Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 11/2009

01-11-2009

Helicopter Evacuation of Trauma Victims in Los Angeles: Does it Improve Survival?

Authors: Peep Talving, Pedro G. R. Teixeira, Galinos Barmparas, Joseph DuBose, Kenji Inaba, Lydia Lam, Demetrios Demetriades

Published in: World Journal of Surgery | Issue 11/2009

Login to get access

Abstract

Background

The purpose of this study was to investigate the relationship between the method of transport after injury and survival among trauma patients admitted to a Level 1 trauma facility in Los Angeles, California.

Methods

The trauma registry of LAC+USC Medical Center was reviewed to identify all injured patients evacuated by emergency medical service (EMS) from the injury scene from 1998 to 2007. The study population was divided into those who were airlifted (HEMS) and those who were transported by ground emergency medical service (GEMS) with transportation time that exceeded 30 minutes (GEMS > 30 minutes).

Results

During the 10-year study period, 1,836 patients were airlifted (helicopters for emergency medical service (HEMS)) and 1,537 patients were ground transported (GEMS > 30 minutes). HEMS patients suffered more frequently a penetrating injury (19% vs. 11%, p < 0.001), presented more often hypotensive to the emergency department (4% vs. 1%, p < 0.001), had more frequently a Glasgow Coma Scale (GCS) ≤ 8 (9% vs. 3%, p < 0.001) and required more often an intubation at the injury scene (1.6% vs. 0.4%, p < 0.001). However, the transportation time and the total prehospital time were significantly shorter for airlifted patients. After multivariable analysis, the difference in mortality between the two transport modalities was not significant (adjusted odds ratio (95% confidence interval, 0.72 (0.22, 2.35); p = 0.596).

