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Medical Helicopters Bryan Bledsoe, DO, FACEP UNLV

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Page 1: Medical helicopters

Medical Helicopters

Medical Helicopters

Bryan Bledsoe, DO, FACEP

UNLV

Bryan Bledsoe, DO, FACEP

UNLV

Page 2: Medical helicopters

Medical HelicoptersMedical Helicopters

What is the role of medical helicopters in the modern American EMS system?

What is the role of medical helicopters in the modern American EMS system?

Page 3: Medical helicopters

Medical HelicoptersMedical Helicopters

In many areas, the indication for summoning a medical helicopter is:

The presence of a patient.

In many areas, the indication for summoning a medical helicopter is:

The presence of a patient.

Page 4: Medical helicopters

Medical HelicoptersMedical Helicopters

Medical industries that have quickly gotten out of hand:

1980s: Boutique psychiatric and substance abuse facilities.

1990s: Home health care agencies.

2000s: Medical helicopters and motorized wheel chairs.

Medical industries that have quickly gotten out of hand:

1980s: Boutique psychiatric and substance abuse facilities.

1990s: Home health care agencies.

2000s: Medical helicopters and motorized wheel chairs.

Page 5: Medical helicopters

Medical HelicoptersMedical Helicopters

1998 1999 2000 2001 2002 2003 2004 2005 2006 20070

200

400

600

800

1000

1200

Number of Medical Helicopters by Year

Page 6: Medical helicopters

Medical HelicoptersMedical Helicopters

There are more medical helicopters in Dallas/Fort Worth than all of Canada or Australia.

There are more medical helicopters in Dallas/Fort Worth than all of Canada or Australia.

Page 7: Medical helicopters

Medical HelicoptersMedical Helicopters

Are patients needs or helicopter operator profits driving HEMS in the United States?

Are patients needs or helicopter operator profits driving HEMS in the United States?

Page 8: Medical helicopters

Medical HelicoptersMedical Helicopters

In 2002, Medicare increased the rates for medical helicopter transport.Price for airlift ranges from $5,000 to $15,000, 5 to 10 times that of a ground ambulance. Helicopters in the US have doubled from a decade ago; and with more of them scrambling for business, specialists say that emergency personnel are feeling more pressure to use them. In 2004, the number of flights paid for by Medicare alone was 58 percent higher than in 2001. Spending by Medicare has more than doubled to $103 million over the same period.

In 2002, Medicare increased the rates for medical helicopter transport.Price for airlift ranges from $5,000 to $15,000, 5 to 10 times that of a ground ambulance. Helicopters in the US have doubled from a decade ago; and with more of them scrambling for business, specialists say that emergency personnel are feeling more pressure to use them. In 2004, the number of flights paid for by Medicare alone was 58 percent higher than in 2001. Spending by Medicare has more than doubled to $103 million over the same period.

Page 9: Medical helicopters

Medical HelicoptersMedical HelicoptersIn FY 2001, the University of Michigan’s flight program “Survival Flight”:

$6,000,000 operational costs$62,000,000 in inpatient revenues28% of ICU daysHelicopter patients were twice as likely to have commercial health insurance compared to regular patient profile.

In FY 2001, the University of Michigan’s flight program “Survival Flight”:

$6,000,000 operational costs$62,000,000 in inpatient revenues28% of ICU daysHelicopter patients were twice as likely to have commercial health insurance compared to regular patient profile.

Rosenberg BL, Butz DA, Comstock MC, Taheri. Aeromedical Service: How Does it Actually Contribute to the Mission? J Trauma, 2003;54:681-688

Page 10: Medical helicopters

CostsCosts

Comparison of patients before and after helicopter placement.

Sussex = £55,000

Cornwall = £800,000

London = £1,200,000

Comparison of patients before and after helicopter placement.

Sussex = £55,000

Cornwall = £800,000

London = £1,200,000

No improvements in response times.

Scene times longer.

Conclusion:HEMS costly

Benefits smallSnooks HA, Nicholl JP, Brazier JE, Lees-Mlanga S. The Costs and Benefits of Helicopter Emeregency Services in England and Wales. J Pub Health Med. 1996;18:67-77

No improvements in response times.

Scene times longer.

Conclusion:HEMS costly

Benefits smallSnooks HA, Nicholl JP, Brazier JE, Lees-Mlanga S. The Costs and Benefits of Helicopter Emeregency Services in England and Wales. J Pub Health Med. 1996;18:67-77

Page 11: Medical helicopters

CostsCosts

Prospective comparison of seriously-injured patients (survivors) transported by HEMS and GEMS.

Prospective comparison of seriously-injured patients (survivors) transported by HEMS and GEMS.

“As there is no evidence of any improvement in outcomes overall for the extra cost, HEMS has not been found to be a cost-effective service.”Nicholl JP, Brazier JE, Snooks HA. The Cost and Effectiveness of the London Helicopter Emergency Services. J Health Serv Res Policy. 1996;1:232-237

“As there is no evidence of any improvement in outcomes overall for the extra cost, HEMS has not been found to be a cost-effective service.”Nicholl JP, Brazier JE, Snooks HA. The Cost and Effectiveness of the London Helicopter Emergency Services. J Health Serv Res Policy. 1996;1:232-237

Page 12: Medical helicopters

InterfacilityInterfacility

Retrospective review of 388 pedi patients.

80 HEMS (16% mortality)

288 GEMS (5% mortality)

Mean total transport time 170 minutes faster by HEMS.

No significant differences in LOS, ICU days.

Retrospective review of 388 pedi patients.

80 HEMS (16% mortality)

288 GEMS (5% mortality)

Mean total transport time 170 minutes faster by HEMS.

No significant differences in LOS, ICU days.

No differences in outcomes (except mortality) which was due to increased severity of HEMS population.

Quinn-Skillings GQ, Brozen R. Outcomes of Interhospital Transfers fo Critically-Ill Patients: A Comparison of Air and Ground Transport. Ann Emerg Med. 1999;34:597

No differences in outcomes (except mortality) which was due to increased severity of HEMS population.

Quinn-Skillings GQ, Brozen R. Outcomes of Interhospital Transfers fo Critically-Ill Patients: A Comparison of Air and Ground Transport. Ann Emerg Med. 1999;34:597

Page 13: Medical helicopters

InterfacilityInterfacility

Prospective study of:Local HEMS: 1,234

Non-Local HEMS: 25

GEMS: 153

Deaths:HEMS: 19%

GEMS: 15%

No differences found at 30 days for:

Disability

Health status

Health care utilization

Prospective study of:Local HEMS: 1,234

Non-Local HEMS: 25

GEMS: 153

Deaths:HEMS: 19%

GEMS: 15%

No differences found at 30 days for:

Disability

Health status

Health care utilization

Patients transported by HEMS did not have improved outcomes over GEMS.

