Review of:Schiller J, McCormack JE, Tarsia V, et al. "The effect of adding a second helicopter on trauma-related mortality in a county-based trauma system." Prehospital Emergency Care. 13:437 443, 2009.
This study compared hospital mortality before and after introducing a second helicopter to the eastern end of Suffolk County, N.Y. in 2001. It was aimed at reducing transport times to the regional trauma center. Outcomes before and after introducing the second helicopter were compared. A total of 1,551 trauma patients from June 1996 to May 2006were included in this study, with 705 in the single-helicopter period and 846 in the two-helicopter period. Mean ages, gender distributions and mean Injury Severity Scores (ISSs) were similar between groups. Total mortality significantly decreased after the addition of the second helicopter (16.2% before vs. 11.9% after; p = 0.02).
The authors concluded that the introductionof a second helicopter to the east end of Long Island was associated with a significant reduction in the total trauma mortality.
Despite conflicting evidence regarding its efficacy, helicopter transportation of trauma victims is widespread. No matter how you feel about air medical helicopters, the reality is that they're here to stay and the only way to assess their value is to research and report their impact, or lack thereof, on patient care. Dr. Wesley, a longtime critic of air medical use, takes a critical look at this paper. Medic Marshall, who readily admits to being spoiled by the ready availability of air medical in the Twin Cities, sees this issue through the eyes of street medic.
Doc Wesley:For many years, I have been critical of air medical utilization. I was anxious to read this study and was pleasantly surprised to see the openness with which the authors approached this topic. They have set the benchmark by which all air medical services should measure the efficacy of their services. Some East Coast states have 60 helicopters serving a geographic area as large as parts of the Midwest served by just eight. While it's true that there are more people per square mile in the former, there are also more highways and ground ambulances.
This program honestly examined their EMS delivery and determined the potential impact of adding an additional helicopter before doing so. Once they implemented the change, they actually measured its impact and reported it. This should be a challenge to others to do the same.
My only question is: Had the results not shown a benefit, would they have discontinued the service?
Medic Marshall:I thought this study strongly supported the use of medical helicopters. The investigators took a realistic approach by acknowledging the geographical difficulties of Long Island and the locations of hospitals' primarily Level 1 trauma centers. In my six years as a paramedic working for a suburban ambulance service, I've used a helicopter exactly three times. One was a resuscitated pediatric traumatic arrest; another a patient involved in an industrial explosion, and the third was involved in a small aircraft crash. What did they all have in common? Trauma and time (all were greater than 20 minutes by ground to a Level 1 trauma center.) Likewise, that's the focus of this study -- trauma patients who faced possible ground transports ranging from 30 90 minutes.
A lot of conflicting research out there states the use of medical helicopters does not show any improved outcomes in trauma patients. It would be interesting to review them and determine any underlying motivations for those studies. And while the use of medical helicopters is controversial, this paper does show that a well-managed and well-deployed trauma system will greatly improve the care and survivability of our trauma patients.