Does helicopter transport impact outcome following trauma?

Abstract

Helicopter transport (HT) has evolved from military roots into a critical component of trauma systems throughout the world. Concerns over cost and safety continue to challenge the role of HT in the civilian setting. Despite this, recent evidence has demonstrated a survival advantage for trauma patients undergoing HT. For patients transported from the scene of injury, improved survival has been shown in several multicenter studies as well as evaluation of large national databases. Issues of overtriage, however, remain problematic for scene HT and represent a prime area for future research in helicopter emergency medical systems (EMS). Patients undergoing inter-facility transfer have also been shown to have improved outcomes over ground transport in terms of shorter transfer times and increased survival particularly in more severely injured patients. The benefits seen are likely a result of a combination of rapid transport, advanced medical capabilities, and accessibility to remote terrain. Several subgroups of patients undergoing HT have been the subject of study as well. Patients with severe head injury have consistently been shown to have superior outcomes over ground ambulance, attributable to improvements in airway management early in the course of their injury. Conversely, HT for urban and penetrating injury has not seen similar benefits, likely due to proximity of trauma centers and recent advancements in urban EMS systems. The benefits of including physicians in helicopter crews are less clear and vary by region and system. Helicopter transport for trauma does appear to improve outcomes for trauma patients, and optimizing utilization of this valuable resource will be key as the role of helicopter EMS continues to develop within trauma systems.