These data argue against a large advantage of HEMS in interfacility transport.

Arfken CL, Shapiro MJ, Bessey PQ, Littenberg B. Effectiveness of helicopter versus ground ambulance services for interfacility transport. J Trauma. 1998;45:785-790

Patients transported by HEMS did not have improved outcomes over GEMS.

These data argue against a large advantage of HEMS in interfacility transport.

Arfken CL, Shapiro MJ, Bessey PQ, Littenberg B. Effectiveness of helicopter versus ground ambulance services for interfacility transport. J Trauma. 1998;45:785-790

Page 14: Medical helicopters

InterfacilityInterfacility

Comparison of interfacility patients with unstable angina or MI transported by GEMS because HEMS was unavailable due to weather.

Compared to HEMS transports.

No differences in deaths within 72 hours.

Comparison of interfacility patients with unstable angina or MI transported by GEMS because HEMS was unavailable due to weather.

Compared to HEMS transports.

No differences in deaths within 72 hours.

HEMS associated with more total deaths (9/48 v 1/48)

Interfacility transport of cardiac patients by air offers no outcome advantage.

Stone CK, Hunt RC, Sousa JA. Interhospital transfer of cardiac arrest patients: does air transport make a difference? Air Med J. 2004;13:159-162.

HEMS associated with more total deaths (9/48 v 1/48)

Interfacility transport of cardiac patients by air offers no outcome advantage.

Stone CK, Hunt RC, Sousa JA. Interhospital transfer of cardiac arrest patients: does air transport make a difference? Air Med J. 2004;13:159-162.

Page 15: Medical helicopters

InterfacilityInterfacility

145 patients transported from 20 hospitals to the University of Wisconsin hospital by HEMS.

Dispatch times:GEMS: 56HEMS: 178

Referral hospital times:GEMS: 25 13

HEMS: 3111

HEMS patients transport faster.

145 patients transported from 20 hospitals to the University of Wisconsin hospital by HEMS.

Dispatch times:GEMS: 56HEMS: 178

Referral hospital times:GEMS: 25 13

HEMS: 3111

HEMS patients transport faster.

HEMS transport faster for all patients.

For stable patients it may be reasonable to use GEMS.

Svenson JE, O’Connor JE, Lindsay. Is air transport faster? A comparison of air versus ground transport times for interfacility transfers in a regional referral system. Air Med J. 2006;25:170-172

HEMS transport faster for all patients.

For stable patients it may be reasonable to use GEMS.

Svenson JE, O’Connor JE, Lindsay. Is air transport faster? A comparison of air versus ground transport times for interfacility transfers in a regional referral system. Air Med J. 2006;25:170-172

Page 16: Medical helicopters

InterfacilityInterfacility

Retrospective cohort of 243 patients transported by GEMS and 139 patients by air in Ontario.

Time interval between decision to transfer and the actual time has longer for GEMS (41.3 vs. 89.7 minutes).

Travel time shorter by helicopter (58.4 vs. 78.9)

Retrospective cohort of 243 patients transported by GEMS and 139 patients by air in Ontario.

Time interval between decision to transfer and the actual time has longer for GEMS (41.3 vs. 89.7 minutes).

Travel time shorter by helicopter (58.4 vs. 78.9)

Distance of transport not an accurate indicator of transport time.

Karanicolas PJ, Shatia P. Willamson J, et al. The fastest route between two points is not always a straight line: an analysis of air and land transfer of nonpenetrating trauma patients. J Trauma. 2006;61:396-403.

Distance of transport not an accurate indicator of transport time.

Karanicolas PJ, Shatia P. Willamson J, et al. The fastest route between two points is not always a straight line: an analysis of air and land transfer of nonpenetrating trauma patients. J Trauma. 2006;61:396-403.

Page 17: Medical helicopters

NeonatalNeonatal

10-year study of neonatal air transport in Norway.

236 acute care transfers.

13 LBW infants

7 deaths (3.2%)

10-year study of neonatal air transport in Norway.

236 acute care transfers.

13 LBW infants

7 deaths (3.2%)

Low mortality overall.

Lang A, Brun H, Kaaresen PI, Klingenberg C. A population-based 10-year study of neonatal air transports in North Norway.

Acta Paediatr. 2007;96:955-959

Low mortality overall.

Lang A, Brun H, Kaaresen PI, Klingenberg C. A population-based 10-year study of neonatal air transports in North Norway.

Acta Paediatr. 2007;96:955-959

Page 18: Medical helicopters

Pediatric TransportsPediatric Transports

1991-1992 Utah review:

874 pedi patients

HEMS = 561

FWEMS = 313

Charges (average):GEMS = $526

HEMS = $4,879

FWEMS = $4,702

1991-1992 Utah review:

874 pedi patients

HEMS = 561

FWEMS = 313

Charges (average):GEMS = $526

HEMS = $4,879

FWEMS = $4,702

“Air medical transport is expensive and sometimes may be used unnecessarily.”

Diller E, Vernon D, Dean JM, Suruda A. The Epidemiology of Pediatric Air Medical Transports in Utah. Prehosp Emerg Care. 1999;3:217-227

“Air medical transport is expensive and sometimes may be used unnecessarily.”

Diller E, Vernon D, Dean JM, Suruda A. The Epidemiology of Pediatric Air Medical Transports in Utah. Prehosp Emerg Care. 1999;3:217-227

Page 19: Medical helicopters

BurnsBurns

Retrospective review of HEMS transports to burn center over 2-year period.

GEMS transports used as control group.

Retrospective review of HEMS transports to burn center over 2-year period.

GEMS transports used as control group.

Excluded:Inhalation injury

Burns > 24 hours old

> 200 mils away

>30% BSA burn

Associated trauma

Excluded:Inhalation injury

Burns > 24 hours old

> 200 mils away

>30% BSA burn

Associated trauma

Page 20: Medical helicopters

BurnsBurns

Evaluated and found no difference in:

TBSA burned

% of 3° burns

LOS

Vent days

Age

Transport mileage

Evaluated and found no difference in:

TBSA burned

% of 3° burns

LOS

Vent days

Age

Transport mileage

Patients with < 30% TBSA and < 200 miles should be transported by GEMS.

DeWing MD, Curry T, Stephenson E, et al. Cost-effective use of helicopters for the transportation of patients with burn injuries. J Burn Care Rehabil. 2000;21:535-540

Patients with < 30% TBSA and < 200 miles should be transported by GEMS.

