Using helicopters for secondary transfer--does the patient benefit?

In common with many expensive, high-technology devices, helicopters have been introduced into medical practice without the systematic assessment of benefit (if any). The civilian use of helicopters has evolved from a military role in evacuating casualties and is now increasingly directed towards secondary transfer of patients between hospitals as well as primary retrieval from the community. Whilst cost restraints have delayed the development of such services in the UK they have become increasingly available in the last decade. Helicopters are fast, once airborne, have a high profile and generate considerable enthusiasm, but they carry the disadvantages of increased response time, increased time at scene, space restriction, noise, lower safety margins, weather and daylight dependence, and high cost. When considering secondary transfer, it is highly unlikely that the advantage of speed in the air outweighs these disadvantages. Although studies are limited, none has shown any advantage for helicopter against road transport in either primary or secondary transport. The money required to run a helicopter service would be far better spent on establishing properly-equipped and trained road-based retrieval teams who can stabilise the patient on site and then continue treatment in transit, particularly as it has actually been shown that this approach can be used to transfer critically-ill patients without significant deterioration.