Use Of Helicopter Emergency Medical Services Research Articles

Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis

BackgroundTraumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS.MethodsThe Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians’ interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed.ResultsOf the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11–5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16–6.64) may have increased the return of spontaneous circulation (ROSC) rate.ConclusionsThe results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.

Characteristics of Patients Treated by Helicopter Emergency Medical Services in Ireland from 2012 to 2022: A Retrospective Analysis of Ten Years of Data

Introduction:A dedicated primary scene landing Helicopter Emergency Medical Services (HEMS) has been in operation in Ireland since 2012. Commencing with a unique collaboration between the Irish Aer Corps and civilian Emergency Medical Services (EMS) it has expanded to include a second charity funded model in the south west of the country. Both services operate under a single governance and dispatch system and provide an Advanced Paramedic level of care to the patients they serve. There is limited published literature on prehospital care in Ireland and to date no detailed descriptive study of patients treated by HEMS in Ireland. This research describes the characteristics of the patients treated by HEMS in Ireland.Method:This retrospective study will investigate the data of an excess of 8000 patients responded to by HEMS (2012-2022) in the republic of Ireland. Descriptive statistics will be used to interpret patient demographics, geographical spread, receiving facilities, mechanism/etiology of disease or injury, vital trends, transportation decisions and clinical interventions and short-term clinical outcomes.Results:Early stage data extraction shows seasonal variation in HEMS use with increased use in the summer months. Almost twice as many male patients vs. females were treated by HEMS while the most common age profile was 55-65 yrs. Trauma presentations have increased over the past 10 years and now account for over 60% of the overall caseload. The most common medical etiology was cardiac arrest or post resuscitation care followed by STEMI Care, the most common trauma cases were from road traffic collisions followed by falls and farm accidents.Conclusion:This study will be the first to describe the overall characteristics of HEMS patients in Ireland over a decade of service provision. As the Irish health system continues to evolve, so must its aeromedical services.

The introduction of a regional Norwegian HEMS coordinator: an assessment of the effects on response times, geographical service areas and severity scores

BackgroundDue to unwanted delays and suboptimal resource control of helicopter emergency medical services (HEMS), regional HEMS coordinators have recently been introduced in Norway. This may represent an unnecessary link in the alarm chain, which could cause delays in HEMS dispatch. Systematic evaluations of this intervention are lacking. We wanted to conduct this study to assess possible changes in HEMS response times, mission distribution patterns and patient characteristics within our region following this intervention.MethodsWe retrospectively collected timeline parameters, patient characteristics and GPS positions from HEMS missions executed by three regional HEMS bases in Mid-Norway during 2017–2018 (preintervention) and 2019 (postintervention). The mean regional response time in HEMS missions was assessed by an interrupted time series analysis (ITS). The geographical mission distribution between regional HEMS resources was assessed by a before-after study with a convex hull-based method.ResultsThere was no significant change in the level (-0.13 min/month, p = 0.88) or slope (-0.13 min/month, p = 0.30) of the mean regional response time trend line pre- and postintervention. For one HEMS base, the service area was increased, and the median mission distance was significantly longer. For the two other bases, the service areas were reduced. Both the mean NACA score (4.13 ± SD 0.027 vs 3.98 ± SD 0.04, p < 0.01) and the proportion of patients with severe illness or injury (NACA 4–7, 68.2% vs 61.5%, p < 0.001) were higher in the postintervention group.ConclusionThe introduction of a regional HEMS coordinator in Mid-Norway did not cause prolonged response times in acute HEMS missions during the first year after implementation. Higher NACA scores in the patients treated postintervention suggest better selection of HEMS use.