DeWing MD, Curry T, Stephenson E, et al. Cost-effective use of helicopters for the transportation of patients with burn injuries. J Burn Care Rehabil. 2000;21:535-540

Page 21: Medical helicopters

BurnsBurns

437 consecutive acute burn patients to western PA burn center:

GEMS = 339

HEMS = 98< 25 miles = 18

> 25 miles = 80

437 consecutive acute burn patients to western PA burn center:

GEMS = 339

HEMS = 98< 25 miles = 18

> 25 miles = 80

Inhalation injury:GEMS = 3%

HEMS = 28%

Reduce use of HEMS for burn patients.

Slater H, O’Mara MS, Goldfarb IW. Helicopter transportation of burn patients. Burns 2002;28:70-2

Inhalation injury:GEMS = 3%

HEMS = 28%

Reduce use of HEMS for burn patients.

Slater H, O’Mara MS, Goldfarb IW. Helicopter transportation of burn patients. Burns 2002;28:70-2

Page 22: Medical helicopters

ObstetricsObstetrics

22 HEMS transports of preterm labor patients.

No outcome difference found.

No deliveries in flight.

22 HEMS transports of preterm labor patients.

No outcome difference found.

No deliveries in flight.

HEMS = $4,613.64 $581.12

GEMS = $604.02 $306.02.Van Hook JW, Leicht TG, Van

Hook CL, et al. Aeromedical transfer of preterm b\labor patients. Tex Med. 1998;94:88-90

HEMS = $4,613.64 $581.12

GEMS = $604.02 $306.02.Van Hook JW, Leicht TG, Van

Hook CL, et al. Aeromedical transfer of preterm b\labor patients. Tex Med. 1998;94:88-90

Page 23: Medical helicopters

TraumaTrauma

1990-2001 retrospective review of all patients brought to the Santa Clara Valley Trauma Center (CA) by HEMS.

1990-2001 retrospective review of all patients brought to the Santa Clara Valley Trauma Center (CA) by HEMS.

947 consecutive patients:

911 blunt trauma

36 penetrating trauma

Mean ISS = 8.9

Mortality = 15 (in ED)

947 consecutive patients:

911 blunt trauma

36 penetrating trauma

Mean ISS = 8.9

Mortality = 15 (in ED)

Page 24: Medical helicopters

TraumaTrauma

312 (33.5%) discharged home from the ED.

620 hospitalized:339 (54.7%) had an ISS 9.

148 had an ISS 16.

312 (33.5%) discharged home from the ED.

620 hospitalized:339 (54.7%) had an ISS 9.

148 had an ISS 16.

84 (8.9%) required early operation.

Only 17 (1.8%) underwent surgery for life-threatening injuries.

84 (8.9%) required early operation.

Only 17 (1.8%) underwent surgery for life-threatening injuries.

Page 25: Medical helicopters

TraumaTrauma

HEMS faster than GEMS = 54.7%

Only 22.8% of the study population possible benefited from HEMS transport.

HEMS faster than GEMS = 54.7%

Only 22.8% of the study population possible benefited from HEMS transport.

HEMS is used excessively for scene transport. New criteria should be developed.Shatney CH, Homan J, Sherck J, Ho C. The Utility of Helicopter Transport of Trauma Patients from the Injury Scene in an Urban EMS Setting . J Trauma. 2002;53:817-822

HEMS is used excessively for scene transport. New criteria should be developed.Shatney CH, Homan J, Sherck J, Ho C. The Utility of Helicopter Transport of Trauma Patients from the Injury Scene in an Urban EMS Setting . J Trauma. 2002;53:817-822

Page 26: Medical helicopters

TraumaTrauma

1987-1993 review of all helicopter and ground transports from scene to trauma center.

North Carolina Trauma Registry

1987-1993 review of all helicopter and ground transports from scene to trauma center.

North Carolina Trauma Registry

1,346 (7.3%) transported by HEMS.

TS = 12 3.6

ISS = 17 11.1

17,344 (92.7%) transported by ground.

TS = 14 3.6

ISS = 10.8 8.4

1,346 (7.3%) transported by HEMS.

TS = 12 3.6

ISS = 17 11.1

17,344 (92.7%) transported by ground.

TS = 14 3.6

ISS = 10.8 8.4

Page 27: Medical helicopters

TraumaTrauma

Outcomes for HEMS transport not uniformly better for HEMS.

Only TS between 5-12 and ISS between 21-30 achieved significance.

Outcomes for HEMS transport not uniformly better for HEMS.

Only TS between 5-12 and ISS between 21-30 achieved significance.

Only a very small subset of patients benefited from HEMS Transport.Cunningham P, Rutledge R, Baker CC, Clancy RV. 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. 1997;43:940-946

Only a very small subset of patients benefited from HEMS Transport.Cunningham P, Rutledge R, Baker CC, Clancy RV. 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. 1997;43:940-946

Page 28: Medical helicopters

TraumaTrauma

Retrospective Boston MedFlight study (1995-1998):

Complicated study statistically

a priori?

Retrospective Boston MedFlight study (1995-1998):

Complicated study statistically

a priori?

Crude Mortality:Air = 9.4%

Ground = 3.0%

OR 0.76.Thomas SH, Harrison TH, Buras WR, et al. Helicopter transport and blunt trauma mortality: a multicenter trial. J Trauma. 2002;52:136-145

Crude Mortality:Air = 9.4%

Ground = 3.0%

OR 0.76.Thomas SH, Harrison TH, Buras WR, et al. Helicopter transport and blunt trauma mortality: a multicenter trial. J Trauma. 2002;52:136-145

Page 29: Medical helicopters

TraumaTrauma

VARIABLE OR SE WALD p Value

95% CI (OR)

Air Transport 0.756 0.098 0.031 0.586-0.975

Increasing Age 2.71 0.259 <0.001 2.25-3.27

Scene Mission Type 1.49 0.160 <0.001 1.21-1.84

ALS EMS Baseline

BLS EMS 0.423 0.060 <0.001 0.320-6.666

Missing EMS 0.554 0.129 0.011 0.351-0.784

ISS < 9 Baseline <0.001

ISS 9-15 4.08 1.02 <0.001 2.50-6.66

ISS 16-24 19.5 4.88 <0.001 12.0-31.9

ISS > 24 163 37.2 <0.001 104-255

Missing 22.1 10.0 <0.001 9.11-53.7

Page 30: Medical helicopters

TraumaTrauma

Phoenix study (1983-1986):

ISS = 20-29 (451)

ISS = 30-39 (155)

Mean age = 30.5 years

Male = 76%

GEMS = 259GCS Mean = 10.4

TS Mean = 12.7

HEMS = 347GCS Mean = 9.6

TS Mean = 12.1

Phoenix study (1983-1986):

ISS = 20-29 (451)

ISS = 30-39 (155)

Mean age = 30.5 years

Male = 76%

GEMS = 259GCS Mean = 10.4

TS Mean = 12.7

HEMS = 347GCS Mean = 9.6

TS Mean = 12.1

Mortality:HEMS = 18%

GEMS = 13%.

