Does Helicopter EMS Provide Any Benefit Compared to Ground?

A study recently published in JAMA has been making the rounds in the EMS forums and blogosphere, purporting to prove that a certain subset of trauma patients transported by helicopter has a higher survival rate than comparable patients transported by ground EMS.

First I'd like to point out that, whenever you read a study, it's also wise to consider the potential biases of the researchers. I'm not suggesting that the authors here would be so unethical as to fake their numbers to arrive at a predetermined conclusion – far from it. I do believe, however, that it is human to interpret the findings in such a way that they support what we think is right.

A Fort Detrick medic in a CCEMT-P class in Piuttsburgh told me years ago, "How do you confuse a Maryland EMT? Ask him to drive to the Trauma Center."

If you had to pick any single state that is most heavily invested in helicopter EMS, that state would be Maryland, and that is true even after reining things in a bit after the crash of Maryland State Police Trooper Two on a medevac flight in 2008.

I'll state my position here, lest someone accuse me (yet again) of having an axe to grind against helicopter EMS:

I believe helicopter EMS is useful. I believe it saves lives. I also believe that it is vastly overused, inherently dangerous, and that the overhwelming majority of the people we fly don't need a helicopter. I believe that a significant chunk of them don't even need a trauma center. And I believe that we owe it to the HEMS crewmembers who make those flights, not to endanger them needlessly by sending them out for silly shit.

I keep waiting for the study that definitively identifies the subset of trauma (or medical) patients that benefits from helicopter transport. When we have it, we can revise our transport criteria accordingly, rather than our current critera of worshipping the Cult of Mechanism.

I don't think this is that study.

Rogue Medic does a good job of fisking this study on his blog. I urge you to read both parts:

Flawed Helicopter EMS vs Ground Research, Part I

Flawed Helicopter EMS vs Ground Research, Part II

Pay particular attention to the inaccuracy and incompleteness of the National Trauma Data Bank that he highlights in Part II, and ask yourself if we should believe a helicopter EMS study that uses those numbers.

Heck, ask yourself if we should believe any study that uses those numbers.

  • http://www.facebook.com/profile.php?id=1007243313 Christie Lea Hale

    Amen!

  • http://medicalscrubsoutlet.com/ Scrubs

    Interesting read, and thanks for linking the articles! Seems like a still fiery debate.

  • Dave

    I couldn’t agree more! Where I live in Alberta Canada with an area of 256,000 sq mi and population of between 3 and 4 million, we operate 11 fixed wing dedicated air ambulances(Govt operated) and 5 dedicated rotary wing air ambulances(Society owned and operated) out of 3 bases. There is a HUGE push by our newly formed provincial dispatch centers to send rotary wing all the time. They have pushed through a protocol allowing the Helicopter to be dispatched prior to EMS arrival even. I think it is the fault of the PR people involved with the rotary wing service who constantly pull the wool over the eyes of the public and lead them to believe they are doing way more than they actually are, or that they are able to do way more than they really can. Seems everyone has a hard on for HEMS! Don’t get me wrong they do perform a valuable service, they are just most often used in a way that is a disservice to the patient.

  • http://roguemedic.com/ Rogue Medic

    Thank you.

    If I were going to add a Part III, this would be it, and then some.

    -

    I believe helicopter EMS is useful. I believe it saves lives. I also believe that it is vastly overused, inherently dangerous, and that the overhwelming majority of the people we fly don’t need a helicopter. I believe that a significant chunk of them don’t even need a trauma center. And I believe that we owe it to the HEMS crewmembers who make those flights, not to endanger them needlessly by sending them out for silly shit.

    We call them for the ridiculous calls, just as people call us because they want a free ride to the hospital for a prescription refill. 

    We are the system abusers of helicopter EMS.

    .

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  • J Adam Watson

    I meant to email you when this aired on the Baltimore news station, knowing your feelings as a heavy reader of your blog. I don’t ever want to be in another car crash but man the Whirley Birds aka MD Trooper Choppers and around DC some hospital birds, are flying constantly. I primarily monitor Anne Arundel County, but have the State Police Choppers in my scanner as well and it’s crazy. I like flying but my time spent in ambulances is scary enough, I don’t think that a forced flight would do my nerves any goo.