POSB66 Cost-Effectiveness Analysis of the Helicopter Emergency Medical Services for Patients with Myocardial Infarction in Austria

Myocardial infarction (MI) is a life-threatening disease. Accordingly, a time limit of 90 minutes between initial medical contact and percutaneous coronary intervention (PCI) has been established for ST-segment elevation myocardial infarction (STEMI). Thus, many STEMI patients require airlift by helicopter emergency medical services (HEMS) to match the goal of 90 minutes. However, HEMS remains a poorly evaluated aspect of MI-care. The aim of this study was to evaluate the cost-effectiveness of HEMS airlift compared to a ground-based ambulance-transport for patients with MI to a PCI center. A Markov-model was developed based on the distinction between STEMI and non-STEMI to simulate consequences over a 10-year time-horizon. Consequences include recurrent MI, heart failure (HF) due to MI, death due to MI and recurrent MI or other reasons. Health benefits were measured in quality-adjusted life-years (QALYs) and life-years (LYs). Probabilities were derived from the literature. According to data derived from the OEAMTC Air Rescue, 6.9% of all hospital admissions are provided by HEMS. The target value for an appropriate use of HEMS was assumed to be 20%. Direct costs (2020.- €) were derived from published sources from the payer’s perspective. QALYs, LYs and costs were discounted. Monte-Carlo-simulation accounted for uncertainty. A >20% proportion of MI patients who were transported by HEMS to a PCI center is associated with savings over a 10-year time-horizon (2,140.- € to 13,640.- € per patient). Savings are due to reduced follow-up costs for rehabilitation, HF, nursing home and care allowance costs. Patients also achieve a higher life expectancy (0,17 to 0,46 LYs) and quality of life [0,13 to 0,38 QALYs). In the entire cohort of MI patients in 2020 (n=17,305), savings of 37 million euros could be achieved. 1€ spend in HEMS leads to savings of 9.7€ in the health-care and social system.

POSA72 Cost-Effectiveness Analysis of the Helicopter Emergency Medical Services for Stroke Patients in Austria

Many patients suffer from acute stroke at a significant distance from dedicated stroke centers. Since onset of advanced stroke care is time critical, the impact of rapid transport provided by helicopter emergency medical services (HEMS) on patient outcome merits further evaluation. Accordingly, the aim of this study was to evaluate the cost-effectiveness of a HEMS compared with ground-based ambulance-transport for patients with acute stroke to a stroke unit (SU). A Markov-model was developed based on the modified Ranking Scale (mRS) states 90 days after stroke to simulate consequences over a 10-year time-horizon. Consequences include recurrent stroke, deteriorated mRS, death due to recurrent stroke or other reasons. Health benefits were measured in quality-adjusted life-years (QALYs) and life-years (LYs). Probabilities were derived from the literature mainly the stroke registry. According to data derived from the OEAMTC Air Rescue, 4.9% of all SU admissions are carried out by HEMS. The target value for an appropriate use of HEMS was assumed to be 20%. The assumption was because 18% of all patients admitted to a SU suffer a severe stroke (NIH-SS<13). Direct-costs (2020€) were derived from published sources from the payer’s perspective. QALYs, LYs and costs were discounted. Monte-Carlo-simulation accounted for uncertainty. A >20% proportion of stroke patients who were transported by HEMS to a SU is associated with savings over a 10-year time-horizon (3,500.- € to 10,191.- € per patient). Savings are due to a better neurological status (mRS after 90 days), because of the faster onset of stroke interventions. Patients also achieved a higher life expectancy (0.7 to 1.39 LYs) and quality of life [0.23 to 0.86 QALYs). In the entire cohort of stroke patients in 2020 (n=12,953), savings of 45.3 million euros could be achieved. 1€ spend in HEMS results in savings of 15.9.- € in the health-care and social system.

