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Does scene physiology predict helicopter transport trauma admission?
Andrew J Medvecz1, J Bradford Hill, Jeremy Brywczynski
1Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37212-1750, USA.
The Journal of Surgical Research
|July 6, 2013
Summary
Helicopter transport (HT) for trauma patients often involves overtriage, with over 40% not meeting criteria. However, these patients experienced more severe injuries and required greater resources, suggesting overtriage may be appropriate.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Transportation Medicine
Background:
- Civilian trauma management necessitates helicopter transport (HT), but its high cost demands efficient utilization.
- Overuse and inefficiency in HT raise concerns about patient selection and resource allocation.
Purpose of the Study:
- To evaluate if on-scene physiologic criteria can accurately predict appropriate triage for helicopter transport (HT) in trauma patients.
- To identify factors influencing triage decisions in helicopter emergency medical services (HEMS).
Main Methods:
- Retrospective review of 2522 patients transported by a university HT service from 2006-2010.
- Analysis included demographics, injury mechanisms, scene Revised Trauma Score (RTS), travel distance, and outcomes.
- Comparison with ground transport patients admitted for trauma.
Main Results:
- 59% of HT patients were appropriately triaged, while 41% were overtriaged.
- Scene RTS and travel distance did not reliably predict triage status in regression models.
- Overtriaged HT patients exhibited higher injury severity scores and longer hospital stays compared to ground transport.
Conclusions:
- On-scene physiologic criteria were insufficient for predicting appropriate triage in helicopter transport (HT) trauma patients.
- Despite a high overtriage rate, helicopter-transported patients demonstrated greater injury severity and resource utilization.
- The findings suggest that a degree of overtriage in HT programs may be clinically justified.
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