly more exposure to unfavourably low temperatures than the ground ambulance transports. Furthermore, the helicopter cabin reached the final temperature much slower than the ground ambulance cabins did or remained at a lower than comfortable temperature.ConclusionsHelicopter cabin temperature during ambulance missions should be monitored closer, particularly for patients at risk for developing admission hypothermia.

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation.

Pediatric lung transplantation is a life-saving intervention for children with irreversible end-stage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant. We report the development of a service at our center to provide transport services to our hospital for patients unable to wean from ECMO support at their local institution for the purpose of evaluation for lung transplantation by our program. We developed a process for pre-transport consultation by the lung transplant physician team, standardized hand-off tools and equipment lists, and procedures for transitioning patients to transport ECMO machinery. Four patients have been transported to date including fixed wing (FW) and helicopter transports. All patients were successfully transported with either none or minor complications. Transport of ECMO-supported patients is a feasible method to increase access of patients with irreversible lung injured patients to evaluation for lung transplant.

Maryland’s Helicopter Emergency Medical Services Experience From 2001 to 2011: System Improvements and Patients’ Outcomes

Helicopter emergency medical services (EMS) has become a well-established component of modern trauma systems. It is an expensive, limited resource with potential safety concerns. Helicopter EMS activation criteria intended to increase efficiency and reduce inappropriate use remain elusive and difficult to measure. This study evaluates the effect of statewide field trauma triage changes on helicopter EMS use and patient outcomes. Data were extracted from the helicopter EMS computer-aided dispatch database for in-state scene flights and from the state Trauma Registry for all trauma patients directly admitted from the scene or transferred to trauma centers from July 1, 2000, to June 30, 2011. Computer-aided dispatch flights were analyzed for periods corresponding to field triage protocol modifications intended to improve system efficiency. Outcomes were separately analyzed for trauma registry patients by mode of transport. The helicopter EMS computer-aided dispatch data set included 44,073 transports. There was a statewide decrease in helicopter EMS usage for trauma patients of 55.9%, differentially affecting counties closer to trauma centers. The Trauma Registry data set included 182,809 patients (37,407 helicopter transports, 128,129 ambulance transports, and 17,273 transfers). There was an increase of 21% in overall annual EMS scene trauma patients transported; ground transports increased by 33%, whereas helicopter EMS transports decreased by 49%. Helicopter EMS patient acuity increased, with an attendant increase in patient mortality. However, when standardized with W statistics, both helicopter EMS- and ground-transported trauma patients showed sustained improvement in mortality. Modifications to state protocols were associated with decreased helicopter EMS use and overall improved trauma patient outcomes.

Prehospital Use of Blood and Plasma in Pediatric Trauma Patients

ObjectiveOur rural trauma center uses packed red blood cells (PRBCs) and plasma onboard our helicopter to offset the delay of transport. We summarize our initial experience with prehospital blood use in pediatric trauma patients. MethodsOur air ambulance service began carrying PRBCs in 1987 and plasma in 2009. We performed a 9-year retrospective review including patients (< 18 years) who received blood during helicopter transports. Only patients transported to our level 1 trauma center were included to ensure complete follow-up. ResultsSixteen patients (6 females) were identified with a mean age of 13 years. The mean transport time was 30 minutes with 75% transferred in from a referring center. Injuries were blunt in 9 patients and penetrating in 2 patients. The mean Injury Severity Score was 30. Fifteen patients received an average of 1.5 units of PRBCs during flight. Indications for PRBCs were severe anemia (6), known blood loss (5), and nonresponder to intravenous fluids (4). Average hemoglobin improved from 9.4 to 11.4 mg/dL at our center. Base deficit improved from −7 to −5.7 at arrival. Five patients received a mean of 1.4 units of plasma. The arrival international normalized ratio was 1.4. The average length of stay was 9.3 days. Four patients died. Trauma Related Injury Severity Score showed 3 patients were unexpected survivors (0.24, 0.24, and 0.38). ConclusionPrehospital use of blood in injured children is rare. However, when indicated, this initial review of our protocol showed increased hemoglobin, decreased acidosis, and unexpected survivors with our program. Because of the rarity of prehospital blood use in children, administration triggers require continued review and refinement.

Patient and trauma center characteristics associated with helicopter emergency medical services transport for patients with minor injuries in the United States.