Association of Helicopter vs Ground Emergency Medical Transportation With 1-Year Mortality in Denmark

Appropriate use of helicopter emergency medical service (HEMS) is important in ensuring that patients with critical illness or injury receive adequate treatment. To investigate the association between use of HEMS compared with use of ground EMS (GEMS) and mortality overall and in a subgroup of patients with critical illness or injury. This register-based, nationwide cohort study used data retrieved from Danish registries from October 1, 2014, to April 30, 2018. Patients receiving GEMS originated from dispatched HEMS missions for which a helicopter was unavailable. For the primary analysis, patients from accepted HEMS missions and patients from missions in which HEMS was dispatched but unavailable were included. The secondary analysis included patients assigned a hospital International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis considered a critical illness or injury. These patients were selected via a consensus-based agreement among all authors by reviewing the Danish version of the World Health Organization's ICD-10 classification. Data were analyzed from March to June 2020. Dispatch of HEMS vs GEMS unit (primary analysis) and treatment and transport by HEMS vs GEMS unit among patients with critical illness or injury (secondary analysis). One-year mortality was retrieved from the Danish Civil Registration System. Among 10 618 patients (median [interquartile range] age, 60 [42-72] years; 6834 [64.4%] men) included in the primary analysis, 9480 patients (89.3%) received HEMS and 1138 patients (10.7%) received GEMS. Median (interquartile range) age was 60 (42-72) years, and 6834 patients (64.4%) were men. Adjusted cumulative 1-year mortality was 23.2% (95% CI, 22.4%-24.1%) among patients receiving HEMS vs 24.5% (95% CI, 21.9%-27.1%) among patients receiving GEMS. The difference in mortality risk for HEMS compared with GEMS was not statistically significant (hazard ratio, 0.94 [95% CI, 0.84-1.06]). Among 2260 patients with critical illness or injury receiving HEMS, compared with 315 patients with critical illness or injury receiving GEMS, adjusted cumulative 1-year mortality was 25.1% (95% CI, 23.5%-26.7%) vs 27.1% (95% CI, 22.0%-32.1%). The difference in mortality risk for HEMs compared with GEMs was not statistically significant (hazard ratio, 0.91 [95% CI, 0.73-1.14]). This study found that 1 year after dispatch, the use of HEMS, compared with the use of GEMS, was not associated with a statistically significant difference in mortality overall or mortality among patients with critical illness or injury. Further research is needed to determine whether optimized dispatch systems may be associated with further improvements in survival among selected patients.

Association of Risk of Mortality in Pediatric Patients Transferred From Scene by Helicopter With Major But Not Minor Injuries.

Helicopter emergency medical services (HEMS) are used for 16% of pediatric trauma. National HEMS guidelines advised that triage criteria be standardized for pediatric patients. A national report found pediatric HEMS associated with decreased mortality compared with ground emergency medical services (GEMS) but did not control for transport time. We hypothesized that the rate of HEMS has decreased nationally and the mortality risk for HEMS to be similar when adjusting for transport time compared with GEMS. The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients younger than 16 years transported by HEMS or GEMS. A multivariable logistic regression was used. From 25,647 patients, 4527 (17.7%) underwent HEMS. The rate of HEMS from scene decreased from 21.2% in 2014 to 18.2% in 2016. The rate of HEMS for minor trauma (Injury Severity Score <15) decreased from 14.9% in 2014 to 13.5% in 2016 and major trauma (Injury Severity Score > 15) from 38.4% in 2014 to 35.9% in 2016. After controlling for predictors of mortality and transport time, HEMS was associated with decreased risk of mortality for only those with major injuries transferred from scene (odds ratio, 0.48; 95% confidence interval, 0.26-0.88; P = 0.01) compared with GEMS. The rate of HEMS in pediatric trauma has decreased. However, there is room for improvement as 14% of those with minor trauma are transported by HEMS. Given the similar risk of mortality compared with GEMS, further development of guidelines that avoid the unnecessary use of HEMS appears warranted. However, utilization of HEMS for transport of pediatric major trauma should continue.