No survival advantage for the HEMS group in an urban setting with sophisticated EMS system.Schiller WR, Knox R, Zinnecker H et al. Effect of helicopter transport of trauma victims on survival in an urban trauma center. J Trauma. 1988;25:1127-1134

Mortality:HEMS = 18%

GEMS = 13%.

No survival advantage for the HEMS group in an urban setting with sophisticated EMS system.Schiller WR, Knox R, Zinnecker H et al. Effect of helicopter transport of trauma victims on survival in an urban trauma center. J Trauma. 1988;25:1127-1134

Page 31: Medical helicopters

TraumaTrauma

4-year retrospective review of trauma scene flights.

Audit of scene flights provided half-way through.

Inappropriate flights decreased after audit.

4-year retrospective review of trauma scene flights.

Audit of scene flights provided half-way through.

Inappropriate flights decreased after audit.

Criteria for HEMS should be based upon physiologic criteria.Norton R, Wortman E, Eastes L. et al. Appropriate Helicopter Transport of Urban Trauma Patients. J Trauma. 1996;41:886-891

Criteria for HEMS should be based upon physiologic criteria.Norton R, Wortman E, Eastes L. et al. Appropriate Helicopter Transport of Urban Trauma Patients. J Trauma. 1996;41:886-891

Page 32: Medical helicopters

TraumaTrauma

Review of 122 consecutive victims of noncranial penetrating trauma in Houston:

Average RTS = 10.6

Died = 15.8%

HEMS transport faster = 0%

4.9% of patients required intervention not available on ground EMS.

Only 3.3% received such intervention.

Review of 122 consecutive victims of noncranial penetrating trauma in Houston:

Average RTS = 10.6

Died = 15.8%

HEMS transport faster = 0%

4.9% of patients required intervention not available on ground EMS.

Only 3.3% received such intervention.

Scene flights in Houston for noncranial penetrating trauma are not efficacious.Cocanour CS, Fischer RP, Ursic CM. Are Scene Flights for Penetrating Trauma Justified? J Trauma. 1997;43:83-88

Scene flights in Houston for noncranial penetrating trauma are not efficacious.Cocanour CS, Fischer RP, Ursic CM. Are Scene Flights for Penetrating Trauma Justified? J Trauma. 1997;43:83-88

Page 33: Medical helicopters

TraumaTrauma

Retrospective review of New England flight service.

Results compared to nationalized database.

13% reduction in mortality when compared to controls.

35% reduction in mortality when TS between 4 and 13

No differences at extremes of RTS.

Retrospective review of New England flight service.

Results compared to nationalized database.

13% reduction in mortality when compared to controls.

35% reduction in mortality when TS between 4 and 13

No differences at extremes of RTS.

Rapid utilization of HEMS can have a dramatic effect on patient outcomes.Jacobs LM, Gabram SGA, Sztajnkrycer MD, Robinson KJ, Libby MCN. Helicopter Air Medical Transport: Ten-Year Outcomes for Trauma Patients in a New England Program. Connecticut Med. 1999;63:677-682

Rapid utilization of HEMS can have a dramatic effect on patient outcomes.Jacobs LM, Gabram SGA, Sztajnkrycer MD, Robinson KJ, Libby MCN. Helicopter Air Medical Transport: Ten-Year Outcomes for Trauma Patients in a New England Program. Connecticut Med. 1999;63:677-682

Page 34: Medical helicopters

TraumaTrauma

Retrospective review of 1,877 HEMS and GEMS trauma patients transported from the scene.

Multiple parameters evaluated by logistic regression analysis:

CUPS

Patient age

ISS

RTS

Total out-of-hospital time

Retrospective review of 1,877 HEMS and GEMS trauma patients transported from the scene.

Multiple parameters evaluated by logistic regression analysis:

CUPS

Patient age

ISS

RTS

Total out-of-hospital time

Significant Predictors of Trauma Mortality

Not a Significant Predictor of Trauma Mortality

Lerner EB, Billittier AJ, Dorn JM, Wu YW. Is Total Out-of-Hospital Time a Significant Predictor of Trauma Patient Mortality? Acad Emerg Med. 2003;10:949-954

Page 35: Medical helicopters

TraumaTrauma

Comparison of prehospital scene times (PST) between GEMS and HEMS.

Patients: 1,457

GEMS: 1,197

HEMS: 260

GEMS PST: 24.6 minutes

HEMS PST: 35.4 minutes

Logistic regression analysis and correction for ISS, RTS, age.

Comparison of prehospital scene times (PST) between GEMS and HEMS.

Patients: 1,457

GEMS: 1,197

HEMS: 260

GEMS PST: 24.6 minutes

HEMS PST: 35.4 minutes

Logistic regression analysis and correction for ISS, RTS, age.

PST not associated with increased mortality.Ringburg AN, Spanjersberg WR, Franema SP et al. Helicopter emergency medical service (HEMS): impact on scene times. J Trauma. 2007;63:258-262

PST not associated with increased mortality.Ringburg AN, Spanjersberg WR, Franema SP et al. Helicopter emergency medical service (HEMS): impact on scene times. J Trauma. 2007;63:258-262

Page 36: Medical helicopters

Penetrating TraumaPenetrating Trauma

Danville, PA study 1990-1998.

2,048 penetrating trauma cases:

GEMS = 2,914

HEMS = 494

Mean transport time:GEMS = 30.5 minutes

HEMS = 52.7 minutes

Mean ISS:GEMS = 9

HEMS = 16 .

Danville, PA study 1990-1998.

2,048 penetrating trauma cases:

GEMS = 2,914

HEMS = 494

Mean transport time:GEMS = 30.5 minutes

HEMS = 52.7 minutes

Mean ISS:GEMS = 9

HEMS = 16 .

