Appropriate Use of Helicopter EMS

Street Science

 

 
 
 

Keith Wesley | | Friday, August 10, 2007


Review of: Petrie DA, Tallon JM, Crowell W, et al: Medically appropriate use of helicopter EMS: The mission acceptance/triage process. Air Medical Journal. 26(1):50 54, 2007.

The Science

This study from Nova Scotia examined the appropriateness of helicopter EMS (HEMS) in the region during a 21-month period with the goal to determine the current level of overtriage. They determined flights to be appropriate if the patient required ICU admission, died during transport or within 24 hours, and, in the case of trauma, an injury severity scale (ISS) score was 12 or less. Overtriage was defined as not meeting these criteria.

They transported 584 patients using a mission acceptance process that relied on outreach education, dispatcher oversight and clinician-to-clinician discussion about each case.

They report their overall overtriage rate was 13.1%

The Street

The American College of Surgeons has suggested that for major trauma an overtriage rate of 50% would generally result in an undertriage of 10%. That is, in order to feel comfortable that you re missing less than 10% of the patients who need a trauma center, the patients you do transport will have only a 50% chance of actually needing a trauma center. Although this may apply to EMS as a whole, the risk and benefit of air medical transport probably dictate a more conservative approach.

This study is another example of why we must read the entire study to determine its value. Of the 584 patients transported, only 199 were for trauma; of those, 49 were from the scene. The overtriage of the medical cases was 3.4% for cardiac and 14.3% for other medical.

For the trauma patients, the overtriage rate was 19.1% overall and 34.7% for those transported from the scene. Trauma patients transported from a facility had an overtriage rate of 14%, which is similar to that of medical.

In Canada, multiple trauma is defined as an ISS score of 12 and higher, whereas in the U.S. it s a score of 16 and higher. Had the authors applied the U.S. criteria to the study, the overtriage rate for trauma would have been even higher.

I m not suggesting we stop calling for helicopters. Instead, let s look at the implications of the study. Clearly, there s a difference between medical and trauma cases. Perhaps we need better definitions of appropriateness, such as requiring time-dependent imaging or requiring potentially life-saving procedure. However, this would result in worsening of the debate. The study clearly indicates that once patients arrive at a hospital, the physicians are able to make a better determination of the need for HEMS.

This system used an auto-launch program based on dispatch criteria. Perhaps what s needed is a closer examination of these criteria as well as that used by rescuers on scene.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Vehicle Ops

 
What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Innovation & Progress

Follow in the footsteps of these inspirational leaders of EMS.
More >

Multimedia Thumb

University of Pittsburgh STAAMP Trial

Trauma experts launch tranexamic acid trial.
Watch It >


Multimedia Thumb

New York Ambulance Service Begins Using Power Cot

Service is first in county with new technology.
Watch It >


Multimedia Thumb

Traffic Cam Captures Wisconsin Ambulance Crash

Driver of ambulance cited for failing to operate safely.
Watch It >


Multimedia Thumb

New Mexico Hospital Mourns Helicopter Crash Victims

TriState CareFlight pilot and crew killed in crash.
Watch It >


Multimedia Thumb

Moscow Subway MCI

At least 20 dead and 150 injured in subway derailment.
More >


Multimedia Thumb

Hands On July 2014

Check out the latest products and innovations in JEMS.
More >


Multimedia Thumb

Wounded Veteran Resiliency

Marine is one of many in quality of life study.
More >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


More Product Videos >