  • Old_NFO

    We’ve HAD this chat more than once… Helos are now a PROFIT center… They don’t run, they don’t make money… Patients are the least of their worries…

    • http://combatdoc-combatdoc.blogspot.com/ CombatDoc

      Your forgetting that they paid a shit ton of money for that billboard.  Gotta get pics in the paper to justify that paint job…

  • Tolewyn

    Here’s an instance where they came in handy.  My Dad recently had surgery and after being discharged from the hospital (3 hours away) he developed an infection and needed to be transported back to the surgeon’s hospital for follow-up care.  My town’s hospital only has one ambulance in its fleet and could not afford to have it gone for the six hours minimum that the round trip would have required.

    My parents are annual members of the local helo service which costs them $60 a year for a family membership and covers any amounts that their insurance won’t pay.  Since their primary is Medicare I’m sure the amount paid is pretty slim.

    Was it faster than driving?  Barely.  He only beat us there by about 30 minutes.  But the benefit comes in the fact the Podunk General still had its rolling ambulance incase Farmer John de-gloves his hand and needs to be seen to.

    This story in and of itself is not a justification for the existance of care flight servies, but on a personal level I’m glad it was there.

    • http://roguemedic.com/ Rogue Medic

      Tolewyn,

      And as Kelly and I have stated many times, there is appropriate use of helicopters in EMS.

      Kelly wrote - 


      I believe helicopter EMS is useful. I believe it saves lives. I also believe that it is vastly overused, inherently dangerous, and that the overhwelming majority of the people we fly don’t need a helicopter. I believe that a significant chunk of them don’t even need a trauma center. And I believe that we owe it to the HEMS crewmembers who make those flights, not to endanger them needlessly by sending them out for silly shit.

      In Part I, I wrote - 

      Few people doubt that there is a benefit from flying critically injured patients who are more than 45 minutes from the closest trauma center.Did this show that there is any benefit to patient closer than 45 minutes from the closest trauma center?No.The authors didn’t draw any conclusions about time saved.

      You make it seem as if what you wrote in some way contradicts what Kelly and I have written.Where I am, you can be less than 10 minutes from a level two trauma center and you will be flown to the level one trauma center that is a little over 20 minutes away. That is the kind of ridiculous and routine abuse of helicopters that we are criticizing and the authors of the study appear to be defending.. 

    • http://roguemedic.com/ Rogue Medic

      Tolewyn,

      You are not contradicting anything AD wrote.

      You are not contradicting anything I wrote.

      .

      • Tolewyn

        Oh, I know.  I just like to show that they are useful.  I don’t disagree with what AD or you have said.  I think that the trigger gets pulled WAY to often when I wheels on the ground crew could be just as if not more effective and cost the insurance company or the patient lost of $$.

        • http://roguemedic.com/ Rogue Medic

          If we could get people to use helicopters appropriately, we would not have this problem. 

          Unfortunately, there is not a lot of agreement on what is appropriate. That leads to the desire for some research to show some benefit from the overuse of helicopters. .

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  • Ramorris58

    I agree with your opinion on this matter. It has its place, but way over used.

  • RoCr

    It seems odd to me that a small, population-dense state like Maryland would be the most heavily  invested in helicopter EMS.  I would think that the large, mostly rural western states would be far more dependent on it, given that an accident/heart attack/stroke/whatever can happen several hundred miles from a hospital capable of doing much more than stabilizing the patient, if that.

  • Anitra

    I live in Maryland and can explain why they use, and probably abuse, the copters. Even though some may think that MD is a densely packed and small state, you need to realize that our Shock Trama units are over an hour away from MOST of the state. I live in a highly rural area, and it takes around 45 mins to get to the nearest cardiac specialty hospital. Granted there is a county hospital in each of MD’s counties, but is someone was to be injured in some way and needed the specialized care of a Shock Trama unit, from where I live in SoMD, that is a TWO HOUR drive, at least, and with many prayers that there is no traffic between the scene and Baltimore! A critical patient in need of Maryland Shock Trama’s resources can’t wait that long. Just my personal observations.

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