Despite longer transport and higher ISS, controlling for injury severity found no difference in survival.Dula DJ, Palys K, Leicht M Madtes K. Helicopter versus Ground Ambulance Transport of Patients with Penetrating Trauma. Ann Emerg Med. 2000;38:S16

Despite longer transport and higher ISS, controlling for injury severity found no difference in survival.Dula DJ, Palys K, Leicht M Madtes K. Helicopter versus Ground Ambulance Transport of Patients with Penetrating Trauma. Ann Emerg Med. 2000;38:S16

Page 37: Medical helicopters

Pediatric TraumaPediatric Trauma

All pediatric HEMS trauma transports for 3 year period.

Results:189 patients

Median age = 5

RTS > 7 = 82%

All pediatric HEMS trauma transports for 3 year period.

Results:189 patients

Median age = 5

RTS > 7 = 82%

ISS:0-15 = 83%

16-60 = 15%

> 30 = 3%

14% intubated

18% admitted to PICU

4% taken directly to the OR.

ISS:0-15 = 83%

16-60 = 15%

> 30 = 3%

14% intubated

18% admitted to PICU

4% taken directly to the OR.

Page 38: Medical helicopters

Pediatric TraumaPediatric Trauma

33% discharged home and not admitted.

The majority of pediatric patients transported by helicopter sustained minor injuries.

33% discharged home and not admitted.

The majority of pediatric patients transported by helicopter sustained minor injuries.

Eckstein M, Jantos T, Kelly N, Cardillo A. Helicopter Transport of Pediatric Trauma Patients in an Urban Emergency Medical Services System: A Critical Analysis. J Trauma. 2002;53:340-344

Eckstein M, Jantos T, Kelly N, Cardillo A. Helicopter Transport of Pediatric Trauma Patients in an Urban Emergency Medical Services System: A Critical Analysis. J Trauma. 2002;53:340-344

Page 39: Medical helicopters

Pediatric TraumaPediatric Trauma

Retrospective analysis of pedi trauma patients transported by air to pedi trauma center from scene and compared to those from other hospitals.

Retrospective analysis of pedi trauma patients transported by air to pedi trauma center from scene and compared to those from other hospitals.

Patients:Scene = 379

Death rate = 8.7%

ICU hours = 149.1

Hospital = 842Death rate = 5.5%

ICU hours = 118.3

Patients:Scene = 379

Death rate = 8.7%

ICU hours = 149.1

Hospital = 842Death rate = 5.5%

ICU hours = 118.3

Page 40: Medical helicopters

Pediatric TraumaPediatric Trauma

Retrospective analysis was not able to demonstrate any benefit from direct transport from the scene.

Hospital stabilization before air transport may improve survival.

Retrospective analysis was not able to demonstrate any benefit from direct transport from the scene.

Hospital stabilization before air transport may improve survival.

Larson JT, Dietrich AM, Abdessalam SF, Werman H. Effective Use of an Air Ambulance for Pediatric Trauma. J Trauma. 2004;56:89-93

Larson JT, Dietrich AM, Abdessalam SF, Werman H. Effective Use of an Air Ambulance for Pediatric Trauma. J Trauma. 2004;56:89-93

Page 41: Medical helicopters

Pediatric TraumaPediatric Trauma

Children’s National Medical Center Study:

3,861 children

Retrospective review

Children’s National Medical Center Study:

3,861 children

Retrospective review

Patients:HEMS = 1,460

Mean ISS = 9.2

Transport time = 45.1 minutes

GEMS = 2,896Mean ISS = 6.7

Transport time= 43.2 minutes

Patients:HEMS = 1,460

Mean ISS = 9.2

Transport time = 45.1 minutes

GEMS = 2,896Mean ISS = 6.7

Transport time= 43.2 minutes

Page 42: Medical helicopters

Pediatric TraumaPediatric Trauma

83% of children transported by air not critically-injured (85% overtriage).

Outcomes uniformly better for children critically-injured.

HEMS triage based upon GCS and pulse rate better and more accurate.

83% of children transported by air not critically-injured (85% overtriage).

Outcomes uniformly better for children critically-injured.

HEMS triage based upon GCS and pulse rate better and more accurate.

Moront ML, Gotschall CS, Eichelberger MR. Helicopter Transport of Injured Children: System Effectiveness and Triage Criteria. J Pedi Surg. 1996;8:1183-1188

Moront ML, Gotschall CS, Eichelberger MR. Helicopter Transport of Injured Children: System Effectiveness and Triage Criteria. J Pedi Surg. 1996;8:1183-1188

Page 43: Medical helicopters

Rural TraumaRural Trauma

Iowa Study of 918 rural trauma victims.

Classified as:Essential = 14.0%

Helpful = 12.9%

Not a Factor = 56.6%

Died = 16.5%

Iowa Study of 918 rural trauma victims.

Classified as:Essential = 14.0%

Helpful = 12.9%

Not a Factor = 56.6%

Died = 16.5%

Based on the data, it was impossible to determine prospectively which patients would benefit from HEMS.

Urdanetta LF, Miller BK, Rigenburg BJ et al. Role of Emergency Helicopter Transport Service in Rural Trauma. Arch Surg. 1987;122:992-996

Based on the data, it was impossible to determine prospectively which patients would benefit from HEMS.

Urdanetta LF, Miller BK, Rigenburg BJ et al. Role of Emergency Helicopter Transport Service in Rural Trauma. Arch Surg. 1987;122:992-996

Page 44: Medical helicopters

StaffingStaffing

Louisville study:145 consecutive adult trauma flights with MD.

114 without MD.

Z statistic and other parameters revealed mortality and care to be similar.

Louisville study:145 consecutive adult trauma flights with MD.

114 without MD.

Z statistic and other parameters revealed mortality and care to be similar.

It appears that experienced nurses and paramedics , operating with well-established protocols, car provide aggressive care equal to that of a physician.

Hamman BA, Cue JI, Miler FB et al. Helicopter Transport of Trauma Victims: Does a Physician Make a Difference? J Trauma. 1991;31:490-494

It appears that experienced nurses and paramedics , operating with well-established protocols, car provide aggressive care equal to that of a physician.

Hamman BA, Cue JI, Miler FB et al. Helicopter Transport of Trauma Victims: Does a Physician Make a Difference? J Trauma. 1991;31:490-494

Page 45: Medical helicopters

StaffingStaffing

Australian study:67 patients in physician group

140 in paramedic group

W statistic showed 8-19 extra survivors per 100,000 in the physician group.

Australian study:67 patients in physician group

140 in paramedic group

W statistic showed 8-19 extra survivors per 100,000 in the physician group.

Physicians perform more procedures without increasing scene time which decreases mortality.

Garner A, Rashford S, Lee A, Bartolacci R. Addition of Physicians to Paramedic Helicopter Services Decreases Blunt Trauma Mortality. Aust N Z J Surg. 1999;69:697-701

Physicians perform more procedures without increasing scene time which decreases mortality.

