For trauma victims, costly choppers save lives

JOHNS HOPKINS / U. MARYLAND (US) — Patients with traumatic injuries fare better when airlifted by helicopter compared to patients transported by ambulance.

According to a new study, airlifted patients by comparison are 16 percent more likely to survive.

“We know helicopter trips are costly and carry some risks, but this research shows they do save lives,” says senior researcher Adil Haider, associate professor of surgery, anesthesiology and critical care medicine at Johns Hopkins University.



“It also tells us that we need to sharpen our ability to identify trauma patients who need the helicopter most to ensure that we deploy the helicopter for people who really will benefit from its use.”

Big cost, big reward

Medical evacuation helicopters—iconic symbols of rapid, lifesaving medical transport in the United States—operate at a price, in terms of both the financial cost and the risk of rare but potentially tragic crashes, according to the study.

A medical helicopter trip costs thousands of dollars, charged, in most states, to insurance companies and consumers.

But trauma is the leading cause of death and disability among young people around the world; in the United States, more than 50 million people are injured annually. Some 169,000 die of injury each year, and the most seriously injured, whether victims of car crashes or other causes of injury, are regularly transported to trauma centers near and far by helicopter.

The study was published April 18 in the Journal of the American Medical Association. (Watch JAMA’s related video.) Samuel M. Galvagno Jr., a former Johns Hopkins student and fellow who is now on the faculty at the University of Maryland, was first author.

Haider, Galvagno, and colleagues used sophisticated analysis techniques to examine records from more than 223,000 patients aged 16 and older from the 2007-2009 National Trauma Data Bank. All patients sustained at least moderately severe injuries and were taken to trauma centers. The researchers compared the more than 161,500 patients sent by ambulance to the nearly 62,000 transported by helicopter.

When they adjusted for such factors as injury severity, type of injury, and age of patient, they determined that airlifted patients were 16 percent more likely to survive than similarly injured patients transported by ground.

‘Who flies?’

Among their conclusions was that one in 65 significantly injured patients brought to a Level I trauma center by helicopter would have died if ground transportation had been the only option.

Because no one can yet predict with precision which patients might survive only with a flight, transporting anyone with serious injuries might seem warranted, Haider notes.

But using Maryland’s average cost $5,000 per helicopter transport, $325,000 would have to be spent to transport 65 more patients and save one more life. And Maryland’s cost are much lower than average because it has the only state-run helicopter system in the country.

Calling for more research to develop better guidelines to determine “who flies,” Haider says he sympathizes with paramedics and emergency responders on the scene who make split-second decisions about whether to call a helicopter in. Sometimes, they make the wrong call, and a patient’s injuries turn out to be less severe than originally believed.

But Haider says there is good reason for overuse of the helicopter: The possibility of making the mistake of not calling for a helicopter and watching a patient who might have survived die instead.

The advantage of a helicopter flight over an ambulance ride can be both the speed at which the patient gets to the hospital as well as the quality of the emergency medical team aboard. Helicopters tend to carry the most experienced crews, Haider says.

“In some cases, helicopters don’t help, but just increase the risk because of the flight and add costs,” says Haider, co-director of the Johns Hopkins Center for Surgery Trials and Outcomes Research. “We need a better way to make sure this scarce and valuable resource is used appropriately.”

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