Ground versus air transport of trauma victims: medical and logistical considerations

Emergency aeromedical transport for trauma victims varies widely, from 10% or less in some programs to more than 90% in others. There is the potential in all such programs for dramatic, lifesaving efforts as well as for costly and dangerous overuse. We propose the following preliminary guidelines for emergency aeromedical transport of trauma victims. Trauma scene flights should be dispatched only for seriously injured patients who are potentially salvageable. Trauma scene flights are not justified if the flight does not significantly reduce the interval between injury and patient arrival at an appropriate hospital (eg, from motor vehicle accident with entrapment) unless the flight delivers needed medical expertise or equipment to the scene. Critically injured patients should be returned to the closest hospital of appropriate capabilities and demonstrated expertise. Flight services should be a public service fully integrated into the metropolitan emergency medical services system. Scene flights should be dispatched within medical guidelines established by the regional emergency medical services system. Emergency aeromedical evacuation of trauma victims should assist the regionalization of trauma care to centers with special capabilities for the management of seriously injured patients. Promulgation of more detailed guidelines will depend on the accumulation of clinical experience and will be possible only if consistent efforts are made to obtain measures of injury severity, categories of injury, and long-term outcomes of management.