Garner A, Rashford S, Lee A, Bartolacci R. Addition of Physicians to Paramedic Helicopter Services Decreases Blunt Trauma Mortality. Aust N Z J Surg. 1999;69:697-701

Page 46: Medical helicopters

StaffingStaffing

Comparison of nurse/nurse and nurse/paramedic crew performance based on patient severity.Multiple parameters examined.

Comparison of nurse/nurse and nurse/paramedic crew performance based on patient severity.Multiple parameters examined.

No objective differences in outcomes of patients when crew types were compared.

Burney RE, Hubert PL, Maio R. Comparison of Aeromedical Crew Performance by Patient Severity and Outcome. Ann Emerg Med. 1992;21:375-378

No objective differences in outcomes of patients when crew types were compared.

Burney RE, Hubert PL, Maio R. Comparison of Aeromedical Crew Performance by Patient Severity and Outcome. Ann Emerg Med. 1992;21:375-378

Page 47: Medical helicopters

StaffingStaffing

Prospective 2-year follow-up and repeat of previous study comparing nurse/nurse and nurse/paramedic crew performance based on patient severity.

Prospective 2-year follow-up and repeat of previous study comparing nurse/nurse and nurse/paramedic crew performance based on patient severity.

No objective differences in outcomes of patients when crew types were compared.

Burney RE, Hubert PL, Maio R. Variation in air medical outcomes by Crew Composition: a two-year follow-up. Ann Emerg Med. 1995;25:187-192

No objective differences in outcomes of patients when crew types were compared.

Burney RE, Hubert PL, Maio R. Variation in air medical outcomes by Crew Composition: a two-year follow-up. Ann Emerg Med. 1995;25:187-192

Page 48: Medical helicopters

StaffingStaffing

“Based upon these resuscitative efforts and invasive procedures, a physician in attendance was deemed medically-desirable for one-half of flights.”

“Based upon these resuscitative efforts and invasive procedures, a physician in attendance was deemed medically-desirable for one-half of flights.”

Mortality in blunt trauma improved when physician part of the crew.

Bartolacci RA, Munford BJ, Lee A, McGougall PA. Air medical scene response to blunt trauma: effect on early survival. MJA. 1998;169:612-612

Mortality in blunt trauma improved when physician part of the crew.

Bartolacci RA, Munford BJ, Lee A, McGougall PA. Air medical scene response to blunt trauma: effect on early survival. MJA. 1998;169:612-612

Page 49: Medical helicopters

UsageUsage

162,730 patients from PA Trauma Registry treated at 28 accredited trauma centers.

HEMS: 15,938

GALS: 6,473

Interhospital and calls without ALS excluded.

162,730 patients from PA Trauma Registry treated at 28 accredited trauma centers.

HEMS: 15,938

GALS: 6,473

Interhospital and calls without ALS excluded.

HEMS patients:Younger

Male

More seriously injured

Likely to have systolic BP < 90 mmHg.

HEMS patients:Younger

Male

More seriously injured

Likely to have systolic BP < 90 mmHg.

Page 50: Medical helicopters

UsageUsage

Logistic regression analysis revealed that when adjusting for other risk factors, transportation by helicopter did not affect the estimated odds of survival.

Logistic regression analysis revealed that when adjusting for other risk factors, transportation by helicopter did not affect the estimated odds of survival.

Braithwaite CEM, Rosko M, McDowell R, Gallagher J, Proneca J, Spott MA. A Critical Analysis of On-Scene Helicopter Transport on Survival in a Statewide Trauma System. J Trauma. 1998;45:140-144

Braithwaite CEM, Rosko M, McDowell R, Gallagher J, Proneca J, Spott MA. A Critical Analysis of On-Scene Helicopter Transport on Survival in a Statewide Trauma System. J Trauma. 1998;45:140-144

Page 51: Medical helicopters

UsageUsage

Finnish Study.

588 flights:40% aborted

Estimated that:3 patients (1.5%) were saved.

42 patients (20%) mostly with cardiovascular disease benefitted.

Remaining patients benefited from ALS care and not HEMS.

Finnish Study.

588 flights:40% aborted

Estimated that:3 patients (1.5%) were saved.

42 patients (20%) mostly with cardiovascular disease benefitted.

Remaining patients benefited from ALS care and not HEMS.

A minority of patients benefit fro HEMS.

Hurola J, Wangel M, Uusaro A, Rukonen E. Paramedic helicopter emergency service in rural Finland—do the benefits justify the cost. Acta Anaesthesiol Scand. 2002;46:779-784

A minority of patients benefit fro HEMS.

Hurola J, Wangel M, Uusaro A, Rukonen E. Paramedic helicopter emergency service in rural Finland—do the benefits justify the cost. Acta Anaesthesiol Scand. 2002;46:779-784

Page 52: Medical helicopters

UsageUsage

Retrospective review of HEMS transports in FDNY (1996-1999).182 transports:

Scene-Hospital = 32

NYC Hospital-NYC Hospital = 18

Outside NYC Hospital – NYC Hospital = 122

NYC Hospital – Outside NYC Hospital = 10

Retrospective review of HEMS transports in FDNY (1996-1999).182 transports:

Scene-Hospital = 32

NYC Hospital-NYC Hospital = 18

Outside NYC Hospital – NYC Hospital = 122

NYC Hospital – Outside NYC Hospital = 10

FDNY infrequently uses HEMS.

Asaeda G, Cherson A, Giordano L, Kusick M. Utilization of Air Medical Transport in a Large Urban Environment: A Retrospective Analysis. Prehosp Emerg Care. 2001;5:36-39

FDNY infrequently uses HEMS.

Asaeda G, Cherson A, Giordano L, Kusick M. Utilization of Air Medical Transport in a Large Urban Environment: A Retrospective Analysis. Prehosp Emerg Care. 2001;5:36-39

Page 53: Medical helicopters

UsageUsage

1995-2000 comparison of HEMS and GEMS transport in Philadelphia.

29,074 transportsISS > 15 = 4,640

5-15 mile radius = 1,245

HEMS = 12.24%

GEMS = 87.66%

1995-2000 comparison of HEMS and GEMS transport in Philadelphia.

29,074 transportsISS > 15 = 4,640

5-15 mile radius = 1,245

HEMS = 12.24%

GEMS = 87.66%

For patients 5-15 miles from trauma center, HEMS transport takes longer.

HEMS outcomes worse.Basile JF, Sorondo B. Comparison Between Helicopter EMS and Ground EMS Transport Time and Outcomes for Severely-Injured Patients within a 5-15 Mile Radius from a Trauma Center. Prehosp Emerg Care. 2004;8:99

For patients 5-15 miles from trauma center, HEMS transport takes longer.

