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Msg ID: 2555146 Interesting article +5/-1     
2/10/2019 12:01:19 AM

Something to think about in light of last week's accident.


When birds can’t fly: An analysis of interfacility ground transport using advanced life support when helicopter emergency medical service is unavailable

Borst, Greg M. MD; Davies, Stephen W. MD, MPH; Waibel, Brett H. MD; Leonard, Kenji L. MD; Rinehart, Shane M. MD, DO; Newell, Mark A. MD; Goettler, Claudia E. MD; Bard, Michael R. MD; Poulin, Nathaniel R. MD; Toschlog, Eric A. MD

Journal of Trauma and Acute Care Surgery: August 2014 - Volume 77 - Issue 2 - p 331–337
doi: 10.1097/TA.0000000000000295
Original Articles

BACKGROUND Helicopter emergency medical service (HEMS) transport of trauma patients is costly and of unproven benefit. Recent retrospective studies fail to control for crew expertise and therefore compare highly trained advance life support with less-trained basic life support crews. The purpose of our study was to compare HEMS with ground, interfacility transport while controlling for crew training. We hypothesized that patients transported by HEMS would experience shorter interhospital transport time and reduced mortality.

METHODS Our National Trauma Registry of the American College of Surgeons database was retrospectively queried to identify consecutive interfacility, hospital transfers (January 1, 2008, to November 1, 2012) to our Level I trauma center. Transfers were stratified by transportation vehicle (i.e., HEMS vs. ground transport). Cohorts were compared across standard demographic and clinical variables using univariate analysis. Multivariate logistic regression was performed to determine the association of these variables with mortality.

RESULTS The HEMS (n = 2,190) and ground (n = 223) cohorts were well matched overall, with no significant differences for demographics, injury severity, physiology, hospital length of stay, or complications. Median (interquartile range) time to definitive care was significantly lower for HEMS (150 [114] minutes vs. 255 [157] minutes, p < 0.001), without change in mortality (9.0% vs. 8.1%, p = 0.71). Multivariate logistic regression did not identify an association between transport mode and mortality.

CONCLUSION Despite faster interfacility transport times, HEMS offered no mortality benefit compared with ground when crew expertise was controlled for, contradicting recent large, retrospective National Trauma Data Bank studies. Our study may represent the best approximation of a prospective study by focusing on patients deemed worthy of HEMS by referring providers. Although HEMS may seem intuitively beneficial for time-dependent injuries, larger studies with a similar methodology are warranted to justify the cost and risk of HEMS and identify subsets of patients who may benefit.

LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.

Msg ID: 2555151 Interesting article +6/-0     
Author:Mortimer A. Lity
2/10/2019 12:54:00 AM

Reply to: 2555146

Mortality shouldn't be the only measure.

Also considered should be reduction in long and short term injury recovery, reduction in severity of, and number of permanent injuries.

And, for those organ donors like motorcylce riders, geting their organs toa processing location faster.

My intuition tells me that HEMS/HAA will show positive comparison to ground transport.

Msg ID: 2555173 And the winner is +3/-1     
2/10/2019 8:56:48 AM

Reply to: 2555151

not the patient.  There is no argument that an ALS crew using a helicopter to transport a patient would provide a higher level of care than a BLS crew using ground transportation. 

I firmly believe every aircrew has, in the back of their mind, "if things start to look bad" we can always turn around before we get in over our head. The truth is, at that point, you are already in over your head.  

If the commitment to continue cannot be made with a 100% resolution, it has to be a non event.  In other words, until the profit motive is removed from the matrix, the insanity will continue.  History will repeat itself.


Msg ID: 2555186 And the winner is +1/-1     
2/10/2019 10:33:54 AM

Reply to: 2555173

A BLS crew?  Really?  You are truly mistaken.  Now, another ALS crew vs helicopter might be a fair comparison but a BLS crew will kill someone in a heartbeat.

Msg ID: 2555208 And the winner is +1/-0     
Author:So will many HEMS crews.
2/10/2019 1:23:29 PM

Reply to: 2555186

Tired, stupid, distracted, impaired, incompetent to begin with. And then there's the flight risk itself. As proven many times over the past 35 years. Not looking forward to the day that I'm the one laying on the flat, looking up.

Msg ID: 2555257 And the winner is +0/-0     
2/10/2019 7:18:13 PM

Reply to: 2555173

of a complicated stretch of a statement.

Msg ID: 2555182 Interesting article +5/-0     
2/10/2019 10:13:24 AM

Reply to: 2555151
In addition, most studies are tailored to meet the personal agenda of the writer/publisher.