Helicopter emergency medical services (EMS) transport is expensive, and previous work has shown that cost-effective use of this resource is dependent on the proportion of minor injuries flown. To understand how overtriage to helicopter EMS versus ground EMS can be reduced, it is important to understand factors associated with helicopter transport of patients with minor injuries. The aim was to characterize patient and hospital characteristics associated with helicopter transport of patients with minor injuries. This was a retrospective analysis of adults ≥18 years who were transported by helicopter to Level I/II trauma centers from 2009 through 2010 as identified in the National Trauma Data Bank. Minor injuries were defined as all injuries scored at an Abbreviated Injury Scale (AIS) score of <3. Patient and hospital characteristics associated of being flown with only minor injuries were compared in an unadjusted and adjusted fashion. Hierarchical, multivariate logistic regression was used to adjust for patient demographics, mechanism of injury, presenting physiology, injury severity, urban-rural location of injury, total EMS time, hospital characteristics, and region. A total of 24,812 records were identified, corresponding to 76,090 helicopter transports. The proportion of helicopter transports with only minor injuries was 36% (95% confidence interval [CI] = 34% to 39%). Patient characteristics associated with being flown with minor injuries included being uninsured (odds ratio [OR] = 1.36, 95% CI = 1.26 to 1.47), injury by a fall (OR = 1.32, 95% CI = 1.20 to 1.45), or other penetrating trauma (OR = 2.52, 95% CI = 2.12 to 3.00). Being flown with minor injuries was more likely if the patient was transported to a trauma center that also received a high proportion of patients with minor injuries by ground EMS (OR = 1.89, 95% CI = 1.58 to 2.26) or a high proportion of EMS traffic by helicopter (OR = 1.35, 95% CI = 1.02 to 1.78). No significant association with urban-rural scene location or EMS transport time was found. Better recognizing which patients with falls and penetrating trauma have serious injuries that could benefit from being flown may lead to the more cost-effective use of helicopter EMS. More research is needed to determine why patients without insurance, who are most at risk for high out-of-pocket expenses from helicopter EMS, are at higher risk for being flown when only having minor injuries. This suggests that interventions to optimize cost-effectiveness of helicopter transport will likely require an evaluation of helicopter triage guidelines in the context of regional and patient needs.

Feasibility of cerebral near‐infrared spectroscopy monitoring in the pre‐hospital environment

Traumatic brain injury (TBI) is a significant cause of death and severe disability from trauma. Pre-hospital care of patients with TBI may be aided by non-invasive monitoring of cerebral tissue oxygenation. This pilot observational study was designed to assess if cerebral tissue oximetry using near-infrared spectroscopy (NIRS) is feasible in the pre-hospital and transport environment. After ethics committee review, we undertook a feasibility trial in healthy volunteers, transported by road ambulance or helicopter, to assess if monitoring signals could be obtained in the outside environment and during patient transport. A total of 33 road ambulance transports and 32 helicopter transports were undertaken. For monitoring commenced outdoors, 33 of 66 probes applied (50%) provided adequate monitoring signal. For road transports, 33 out of 33 transports (100%) resulted in successful bilateral monitoring for more than 70% of the sampling period. For helicopter transports, four transports were cut short by battery failure during the mission and 24 of 28 transports (85.7%) resulted in successful bilateral monitoring for more than 70% of the sampling period. While patient and transport platform movement did not impact on monitoring signals, exposure to ambient light provided a challenge in obtaining monitoring signals that is nevertheless manageable with increased probe shielding. NIRS monitoring is feasible in the pre-hospital environment, opening up the possibility for further research of the role of this modality in this setting.

Air Medical Transport of Prisoners

Introduction The medical problems of the incarcerated population often require emergent transport to medical facilities via air or ground. The transport of this population, however, can be logistically challenging because of the potentially dangerous nature of the patients and requirements for accompanying security personnel. Methods A retrospective chart review was conducted of prisoners transported by our air medical service from January 1, 2000 to December 31, 2008. We examined demographics, reason for call, type of patient, procedures performed by air medical crews during transport, and disposition from the emergency department. Results Twenty-nine patients (0.3%) of the 11,448 helicopter transports during the study period were transported from correctional facilities, 17 of which were medical in nature and 12 of which had a traumatic mechanism. Fifteen (51.7%) were admitted to the operating room or intensive care unit after emergency treatment. The median scene time for these transports was 20.7 minutes and was significantly different from that of both scene and interfacility transports (median scene times of 13.7 and 31.0 minutes, respectively). Conclusion Medical and traumatic problems of this transported population spanned a large variety of emergency complaints. Scene times reflected the nature of these transports and were not excessively long. Air medical programs should be aware of the medical problems of these patients and take measures to protect their crew when transporting this population.