Conclusions

In a metropolitan Los Angeles trauma system, EMS helicopter transportation of injured patients does not appear to improve overall adjusted survival after injury. There is however a potential benefit for severely injured subgroups of patients due to the shorter prehospital times.
Literature
1.
Feliciano DV, Mattox KL, Moore EE (eds) (2008) Trauma, 6th edn. McGraw-Hill, pp 160–161
2.
Baxt WG, Moody P, Cleveland HC et al (1985) Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: a multicenter study. Ann Emerg Med 14:859–864PubMedCrossRef
3.
Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O’Keefe MF (2006) Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis. J Trauma 60:1257–1266PubMedCrossRef
4.
McCowan CL, Swanson ER, Thomas F, Handrahan DL (2007) Outcomes of blunt trauma victims transported by HEMS from rural and urban scenes. Prehosp Emerg Care 11:383–388PubMedCrossRef
5.
Brathwaite CE, Rosko M, McDowell R, Gallagher J, Proenca J, Spott MA (1998) A critical analysis of on-scene helicopter transport on survival in a statewide trauma system. J Trauma 45:140–146PubMedCrossRef
6.
Cocanour CS, Fischer RP, Ursic CM (1997) Are scene flights for penetrating trauma justified? J Trauma 43:83–88PubMedCrossRef
7.
Cunningham P, Rutledge R, Baker CC, Clancy TV (1997) A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene. J Trauma 43:940–946PubMedCrossRef
8.
Urdaneta LF, Miller BK, Ringenberg BJ, Cram AE, Scott DH (1987) Role of an emergency helicopter transport service in rural trauma. Arch Surg 122:992–996PubMed
9.
Schiller WR, Knox R, Zinnecker H et al (1988) Effect of helicopter transport of trauma victims on survival in an urban trauma center. J Trauma 28:1127–1134PubMedCrossRef
10.
Nicholl JP, Brazier JE, Snooks HA (1995) Effects of London helicopter emergency medical service on survival after trauma. BMJ 311:217–222PubMed
11.
Thomas SH, Harrison TH, Buras WR, Ahmed W, Cheema F, Wedel SK (2002) Helicopter transport and blunt trauma mortality: a multicenter trial. J Trauma 52:136–145PubMedCrossRef
12.
Nardi G, Massarutti D, Muzzi R et al (1994) Impact of emergency medical helicopter service on mortality for trauma in north-east Italy. A regional prospective audit. Eur J Emerg Med 1:69–77
13.
Bartolacci RA, Munford BJ, Lee A, McDougall PA (1998) Air medical scene response to blunt trauma: effect on early survival. Med J Aust 169(11–12):612–616PubMed
14.
Di Bartolomeo S, Sanson G, Nardi G, Michelutto V, Scian F (2005) HEMS vs. ground-BLS care in traumatic cardiac arrest. Prehosp Emerg Care 9:79–84PubMedCrossRef
15.
Hartl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J (2006) Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma 60:1250–1256PubMedCrossRef
16.
Meier DR, Samper ER (1989) Evolution of civil aeromedical helicopter aviation. South Med J 82:885–891PubMed
17.
Cornwell EE III, Belzberg H, Hennigan K et al (2000) Emergency medical services (EMS) vs non-EMS transport of critically injured patients: a prospective evaluation. Arch Surg 135:315–319PubMedCrossRef
18.
Sampalis JS, Denis R, Lavoie A et al (1999) Trauma care regionalization: a process-outcome evaluation. J Trauma 46:565–581PubMedCrossRef
19.
Sampalis JS, Lavoie A, Williams JI, Mulder DS, Kalina M (1993) Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. J Trauma 34:252–261PubMedCrossRef
20.
Demetriades D (1997) Penetrating injuries to the thoracic great vessels. J Card Surg 12(2 Suppl):173–180PubMed
21.
Baker FJ II, Baxt WG, Brown GA, Peterson FV Jr, Ross MG (1985) Up, up, and away: aeromedical transport in EMS ··· open forum. Emerg Med Serv 14:26–39PubMed
22.
Eckstein M, Jantos T, Kelly N, Cardillo A (2002) Helicopter transport of pediatric trauma patients in an urban emergency medical services system: a critical analysis. J Trauma 53:340–344PubMedCrossRef
23.
Lerner EB, Billittier AJ IV, Sikora J, Moscati RM (1999) Use of a geographic information system to determine appropriate means of trauma patient transport. Acad Emerg Med 6:1127–1133PubMedCrossRef
24.
Svenson JE, O’Connor JE, Lindsay MB (2006) Is air transport faster? A comparison of air versus ground transport times for interfacility transfers in a regional referral system. Air Med J 25:170–172PubMedCrossRef
25.
Baxt WG, Moody P (1983) The impact of a rotorcraft aeromedical emergency care service on trauma mortality. JAMA 249:3047–3051PubMedCrossRef
26.
Diaz MA, Hendey GW, Bivins HG (2005) When is the helicopter faster? A comparison of helicopter and ground ambulance transport times. J Trauma 58:148–153PubMedCrossRef
27.
Mitchell AD, Tallon JM, Sealy B (2007) Air versus ground transport of major trauma patients to a tertiary trauma centre: a province-wide comparison using TRISS analysis. Can J Surg 50:129–133PubMed
28.
Mann NC, Pinkney KA, Price DD et al (2002) Injury mortality following the loss of air medical support for rural interhospital transport. Acad Emerg Med 9:694–698PubMedCrossRef
29.
Ringburg AN, Spanjersberg WR, Frankema SP, Steyerberg EW, Patka P, Schipper IB (2007) Helicopter emergency medical services (HEMS): impact on on-scene times. J Trauma 63:258–262PubMedCrossRef
30.
Fischer RP, Flynn TC, Miller PW, Duke JH Jr (1984) Urban helicopter response to the scene of injury. J Trauma 24:946–951PubMedCrossRef
31.
Hotvedt R, Kristiansen IS, Forde OH et al (1996) Which groups of patients benefit from helicopter evacuation? Lancet 347(9012):1362–1366PubMedCrossRef
32.
33.
Bledsoe BE, Smith MG (2004) Medical helicopter accidents in the United States: a 10-year review. J Trauma 56:1325–1329PubMedCrossRef
34.
Association of Air Medical Services (1990) Position paper on the appropriate use of emergency air medical services. J Air Med Transp 9:29–33CrossRef
35.
36.
Black JJ, Ward ME, Lockey DJ (2004) Appropriate use of helicopters to transport trauma patients from incident scene to hospital in the United Kingdom: an algorithm. Emerg Med J 21:355–361PubMedCrossRef
37.
Thomson DP, Thomas SH (2003) 2002–2003 Air medical services committee of the national association of EMS physicians. Guidelines for air medical dispatch. Prehosp Emerg Care 7:265–271PubMedCrossRef
38.
39.
Osler T, Baker SP, Long W (1997) A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 43:922–926PubMedCrossRef
40.
41.
Amatangelo M, Thomas SH, Harrison T, Wedel SK (1997) Analysis of patients discharged from receiving hospitals within 24 hours of air medical transport. Air Med J 16:44–47PubMedCrossRef
42.
Wong TW, Lau CC (2000) Profile and outcomes of patients transported to an accident and emergency department by helicopter: prospective case series. Hong Kong Med J 6:249–253PubMed
Metadata
Title
Helicopter Evacuation of Trauma Victims in Los Angeles: Does it Improve Survival?
Authors
Peep Talving
Pedro G. R. Teixeira
Galinos Barmparas
Joseph DuBose
Kenji Inaba
Lydia Lam
Demetrios Demetriades
Publication date
01-11-2009
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 11/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0185-1

Other articles of this Issue 11/2009

World Journal of Surgery 11/2009 Go to the issue

OriginalPaper

Comparison of Invasiveness Between Laparoscopy-Assisted Total Gastrectomy and Open Total Gastrectomy

OriginalPaper

Bilateral Neck Exploration in Primary Hyperparathyroidism—When Is It Selected and How Is It Performed?

OriginalPaper

Adhesional Small Bowel Obstruction in the Absence of Previous Operations: Management and Outcomes

OriginalPaper

Surgical and Medical Treatment of Secondary Hyperparathyroidism in Patients on Continuous Dialysis

OriginalPaper

Lithium Therapy and Hyperparathyroidism: An Evidence-Based Assessment

OriginalPaper

Predicting Morbidity and Mortality After Hepatic Resection in Patients with Hepatocellular Carcinoma: The Role of Model for End-Stage Liver Disease Score