Trauma

Every injured individual should have access to – and has a right to – adequate, timely and effective trauma care that is life or limb saving - Dr Lin Aung, WHO

Trauma

image by: Ed Edahl
     

If you have a medical emergency anywhere in the world you may find yourself being airlifted to a location where there are specialized medical services. At first blush, this rapid transport sounds like one more excellent advance in emergency medical care.

But does the service bring enough value, such as better patient outcomes, to justify the cost? Furthermore, the high incidence of accidents has called into question the very safety of medical helo transport for civilian trauma.

Approximately 550,000 patients in the United States are flown by medical helicopters and small airplanes for emergencies that include car wrecks, hiking accidents and heart attacks, according to the Association of Air Medical Services. Nearly 1,200 aircraft operate from more than 830 bases with about half run by hospitals and half run as stand-alone community services.

Medical transport by air originated with the military back in the 1920's when patients were airlifted from Nicaragua to an Army hospital in Panama, 150 miles away. However, planes were not routinely used for evacuation and transport until World War II and helicopters were introduced during the Korean War in the 1950s, aka MASH. When the Army encountered poor roads and conditions, they began re-routing helicopters from other missions to pick up the critically wounded and fly them quickly and smoothly to field surgical units, often saving lives and limbs.

Over the course of the conflict, the military developed helicopters dedicated to medical transport, the start of today’s HEMS, Helicopter Emergency Medical Service. This new approach was credited with reducing the mortality rate for wounded soldiers. The Vietnam War provided another opportunity to expand and improve air medical transport as over 800,000 troops were evacuated from the field to emergency facilities.

In the 1960's the National Academy of Science urged that helicopters be adopted for civilian emergency rescue. The first service was established in Denver, Colorado in 1972. HEMS has grown rapidly since then, partly as a way for hospitals to increase their visibility and admissions and partly in response to changes in the healthcare system.

For example, the closure of rural hospitals has created gaps in the availability of specialized emergency medical care.  And, as more time-dependent medical treatments   have been shown to improve patient outcomes, such as “clot-busting” drugs, angioplasty and trauma surgery, the need to deliver patients to advanced medical care facilities has grown. 

However, many research studies have shown that there is no significant change in the outcome of patients transported by helicopter over those that were ground transported (GEMS).This apparent lack of effectiveness may have a lot to do with the number of people who didn’t actually need to be air transported.

Meta analysis in 2006 discovered that the majority (almost 70%) of trauma patients transported from the scene by helicopter had nonlife-threatening injuries. And, in a detailed study of 162,730 patients treated at 28 accredited trauma centers in Pennsylvania from 1987--1995, researchers found that transportation by helicopter did not affect the estimated odds of survival.

Then again, there's the safety issue...Air medical transport has had many accidents and compounding this issue, the emergency medical helicopter industry has less strict flight safety regulations than the civilian airline industry. In 2008, 29 people died in 13 medical helicopter crashes across the country in what was the worst year on record for air ambulance safety. In 2009, six people died in two helicopter crashes. In 2010, 21 people died in crashes. The value of reducing the time it takes to get a seriously injured person to medical care is wiped out if an accident occurs during transport.

In response, the Federal Aviation Administration (FAA) proposed new safety and training requirements for pilots of emergency medical helicopters in the fall of 2010 including stricter procedures for flying in challenging weather, at night and in remote landing areas as well as installation of a terrain warning system like those on board passenger airplanes.

However, these proposals do not fully embrace the changes recommended by the National Transportation and Safety Board (NTSB) which investigates accidents and makes recommendations. This safety watchdog group advocates the use of night-vision goggles and installation of an autopilot program on medical helicopters.

While some of the controversy surrounding medical helos is justified and the benefits are not without caveats, many people do benefit. However, it behooves this rapidly expanding industry to improve its safety record at the least. In the meantime, minimize your risk. Keep your feet on the ground, especially in urban areas.

Source: Susan Brissette, Excerpt from Medical Helicopters - Are They Worth the Risk?, Insider, HWN, March 25, 2011.

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Last Updated : Monday, March 16, 2020