When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance Transport Times

A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted. The 911-hospital arrival intervals for three transport methods were compared: ground, helicopter dispatched simultaneously with ground unit, and helicopter dispatched nonsimultaneously after ground unit response. Compared with ground transports, simultaneously dispatched helicopter transports had significantly shorter 911-hospital arrival intervals at all distances greater than 10 miles from the hospital. Nonsimultaneously dispatched helicopter transport was significantly faster than ground at distances greater than 45 miles, and simultaneous helicopter dispatch was faster than nonsimultaneous at virtually all distances. Ground transport was significantly faster than either air transport modality at distances less than 10 miles from the hospital. Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.

Statewide air medical transports for Massachusetts

In 1997, the Massachusetts Department of Public Health (MDPH) established a process to centralize air medical transport information. This database is one of the first statewide, population-based sources for civilian rotary-wing air medical transports (U.S. Coast Guard, police, and military missions are not included). The purpose of this database is to facilitate MDPH review of air medical transport service utilization, with input from a multidisciplinary committee. This article discusses the challenges in producing uniform data from multiple service submissions and presents aggregate “baseline” utilization information for 1996. These data served as a starting point for later studies using data linkage. This indexed article is the first to report statewide, population-based data for all types of air medical helicopter transports. The only other indexed “statewide air medical transport” paper focused on scene transports to trauma centers in Pennsylvania. 1 A previous article by the authors in the July-September 2000 Air Medical Journal provided an overview of air medical transports for fatal motor vehicle crashes for 1 region of the state. 2

Helicopter transportation of burn patients

Analysis of 437 consecutive acute burn patients transported to our burn center revealed 339 transported by ground and 98 by helicopter. There were 18 air transport patients from within a 25-mile-radius, and 80 flown further than 25 miles. Mean age was the same in all groups ( P>0.05). Percent total body surface area (TBSA) burned was 8.26% in ground transport patients, significantly less than the 20.35% (within 25 miles) and 21.40% (greater than 25 miles) seen in helicopter transports ( P<0.0001). Three percent of ground transport patients and 28% of helicopter patients had inhalation injury ( P<0.0001). There was no difference in incidence of inhalation injury among helicopter groups (28 vs. 29%, P=0.8). In patients with coexistent inhalation injury, the mean TBSA burned was significantly larger when compared with the TBSA of burns without inhalation injury ( P<0.001). Air transported groups contained patients whose status was not critical based upon lack of inhalation injury and small burn size, and who could have been transported by ground. Non clinical factors such as insurance status, desire to keep ground ambulances in their community, and competing helicopter services reluctant to refuse to transport a patient appears to be factors in choosing air ambulance transportation. Regional single helicopter services and regional cooperative ground ambulance services should reduce use of helicopter transport of burn patients when it is not clinically indicated.

Comparison of air and ground transport of cardiac patients

Purpose: To investigate the outcome of cardiac patients transported by helicopter versus ground ambulance Setting: A hospital-based helicopter program in southeastern Minnesota Methods: Retrospective chart review assessing an 18-month period (January 1998 to June 1999). Charts were reviewed for type of cardiac diagnosis, level of pain, treatments en route, time to intervention, and length of stay (LOS). Two-hundred-sixty-six cardiac patients came by helicopter. Of the 86 turndowns, 50 came by ground ambulance; 28 records were recovered in this group. These patients composed the comparison ground group. Results: Prehospital time was less for patients transported by air than ground transports ( P < .001). The amount of time from the call for transport until arrival at our hospital was less for helicopter transports ( P = .002). Air transports had more patients with reduced chest pain on arrival. Difference in CCU LOS was not significant ( P = .94). Air patients spent an average of 2 fewer days in the hospital than did ground patients ( P = .036). Discussion: Helicopter transport benefits the cardiac patient with decreased chest pain as a result of more treatments en route; decreased time from the call until arrival, resulting in decreased time to intervention; and shorter prehospital time and hospital stays. Conclusion: All of these improved variables relate to salvaged cardiac muscle.

Rôle de la régulation dans la prise en charge du traumatisé crânien grave

Place of the regulator of the emergency medical ambulance service in the management of patients with severe head trauma. The regulator of the emergency medical ambulance service is involved in the various steps of the initial managment of severe head trauma patients: handling calls, basic life support, prehospital advance life support, transport and hospital admission. The management is rapid (helicopter transports) coherent and adapted (adherence to the guidelines for severe head injury), and considers of local difficulties (geographical, possibility of admission to trauma centres), with the aim of improving the outcome of severely head-injured patients.

Use of a geographic information system to determine appropriate means of trauma patient transport.