Helicopter Transport Has Decreased Over Time and Transport From Scene or Hospital Matters

ObjectiveSeveral reports have found helicopter emergency medical services (HEMS) to be associated with a lower risk of mortality compared with ground emergency medical services (GEMS); however, most studies did not control for transport time or stratify interfacility versus scene. We hypothesize that the HEMS transport rate has decreased nationally and that the risk of mortality for HEMS is similar to GEMS when adjusting for transport time and stratifying by scene or interfacility. MethodsThe Trauma Quality Improvement Program (2010-2016) was queried for adult patients transported by HEMS or GEMS. Multivariable logistic regression was used. ResultsThe HEMS transport rate decreased by 38.2% from 2010 to 2016 (P < .001). After controlling for known predictors of mortality and transport time, HEMS was associated with a decreased risk of mortality compared with GEMS for adult trauma patient transports (odds ratio = 0.74; 95% confidence interval [CI], 0.71-0.77; P < .001). Compared with GEMS, HEMS transports from the scene were associated with a decreased risk of mortality (OR = 0.63; 95% CI, 0.60-0.66; P < .001), whereas HEMS interfacility transfer was associated with an increased risk of mortality (OR = 1.22; 95% CI, 1.14-1.31; P < .001). ConclusionThe rate of HEMS transports in trauma has decreased by nearly 40% over the past 7 years. Our results suggest that HEMS use for scene transports is beneficial for the survival of trauma patients.

Major incident management by helicopter emergency medical services in south-east Norway from 2000 to 2016: Retrospective cohort study.

Helicopter emergency medical services (HEMS) and search and rescue helicopters (SAR) aim to bring specialized personnel to major incidents and transport patients to definite care, but their operational pattern remains poorly described. We aim to describe the use of HEMS and SAR in major incidents in Norway and investigate the feasibility of retrospectively collecting uniform data from incident reports. We searched HEMS medical databases from three HEMS and one SAR base in south-east Norway for the written reports of incidents from 2000 to 2016. After incidents were included through consensus in the author group, we collected data as described in majorincidentreporting.org and a previous cross-sectional study and rated availability of the variables. From a total of 31803 missions, we identified 50 (0.16%) major incidents with HEMS/SAR involvement where road traffic accidents were the most common type of incident (n=28, 56%), and rural area was the most prevalent location (n=35, 70%). Inter-agency cooperation was common and HEMS contributed most often with treatment and transport. The majority of information was found in the free-text area in the medical records hereby increasing the risk for rater variability. Major incidents are rare in Norway. HEMS and SAR play an important role in incident logistics, cooperation with other agencies, treatment and transport of patients and should be included in major incident plans. Retrospective data collection is challenging as data variables are not systematically integrated into the database. Future research should focus on systematic data gathering and a system for sharing lessons learned.

The impact of helicopter emergency medical service on acute ischemic stroke patients: A systematic review

Helicopter emergency medical services (HEMS) is commonly elected transport for acute ischemic stroke (AIS) known as a time-critical illness. To conduct a systematic review in order to explore the HEMS impact on healthcare status, process and outcome measures for AIS patients. A systematic search was conducted of PubMed, Medline, CINAHL, Cochrane Library and Google Scholar. The gray literature and reference lists of included articles were also searched. Thirty studies met inclusion criteria. Using Donabedian's framework, two studies focused on the impact on healthcare structure, twenty-three explored the impact on process measures, and five focused on clinical outcomes. HEMS structure implications could not be assessed due to insufficient studies. HEMS showed no significant outcome benefit compared to ground emergency medical services (EMS) and the impact on process measures was ambiguous. HEMS necessity varied considerably between studies. More robust studies are needed for detection of the most suitable use of HEMS in AIS.

Outcomes of interfacility helicopter transportation in acute stroke care.