HEMS outcomes worse.Basile JF, Sorondo B. Comparison Between Helicopter EMS and Ground EMS Transport Time and Outcomes for Severely-Injured Patients within a 5-15 Mile Radius from a Trauma Center. Prehosp Emerg Care. 2004;8:99

Page 54: Medical helicopters

UsageUsage

Retrospective study 7,584 GEMS and 1,075 HEMS transports.

Transport times:GEMS provided shortest prehospital interval at distances < 10 miles.

Simultaneously dispatched HEMS provided shortest prehospital interval > 10 miles.

Retrospective study 7,584 GEMS and 1,075 HEMS transports.

Transport times:GEMS provided shortest prehospital interval at distances < 10 miles.

Simultaneously dispatched HEMS provided shortest prehospital interval > 10 miles.

Non-simultaneously dispatched HEMS was faster if > 45 miles.

Diaz MA, Hendey GW, Bivins HG. When is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance Transport Times. J Trauma. 2005;58:148-153

Non-simultaneously dispatched HEMS was faster if > 45 miles.

Diaz MA, Hendey GW, Bivins HG. When is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance Transport Times. J Trauma. 2005;58:148-153

Page 55: Medical helicopters

UsageUsage

Retrospective review of all patients transported 2003-2004.

156 trauma patients

Average ISS = 12 (range 1-46)

Discharged home = 45 (41%)

24 to OR

10 to ICU

2 died

Retrospective review of all patients transported 2003-2004.

156 trauma patients

Average ISS = 12 (range 1-46)

Discharged home = 45 (41%)

24 to OR

10 to ICU

2 died

HEMS transfer in the acute setting is of debated value.

Triage categories need to be revised.

Melton JT, Jain S, Kendrick B, Deo SD. Helicopter emergency ambulance service (HEAS) transfer: an analysis of trauma patient case-mix, injury severity and outcomes. Ann R Coll Surg Engl. 2007;89:513-516

HEMS transfer in the acute setting is of debated value.

Triage categories need to be revised.

Melton JT, Jain S, Kendrick B, Deo SD. Helicopter emergency ambulance service (HEAS) transfer: an analysis of trauma patient case-mix, injury severity and outcomes. Ann R Coll Surg Engl. 2007;89:513-516

Page 56: Medical helicopters

Medical HelicoptersMedical Helicopters

Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O’Keefe MF. Helicopter Scene Transport of Trauma Patients with Nonlife-Threatening Injuries: A Meta-Analysis. J Trauma. 2006;60:1254-1266

Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O’Keefe MF. Helicopter Scene Transport of Trauma Patients with Nonlife-Threatening Injuries: A Meta-Analysis. J Trauma. 2006;60:1254-1266

Page 57: Medical helicopters

Bledsoe, et al. Bledsoe, et al.

Considerations:Severe injury:

ISS > 15TS < 12RTS ≤ 11Weighted RTS ≥ 4Triss Ps < 0.90

Non-life-threatening injuries:Patients not in above criteriaPatients who refuse ED treatmentPatients discharged from EDPatients not admitted to ICU

Considerations:Severe injury:

ISS > 15TS < 12RTS ≤ 11Weighted RTS ≥ 4Triss Ps < 0.90

Non-life-threatening injuries:Patients not in above criteriaPatients who refuse ED treatmentPatients discharged from EDPatients not admitted to ICU

Page 58: Medical helicopters

ResultsResults

48 papers met initial inclusion criteria.

26 papers rejected:Failure to stratify scores.

Failure to differentiate scene flights.

Failure to differentiate trauma flights.

22 papers accepted.

Span: 21 years

Cohort: 37,350

48 papers met initial inclusion criteria.

26 papers rejected:Failure to stratify scores.

Failure to differentiate scene flights.

Failure to differentiate trauma flights.

22 papers accepted.

Span: 21 years

Cohort: 37,350

Page 59: Medical helicopters

ResultsResults

ISS ≤ 15:N = 31,244

ISS ≤ 15 = 18,629

ISS ≤ 15 = 60.0% [99% CI: 54.5 to 64.8]

TS ≥ 13:N = 2,110

TS ≥ 13 = 1,296

TS ≥ 13 = 61.4% [99% CI: 58.5 to 80.2]

ISS ≤ 15:N = 31,244

ISS ≤ 15 = 18,629

ISS ≤ 15 = 60.0% [99% CI: 54.5 to 64.8]

TS ≥ 13:N = 2,110

TS ≥ 13 = 1,296

TS ≥ 13 = 61.4% [99% CI: 58.5 to 80.2]

Page 60: Medical helicopters

ResultsResults

RTS > 11:Insufficient data

TRISS Ps > 0.90:

N = 6,328

TRISS Ps > 0.90 = 4,414

TRISS Ps > 0.90 = 69.3% [99% CI: 58.5 to 80.2]

RTS > 11:Insufficient data

TRISS Ps > 0.90:

N = 6,328

TRISS Ps > 0.90 = 4,414

TRISS Ps > 0.90 = 69.3% [99% CI: 58.5 to 80.2]

Page 61: Medical helicopters

ResultsResults

ISS TS TRISS54

56

58

60

62

64

66

68

70

Percentage with minor injuries

Source: Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O’Keefe MO. Helicopter scene transport of trauma patients: a meta-analysis. J Trauma. 2006:60:1254-1266

N=37,350

Page 62: Medical helicopters

ResultsResults

Patients discharged < 24 hours:N = 1,850

Discharged < 24 hours = 446

Discharged < 24 hours = 25.8% [99% CI: -0.90 to 52.63]

Patients discharged < 24 hours:N = 1,850

Discharged < 24 hours = 446

Discharged < 24 hours = 25.8% [99% CI: -0.90 to 52.63]

Page 63: Medical helicopters

Medical Helicopter Accidents

Medical Helicopter Accidents

Bledsoe BE, Smith MG. Medical Helicopter Accidents in the United States: A 10-Year Review. Journal of Trauma. 2004;56:1325-1329

Bledsoe BE, Smith MG. Medical Helicopter Accidents in the United States: A 10-Year Review. Journal of Trauma. 2004;56:1325-1329

Page 64: Medical helicopters

Medical Helicopter AccidentsMedical Helicopter Accidents

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

0

5

10

15

20

25

3 4

8

24

910

15

12

16

2119 19

15

11Accidents

1993-2007 (Source: NTSB)