To determine whether a geographic information system (GIS) and historical transport data can be used to create a map that identifies locations (zones) from which either ambulance or helicopter transport will result in shorter out-of-hospital times. A retrospective, cross-sectional review of a trauma registry was conducted in a two-county region served by a single trauma center. Data were gathered for all patients transported directly to the trauma center between 1993 and 1996. Incident locations and times from first 911 contact until arrival at the trauma center (out-of-hospital time) were extracted. A GIS was used to create a reference map with all incident locations plotted and given z-coordinates corresponding to out-of-hospital time. Two contour surfaces were interpolated: one for all helicopter transports and one for all ground transports. Areas where the helicopter surface was lower than the ambulance surface were designated air zones since helicopter transport resulted in shorter out-of-hospital times. The remaining area was designated a ground zone since ambulance transport resulted in shorter out-of-hospital times. The mean out-of-hospital times were calculated for each mode of transport in both zones and were compared using a two-tailed t-test. An air zone was identified beginning between 5 and 16 miles from the trauma center. Mean (+/-SD) out-of-hospital time from the air zone was 50 +/- 9 minutes for helicopter transport (n = 54) and 63 +/- 14 minutes for ambulance transport (n = 140). The difference between the means was 13 minutes (p < 0.000001; 95% CI = 8.95 to 17.05). Mean out-of-hospital time from the ground zone was 68 +/-16 minutes for helicopter transport (n = 122) and 32 +/- 14 minutes for ambulance transport (n = 2,047). The difference between the means was 36 minutes (p < 0.000001; 95% CI = 33.59 to 38.41). A GIS and historical transport data can be used to create a map identifying locations from which either helicopter or ambulance transport will minimize out-of-hospital time. Inappropriate choice of transport mode is associated with increased out-of-hospital time.

The epidemiology of pediatric air medical transports in utah

Objective. To describe the air-transported patients treated at Primary Children's Medical Center (PCMC), the sole pediatric tertiary care center in Utah and a referral center in the intermountain region. This study describes the patients who utilized the air medical transport system, the medical services provided in the prehospital setting, and the corresponding charges for transport and treatment. Methods. Participants were air-transported patients aged 17 years and less who were treated at PCMC during the calendar years 1991–1992. The study population excluded patients who were transported to other medical facilities, and newborns. Data were abstracted retrospectively from the patients' medical and transport records. Data collected included demographic information, patient diagnoses, and treatments performed during transport. Financial data were supplied by the hospital. Results. During the study period, 874 pediatric patients met the participant criteria. Helicopter and fixed-wing transports comprised 561 and 313, respectively, from nine states in the mountain and western regions. The majority (313, 56%) of the patients transported by helicopter were trauma patients, while the majority (195, 62%) of fixed-wing transports were for illness-related conditions. Scene transports accounted for 120 (21%) of helicopter transports. Children with special health care needs accounted for 171 (20%) of all transports. Conclusions. Injury severity scores indicate that, overall, air-transported patients were more severely injured than comparable ground-transported patients. However, it is apparent that some patients who were air-transported could have been transported by ground ambulance without detriment.

Helicopter transport of injured children: system effectiveness and triage criteria

The authors compared air and ground transport to a level I pediatric trauma center to assess the effectiveness of helicopter transport of injured children. They also performed a retrospective assessment of triage criteria and utilization patterns for helicopter transports. The sample comprised 3,861 children who were admitted (consecutively) to an urban level I pediatric trauma center during a 4-year period and who were transported by emergency mediacal services. TRISS probability of survival (Ps), z, and W scores were used to compare outcomes of ground and air transports. An absolute value of z greater than 1.96 indicates a statistically significant difference in mortality rate; the 4 statistic represents the number of survivors more than expected per 100 patients treated. Receiver operator characteristic (ROC) curves were used to identify optimal triage criteria, using Ps < .95 to define children who potentially could benefit from air transport. The triage criteria were applied to the air transport group to determine overtriage rates. Nearly 75% of the children arrived directly from the scene of injury. Those transported by air were more severely injured, as shown by significant differences in the mean Glasgow Coma Scale (GCS), Ps, Injury Severity Score, and mortality rate. The better survival rate for children transported by helicopter was indicated by a TRISS z score of 2.81, compared with a z score of 0.31 for those transported by ambulance. The W statistic for the children transported by air was 1.11. ROC analysis identified GCS < 12 and heart rate > 160 beats per minute as optimal air triage criteria; these yielded 99% sensitivity and 90% specificity. Using these criteria, approximately 85% of air transports would be considered overtriage. The authors conclude that (1) helicopter transport was associated with better survival rates among urban injured children; (2) pediatric helicopter triage criteria based on GCS and heart rate may improve helicopter resource utilization without compromising care; and (3) current air triage practices result in overuse of helicopters in approximately 85% of flights.