To evaluate the long-term functional outcome of interhospital transfer of patients with stroke with suspected large vessel occlusion (LVO) using Helicopter Emergency Medical Services (HEMS). Records of consecutive patients evaluated through 2 telestroke networks and transferred to thrombectomy-capable stroke centers between March 2017 and March 2018 were reviewed. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to address confounding factors. Multivariate logistic regression analysis with IPTW was used to determine whether HEMS were associated with good long-term functional outcome (modified Rankin scale score ≤ 2). A total of 199 patients were included; median age was 67 years (interquartile range [IQR] 55-79 years), 90 (45.2%) were female, 120 (60.3%) were white, and 100 (50.3%) were transferred by HEMS. No significant differences between the 2 groups were found in mean age, sex, race, IV tissue plasminogen activator (tPA) receipt, and thrombectomy receipt. The median baseline NIH Stroke Scale score was 14 (IQR 9-18) in the helicopter group vs 11 (IQR 6-18) for patients transferred by ground (p = 0.039). The median transportation time was 60 minutes (IQR 49-70 minutes) by HEMS and 84 minutes (IQR 25-102 minutes) by ground (p < 0.001). After weighting baseline characteristics, the use of HEMS was associated with higher odds of good long-term outcome (OR 4.738, 95% CI 2.15-10.444, p < 0.001) controlling for transportation time, door-in-door-out time, and thrombectomy and tPA receipt. The magnitude of the HEMS effect was larger in thrombectomy patients who had successful recanalization (OR 1.758, 95% CI 1.178-2.512, p = 0.027). HEMS use was associated with better long-term functional outcome in patients with suspected LVO, independently of transportation time.

Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study

BackgroundA stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process.Material/MethodsA retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals.ResultsHelicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients’ condition was the drawing out of the extent of time spent by the crew at the scene.ConclusionsThe use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.

Helicopter Emergency Medical Services for Trauma: An Update

Helicopter emergency medical services (HEMS) have become a well-established component of most contemporary trauma systems throughout the world. HEMS is associated with significant costs, safety concerns, and potential inappropriate use. In this update, we briefly review the historical context, evidence for clinical effectiveness, and methods for ensuring proper utilization of HEMS. A recently validated prehospital triage score—the Air Medical Prehospital Triage (AMPT)—is reviewed. Examples of system improvements using evidence-based practices and adherence to both national and local utilization guidelines are also discussed. Appropriate triage for HEMS use remains an important goal for developed trauma systems. Although associated with significant costs and safety concerns, recent literature has highlighted the association of HEMS with improved outcomes for trauma patients.

Analysis of Transport to an American College of Surgeons Level I Trauma Center

IntroductionEfficient patient transportation by ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) to a trauma center is vital for optimal care. We investigated differences between the modes of transport in terms of demographics, injury, scene location, and outcome. SettingMorristown Medical Center (MMC), Morristown, NJ MethodsAll 903 trauma admissions in 2016 by advanced life support (ALS) to MMC, a Level I Trauma Center, were retrospectively analyzed. Results22% of admissions were HEMS and 78% were GEMS. HEMS patients had higher Injury Severity Scores (ISS) (p<0.001); however, mortality and length of stay were not statistically different. The percentage of pediatric patients transported by HEMS that were discharged home after emergency department evaluation was greater than the older populations (p<0.001). Older age and higher ISS had the largest impact on mortality (p<0.001). ConclusionWe believe our current use of HEMS is adequate since patient outcomes between HEMS and GEMS was similar, even though HEMS patients have higher ISS. However, helicopter use in the pediatric population was over-utilized, possibly due to the scarcity of hospitals capable of managing pediatric traumas. Implementation of the Air Medical Prehospital Triage scoring system may also help correct for these unnecessary HEMS transports.

Disparities in Inter-hospital Helicopter Transportation for Hispanics by Geographic Region: A Threat to Fairness in the Era of Thrombectomy

