Utilization of specialized services by air transported cardiac patients: an indicator of appropriate use

Recent studies of appropriateness of air medical transport have not specifically examined the need of cardiac patients for specialized services not available in the original community setting. This study examined the subsequent use of specialized services (i.e., coronary bypass surgery, angioplasty) by 796 consecutively aeromedically transported cardiac patients as an indicator of appropriate use of air transport. At least one specialized service was received by 552 (69.3%) patients. Preflight or transport interventions outside the clinical scope of the available ground transport system--a narrow, but objective assessment of appropriateness--were received by 507 patients and were associated with subsequent receipt of posttransport specialized services (p less than 0.0001). We conclude that the use of specialized services by cardiac patients was high and associated with an objective measure of appropriateness of transport. Studies of aeromedical transport should consider the need for specialized services in addition to intensity of care in the determination of appropriate use.