This is very subjective due to the mere fact it has been and continues to be arguable from both sides.

I would present that the medical care in any air ambulance operation is far superior to the [no insult intended] BLS and ALS ground units. The level of mere educational requirements are well exceeded from ground transport systems; not to mention the experience required to move into the HAA arena.

Humble Pilot

Msg ID: 2555195 Crews can turn around faster by HEMS (NT) +0/-0     
Author:than with ground transports
2/10/2019 11:43:00 AM

Reply to: 2555146

Msg ID: 2555206 The recent probable CFIT accident could have +4/-0     
Author:been avoided.
2/10/2019 1:16:00 PM

Reply to: 2555195

Culture and management is to blame. No matter how they spin it, they are to blame. Management sets the tone for the culture.

Msg ID: 2555210 The recent probable CFIT accident could have +5/-0     
2/10/2019 1:25:47 PM

Reply to: 2555206

And nothing about that, anywhere in the industry, is going to change soon. Cuz it's all about the ca-ching of the cash register.

Msg ID: 2555235 The recent probable CFIT accident could have +0/-0     
2/10/2019 3:44:58 PM

Reply to: 2555210


Msg ID: 2555315 CFIT is a result, not a cause! (NT) +0/-0     
2/11/2019 9:20:20 AM

Reply to: 2555210

Msg ID: 2555331 CFIT is a result, not a cause! +0/-0     
2/11/2019 10:43:38 AM

Reply to: 2555315

But dead is dead.

Msg ID: 2555337 Dead is also a result, not a cause! (NT) +0/-0     
2/11/2019 11:31:17 AM

Reply to: 2555331

Msg ID: 2555382 Dead is also a result, not a cause! +0/-0     
Author:You didn't need to do that.
2/11/2019 4:51:19 PM

Reply to: 2555337

We knew you were a blockhead after the first post. Now make some more self-serving know-it-all comment so even more people find you annoying, boring, and obtrusive. Why should just co-workers and relatives and people in line behind you at WalMart feel that way?

Msg ID: 2555386 My first post was to tell you CFIT was a result +0/-0     
Author:not a cause.
2/11/2019 5:00:30 PM

Reply to: 2555382

You seem to be yelling to fix a result.  Put a bandade on the scab.


You can't fix a leak by mopping the floor

Msg ID: 2555232 Crews can turn around faster by HEMS +0/-0     
Author:I suspect that this is
2/10/2019 3:03:28 PM

Reply to: 2555195

the reason you don't see a big rush to operate ground vehicles with HEMS quality med personnel and equipment. 

I've often wondered why someone wouldn't offer this type of service as the operating costs would seem to favor ground transport.  The only reason that makes sense is that the turn-around times would be too great.

Msg ID: 2555258 Interesting article +0/-0     
Author:Mortality is one thing,
2/10/2019 7:20:08 PM

Reply to: 2555146

morbidity is THE thing.  Sure, mortality is the big deal, but morbidity is the most expensive by far for all concerned.  Once the latter is started to be measured (somehow) I suspect HAA will be more relevant than the results of the study.

Msg ID: 2555297 Interesting article +0/-0     
2/10/2019 11:14:54 PM

Reply to: 2555258

This is truly a complicated issue. Air versus ground depends on injury, population density, central place distances, regional economics, etc.

The bottom line is air was primarily introduced, by hospitals, to fill beds. The good old profit motive. The cost of the transport is easily offset by the cost of hospitalization for traumatic injuries.

I know, on a personal level, that if you are injured and hurting you want to get to the hospital as fast as possible. A 10 minute helicopter ride seems far more preferable than a 50 minute ride on rubber tires. I will say, in some of the moderately remote areas I've worked, if the ground ambulance crew headed straight for the hospital their enroute times are comparable to the time necessary to transfer from the ground ambulance to the air ambulance and then transport.

I guess what I'm saying is that, studies aside, if hospitals profit more from using air transport there will always be a place for HEMS.

Msg ID: 2555325 Profit....... +0/-0     
2/11/2019 10:26:33 AM

Reply to: 2555297

Pretty much sums it up.  The helicopter is not an asset to the hospital, it is a liability.  A once large hospital group in Phoenix terminated their contracts for helicopter transport when an audit showed they were not a core asset, and transport to the hospital continues to occur through stand alone providers.  The burden now falls on those ambulance providers be they air or ground, which is why the bill for transport makes it to your house, even before you are discharged from the hospital.