Background and Purpose: Mechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital emergent evacuation with Helicopter Emergency Medical Services (HEMS) to be considered for MT. It is not known whether the use of HEMS is equitable across different groups of patients. Methods: Acute ischemic stroke patients emergently transferred to another facility were identified in a retrospective review of a large Medicare claims database. Mode of transportation (HEMS, advanced, or basic ground ambulances) was determined by CPT codes. Distance from patient's residence to the closest center with MT capabilities was calculated. Generalized linear mixed logit models were used to determine the odds of HEMS relative to ground services for Hispanic and non-Hispanic black (NHB) patients relative to non-Hispanic white (NHW) patients while controlling for confounders. Results: A total of 8027 patients that underwent emergent interhospital transportation were analyzed. HEMS utilization was 18.1% for NHB, 20.6% for Hispanics, and 21.6% for NHW (P = .054). In adjusted analyses for confounders, including distance to a MT-capable hospital, Hispanic patients were less likely than NHWs to be transported by HEMS. While that association had marginal significance for the whole United States (OR = .76; 95% CI, .57-1.01; P = .055), it was statistically significant for patients living in the southern region of the United States (OR = .6; 95% CI, .40-.92; P = .019). Discussion: Our findings suggest there is a disparity in the use of HEMS in Hispanic stroke patients compared to NHW. Such a disparity may delay arrival to a MT-capable hospital, delay treatment times, or lead to ineligibility for MT altogether. Given the known benefit of MT and known existing disparities in stroke treatment and outcomes, it is important to further investigate and address disparities in mode of interhospital transportation.

Characteristics of Children Cared for by a Physician-Staffed Helicopter Emergency Medical Service.

The effectiveness of Japanese helicopter emergency medical services (HEMS) and interventions at the scene is not clear as regard children. For effective use of HEMS at the clinical scene, we need to clarify the characteristics of pediatric patients cared for by HEMS. Therefore, the objective of this study was to describe the characteristics of pediatric scene flights and to describe the procedures performed on the patients. This was a retrospective cohort study based on the database for children aged younger than 18 years who were cared for by physician-staffed HEMS of Ibaraki prefecture, in Japan. We reviewed the database for air medical transports conducted at our institution from July 2010 to December 2016. During the 6.5-year period, the Ibaraki HEMS attended to 288 children. The median age of the children was 11 (interquartile range, 5-14) years. Of the total, 196 (68.1%) of the children had trauma-related injuries. The head was the most common site of significant injuries (12.4%). The most common cause of nontrauma incidents was seizure (9.0%). In 65.9% of the patients, the injury or illness was of mild or moderate severity at the scene. An intervention was applied at the scene in 76.0% of the cases: 75.1%, intravenous route; 6.9%, intubation; and 13.4%, drug administration. Of those patients, 29.1% were discharged from the emergency department. In-hospital mortality accounted for 1.5% (n = 2) of the cases. Although the condition at the scene of most of the pediatric patients transported by the physician-staffed HEMS was not severe, an intervention was frequently applied from the scene. Improving the dispatch criteria and monitoring compliance are needed for appropriate use of HEMS.

Abstract WP224: Hispanics are Transported With Slower and Less Capable Ambulances During Inter-Hospital Transfer: A Threat to Fairness in the Era of Thrombectomy

Background &amp; Purpose: In the mechanical thrombectomy (MT) era, it is imperative to ensure that patients with stroke have a fair access to advanced ground ambulances (AGA) or the more rapid Helicopter Emergency Medical Services (HEMS) to avoid disparities in functional outcomes. In this study we investigated racial/ethnic disparities in the use of AGA or HEMS for inter-hospital transfer of stroke patients in the US. Methods: We used Medicare claims for years 2010-2013 for Medicare beneficiaries with a new diagnosis of atrial fibrillation. Cases were patients with a primary diagnosis of ischemic or hemorrhagic stroke that underwent an inter-hospital transfer between acute facilities within the day of the stroke. Transportation was categorized as basic ground, AGA or HEMS. A multinomial logit model was used to adjust for confounders such as patient’s characteristics, distance and geographical location. Results: A total of 11,172 acute hospital to hospital transfers were analyzed. In unadjusted analysis, 17.7% of black, 20.9% of Hispanic and 21.7% of white patients were transferred by HEMS, and 73.7% of black, 67.3% of Hispanic and 69.9% of white patients were transferred by AGA (p=0.003). These differences, however, disappeared after controlling for confounders. The exception were Hispanic patients, who remain less likely to be transported by HEMS (OR=0.64; 0.45-0.90; p=0.01) or AGA than white patients (OR=0.74; 0.55-1.00; p=0.048) Conclusion: Hispanic patients with stroke undergoing an acute inter-facility transfer are less likely to be transported by HEMS or advance ground ambulances after adjusting for all possible confounders, including distance and insurance. This unacceptable disparity is a barrier to timely access to a thrombectomy-capable hospital and best care en-route for these patients, which may result in worse outcomes after MT.

