Helicopters and trauma: systematic review

In the midst of reconfiguring its trauma systems, the United Kingdom’s National Health Service needed to evaluate the cost effectiveness of helicopter emergency medical services (HEMS). A systematic literature review was undertaken of all population-based studies evaluating the impact on mortality of helicopter transfer of trauma patients from the scene of injury. The authors also attempted to analyse whether it is the helicopter as a transport platform or the standard of the emergency medical service that accounts for any differences seen.

A search of the literature revealed 23 eligible studies. 14 of these studies demonstrated a significant improvement in trauma patient mortality when transported by helicopter from the scene. 5 of the 23 studies were of level II evidence with the remainder being of level III evidence.

Only one eligible study assessed HEMS in the UK. The other papers reported data from the USA, Italy, Australia, the Netherlands, Germany and South Africa.

The majority of studies show a mortality benefit with HEMS: fourteen studies reported results that demonstrated a significant mortality rate improvement with HEMS, four reported data that did not reach significance and five did not report whether results reached significance.

The authors suggest this variation may be a result of any of the following factors, and provide a thorough discussion of the literature pertaining to each of them:

  1. Transport of a physician to the scene
  2. Transport of advanced airway skills to the scene
  3. Transporting a team experienced in managing trauma patients
  4. Triage to the definitive treatment facility

The full text of the review is available at the link below.

Is it the H or the EMS in HEMS that has an impact on trauma patient mortality? A systematic review of the evidence
EMJ 2010;27(9):692-701 (Free Full Text)

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