Page 65: Medical helicopters

Medical Helicopter AccidentsMedical Helicopter Accidents

0

2

4

6

8

10

12

14

16

18

1993 1995 1997 1999 2001 2003 2005 2007

Fatalities

Injuries

Source: NTSB

Page 66: Medical helicopters

Medical Helicopter AccidentsMedical Helicopter Accidents

12AM

2AM

4AM

6AM

8AM

10AM

12PM

2PM

4PM

6PM

8PM

10PM

0

2

4

6

8

10

1993-2002

Accidents

Source: NTSB & Bledsoe BE and Smith MG. Medical Helicopter Accidents in the United States: A 10-Year Review. J Trauma. 2004;56:1225-1229

Page 67: Medical helicopters

Medical Helicopter AccidentsMedical Helicopter Accidents

61%26%

11%

2%

Accidents by Cause

Pilot Error

Mechanical Failure

Undetermined

Other

Source: NTSB & Bledsoe BE and Smith MG. Medical Helicopter Accidents in the United States: A 10-Year Review. J Trauma. 2004;56:1225-1229

Page 68: Medical helicopters

Occupational Deaths per 100,000 per Year

Occupational Deaths per 100,000 per Year

All Workers 5

Farming 26

Mining 27

Air Medical Crew 74

US 1995-2001

Source: Johns Hopkins University School of Public Health

Page 69: Medical helicopters

Fatal Crashes per Million Flight Hours (2001)

Fatal Crashes per Million Flight Hours (2001)

Series10

2

4

6

8

10

12

14

16

18

20

1

6

12 12

19

Airline

Commuter

Ground Ambulance

All Helicopters

Medical Helicopters

Source: AMPA, A Safety Review and Risk Assessment in Air Medical Transport (2002)

Page 70: Medical helicopters

Medical Helicopter Accidents

Medical Helicopter Accidents

Weather a factor in one-fourth of all crashes.

Source: AMPA. A Safety Review and Risk Assessment in Air Medical Transport, 2002

Weather a factor in one-fourth of all crashes.

Source: AMPA. A Safety Review and Risk Assessment in Air Medical Transport, 2002

Page 71: Medical helicopters

Pressure on PilotsPressure on Pilots

Undue pressure from:Management

Dispatch

Flight Crews

Pressure to:Speed response or lift-off times

Launch/continue in marginal weather

Fly when fatigued or ill

Undue pressure from:Management

Dispatch

Flight Crews

Pressure to:Speed response or lift-off times

Launch/continue in marginal weather

Fly when fatigued or ill

EMS Line Pilot Survey, 2001

Page 72: Medical helicopters
Page 73: Medical helicopters

SummarySummary

HEMS-related research scant and of generally poor quality.

Papers showing benefit generally from researchers and institutions with a helicopter (a priori?).

Most negative literature from researchers and institutions without a helicopter.

HEMS-related research scant and of generally poor quality.

Papers showing benefit generally from researchers and institutions with a helicopter (a priori?).

Most negative literature from researchers and institutions without a helicopter.

Page 74: Medical helicopters

SummarySummary

In many articles there is a virtual statistical “leap of faith” to justify HEMS transports.

Concerns often expressed about selection and publication bias (by both sides).

Oftentimes there is an appeal to emotion.

In many articles there is a virtual statistical “leap of faith” to justify HEMS transports.

Concerns often expressed about selection and publication bias (by both sides).

Oftentimes there is an appeal to emotion.

Page 75: Medical helicopters

SummarySummary

Argument often comes down to:Speed

Better care

Traffic

Keeping local ambulances “available”

Oftentimes, factors not considered:Costs

Risks

Comfort

Argument often comes down to:Speed

Better care

Traffic

Keeping local ambulances “available”

Oftentimes, factors not considered:Costs

Risks

Comfort

Page 76: Medical helicopters

SummarySummary

Who benefits from HEMS?Trauma patients with ISS > 30

Patients with time-sensitive surgical lesion that cannot be managed at local hospital:

AAA

Epidural hematoma

Complex pelvic fractures

Significant chest trauma

Rescue situations where GEMS ingress/egress impaired.

Who benefits from HEMS?Trauma patients with ISS > 30

Patients with time-sensitive surgical lesion that cannot be managed at local hospital:

AAA

Epidural hematoma

Complex pelvic fractures

Significant chest trauma

Rescue situations where GEMS ingress/egress impaired.

Page 77: Medical helicopters

SummarySummary

Who benefits from HEMS?STEMI/ACS patients who need critical intervention and HEMS will get them into interventional lab in time and GEMS will not.

Stroke care controversial (few stroke patients are truly candidates for therapy).

Situations where road conditions would prevent access to a facility for time-sensitive care.

Who benefits from HEMS?STEMI/ACS patients who need critical intervention and HEMS will get them into interventional lab in time and GEMS will not.

Stroke care controversial (few stroke patients are truly candidates for therapy).

Situations where road conditions would prevent access to a facility for time-sensitive care.

Page 78: Medical helicopters

SummarySummary

Who does benefit not from HEMS?Most patients using current triage criteria.

Burn patients (unless > 30% TBSA and GEMS cannot provide analgesia or airway care).

Neonates (other than delivery of rapid intervention team).

OB patients.

Who does benefit not from HEMS?Most patients using current triage criteria.

Burn patients (unless > 30% TBSA and GEMS cannot provide analgesia or airway care).

Neonates (other than delivery of rapid intervention team).

OB patients.

Page 79: Medical helicopters

SummarySummary

Who does not from HEMS?Interfacility transfers unless patient has a time-sensitive lesion/condition that would not make a therapeutic window by GEMS transport.

CPR cases (trauma or medical)

Most pediatric trauma (except those with a high ISS or low or falling GCS).

Who does not from HEMS?Interfacility transfers unless patient has a time-sensitive lesion/condition that would not make a therapeutic window by GEMS transport.

CPR cases (trauma or medical)

Most pediatric trauma (except those with a high ISS or low or falling GCS).

Page 80: Medical helicopters

SummarySummary

Only a small number of patients, when objectively evaluated, benefit from HEMS transport.

Physicians must always weigh benefits and risks and costs.

Only a small number of patients, when objectively evaluated, benefit from HEMS transport.

Physicians must always weigh benefits and risks and costs.

Page 81: Medical helicopters

SummarySummary

Who is to blame for the current mess?

Physicians

HEMS industry

Lack of state and federal oversight of HEMS.

Insurers.

Local EMS agencies (cost shifting).

Who is to blame for the current mess?

Physicians

HEMS industry

Lack of state and federal oversight of HEMS.

Insurers.

Local EMS agencies (cost shifting).