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Helicopter trauma transport trumps ground ambulances: study

Researchers from the
Departments of Surgery at the Columbus Regional hospital, Atlanta
Medical Center and Emory University in Atlanta, Georgia, and at the
University of Calgary conducted a 10-year study comparing the injuries,
surgical interventions and outcomes of patients transported to hospital
by air or ground ambulance. The types of injuries investigated ranged
from motor vehicle crashes to falls to all-terrain vehicle accidents.

The
researchers found that patients brought to hospital by ground ambulance
more often died in the emergency room than patients brought by air: 585
versus 43 deaths, respectively. The authors state that this improved
survival may be explained by the availability of more advanced
monitoring and equipment and more medications as well as the presence of
a flight nurse and paramedic in the air ambulance.

"This
American-based study has considerable applicability to Canadian
patients," says Chad Ball, the study author from the University of
Calgary. "Given that so many of our patients are located in
geographically remote locations, timely transport to trauma centres is a
persisting concern. We also know that patients who live in rural areas
carry a higher risk of death after injury than their urban-based
counterparts. Appropriate air ambulance transport is one potential
method to shorten transfer times to definitive care and therefore
decrease this risk."

The debate over outcome differences between
patients transported to hospital by air and those transported by ground
ambulance has continued for more than two decades, but there is general
consensus that severely injured patients transported by air have a
better chance of survival. The controversy is whether helicopter
transport is necessary for particular cohorts of patients.

"The
improved outcomes in our study indicate that appropriate helicopter
transport, even with the associated cost and safety risk, is beneficial
to severely injured patients," the authors state.

The authors
note that the cost of air ambulance services, at least in the United
States, has been concerning to third-party payers as well as patients.
They state the dramatic difference between charge and reimbursement is
often borne by the patients and their families.

Although
cost-benefit analyses are warranted, the authors indicate that "air
ambulance transport for injured patients is vitally important given
increasing patient volumes, the limited number of trauma centres and
inadequate subspecialty coverage in nontrauma hospitals."