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

Trauma-related mortality remains a global concern, causing ~ 5 million deaths annually. Helicopter emergency medical services (HEMS) enable rapid transport to difficult-to-reach areas, potentially benefiting critical trauma patients. However, the survival advantage of HEMS over ground emergency medical services (GEMS) remains unclear. This systematic review evaluates the impact of HEMS versus GEMS on in-hospital trauma mortality.

A literature search (2014-2024) identified studies reporting trauma patient survival and emergency medical service (EMS) transport modality. Inclusion/exclusion screening used Rayyan and multiple reviewers. Secondary inter-facility and nontrauma transports were excluded. The primary outcome was in-hospital mortality, with additional analyses of injury severity score (ISS), Glasgow Coma Scale (GCS), and regional differences. Analysis was done using an inverse variance weighting method.

Of 628 articles, 29 were included, covering 3,101,673 patients (602,068 HEMS, 3,158,152 GEMS). HEMS was linked to higher in-hospital mortality (odds ratio [OR] = 1.27; 95% confidence interval, 1.05-1.53; I ² = 98.99%). HEMS patients had a higher mean ISS (14.42 vs. 10.21, P = 0.02) but similar GCS (P = 0.34). Day 1 and 30-day mortality showed no significant differences. For pediatrics (7 studies, 281,906 patients), HEMS was also associated with increased mortality (OR = 2.47; P = 0.001; I ² = 97.2%) and higher ISS (11.67 vs. 6.33, P = 0.11). Regional analysis showed higher HEMS mortality odds in North America but not in Asia, Europe, or the Middle East.

Despite its advantages, HEMS was associated with higher trauma mortality, suggesting selective use based on patient and regional factors. Further research should refine transport criteria.