HEMS dispatch: A systematic review

Introduction Helicopter emergency medical services dispatch is a contentious issue in modern prehospital services. Whilst the link between helicopter emergency medical services and improved patient outcome is well evidenced, allocation to the most appropriate incidents remains problematic. It is unclear which model of deployment is the most efficient at targeting major trauma and whether this can be improved with a change in dispatch process. The objective of this study was to have an overview of the evidence for dispatch models of helicopter emergency medical services to critically ill or injured patients. Methods This systematic review was conducted in accordance with a protocol developed from the PRISMA guidelines. MEDLINE, Embase, CINAHL and the Cochrane library were searched focusing on keywords involving dispatch of helicopter emergency medical services resources. Results Ninety-seven articles were screened and 14 articles were eligible for inclusion. Most were of low quality, with three of moderate quality. Heterogeneity in the methodology of included articles precluded meta-analysis, so a narrative review was performed. Conclusions This review demonstrates the lack of evidence surrounding helicopter emergency medical services dispatch models. Whilst it is not possible to identify a method of dispatch that will optimize helicopter emergency medical services allocation, common themes within the literature indicate that helicopter emergency medical services use is region specific and dispatch criteria should be designed to match specific systems. Additionally, mechanism of injury as well as physiological data from scene was shown to be the most accurate indicator for helicopter emergency medical services attendance.

Hospital Mortality Based on the Mode of Emergency Medical Services Transportation

ObjectiveWe assessed the presentations and outcomes of trauma patients transported by helicopter emergency medical services (HEMS) versus ground emergency medical services (GEMS). MethodsA retrospective analysis of trauma registry data at a level I trauma center was conducted for patients transported by GEMS and HEMS between 2011 and 2013. Data were analyzed and categorized based on the mode of transportation. ResultsA total of 4,596 trauma patients were admitted to the hospital with a mean age of 31 ± 15 years. Injured patients were transported to the trauma center by GEMS (93.3%) and HEMS (6.7%). The common mechanisms of injury were motor vehicle crash (37%) and falls (25%). Compared with GEMS, patients transported by HEMS were characterized by having a greater injury severity, more proportion of traumatic brain injury, on-scene intubation, and a 2.5-fold higher mortality. However, the impact of mode of transportation on the hospital mortality among severely injured patients has disappeared after adjusting for potential confounders. ConclusionPatients transported by HEMS may have different characteristic features and outcomes when compared with GEMS. However, further work is needed to identify the subgroups of trauma patients who clearly benefit from the use of HEMS.

Current use and outcomes of helicopter transport in pediatric trauma: a review of 18,291 transports

PurposeThe role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries. MethodsAll blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS)≥9 were included. ResultsOf 127,489 included patients, 18,291 (14%) arrived via HEMS, compared to 56% by ground ambulance and 29% by private vehicle/walk-in. HEMS patients had more severe injuries (ISS≥25; 28% vs. 14%) and altered mental status (GCS≤8; 29% vs. 11%), but also contained many patients with only minor injuries or no major physiologic derangements. In unadjusted analysis, HEMS was associated with increased mortality (OR: 1.6; 95% CI: 1.4–1.7). However, it had decreased mortality by regression (0.5; 0.4–0.6) and propensity analysis (0.7; 0.6–0.8) to adjust for confounders. ConclusionWe found multiple indicators for overuse of HEMS, with nearly 40% of children having only minor injuries. In moderate/severe injuries, HEMS is associated with decreased mortality, potentially saving one life for every 47 flights. Research is needed to determine appropriate criteria for helicopter triage. Comparative Study/Level of evidenceIII