The Ideal Trauma Transport Modality: Helicopter or Ground Ambulance? A Systematic Review and Meta-analysis

Area of Science:

• Trauma Care
• Emergency Medicine
• Public Health

Background:

• Trauma-related mortality is a significant global health issue, with millions of deaths annually.
• Helicopter emergency medical services (HEMS) offer rapid transport but their survival benefit over ground emergency medical services (GEMS) is debated.

Purpose of the Study:

• To systematically review and evaluate the impact of HEMS versus GEMS on in-hospital trauma mortality.

Main Methods:

• A comprehensive literature search (2014-2024) identified relevant studies on trauma patient survival and EMS transport modality.
• Inclusion/exclusion screening was performed using Rayyan with multiple reviewers, excluding inter-facility and non-trauma transports.
• Primary outcome was in-hospital mortality; secondary outcomes included Injury Severity Score (ISS) and Glasgow Coma Scale (GCS), analyzed using inverse variance weighting.

Main Results:

• The review included 29 studies with over 3 million patients, revealing HEMS was linked to higher in-hospital mortality (OR=1.27).
• HEMS patients presented with higher Injury Severity Scores (ISS) but similar Glasgow Coma Scale (GCS) scores.
• Pediatric HEMS use was also associated with increased mortality and higher ISS, with regional variations noted, particularly higher mortality odds in North America.

Conclusions:

• Despite rapid transport advantages, HEMS is associated with increased trauma mortality, indicating a need for selective application.
• Patient and regional factors should guide HEMS transport decisions.
• Further research is recommended to refine criteria for optimal HEMS utilization in trauma care.