flighterdoc said:
A GCS range of 4-13 is essentially meaningless: You can be dead and score a 3 (no eye opening, no motor response, no verbal response), and everything fully functioning is 15 so a 13 is not necessarily a particularly dangerous score - Guarding a broken arm and slightly confused responses (from EtOH) will get you a 13.
Once again crappy research delivers meaningless "evidence".
Did you actually read the paper or are you just making as general comment overall?
Here is the abstract:
Authors
Jacobs LM. Gabram SG. Sztajnkrycer MD. Robinson KJ. Libby MC.
Institution
Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine, Farmington, USA.
Title
Helicopter air medical transport: ten-year outcomes for trauma patients in a New England program.
Source
Connecticut Medicine. 63(11):677-82, 1999 Nov.
Abstract
BACKGROUND: Twenty-five years have passed since the introduction of the first civilian hospital-based air medical helicopter service. This study reviews the impact of a single air medical service during a decade of service on the survival of severely injured trauma patients. METHODS: A retrospective database analysis was performed to determine program demographics and obtain outcome data. The outcomes of trauma patients were compared to mortality derived from a national database utilizing physiologic indices of severity. RESULTS: Outcome analysis demonstrated an overall 13% reduction in mortality for air transported patients when compared to controls. Stratification based upon Trauma Score demonstrated a 35% reduction in mortality for victims transported directly from the scene with scene scores between four and 13, and essentially no difference in outcome for patients at Trauma Score extremes. CONCLUSIONS: Rapid utilization of helicopter air medical transport can have a dramatic impact upon patient outcome, especially within a select group of scene transported trauma patients with Trauma Scores ranging from four to 13.
Notice they agree with you, finding "essentially no difference in outcome for patients at Trauma Score extremes". So where is the poor research? Or is it merely poor lit review prior to comment?
Other abstracts of note:
Gearhart PA. Wuerz R. Localio AR.
Cost-effectiveness analysis of helicopter EMS for trauma patients.
Annals of Emergency Medicine. 30(4):500-6, 1997 Oct.
College of Medicine, Pennsylvania State University College of Medicine, Hershey, USA.
Abstract
STUDY OBJECTIVE: To evaluate the cost-effectiveness of helicopter EMS for trauma patients. METHODS: We applied a cost-effectiveness analysis from the service provider's perspective to cost and effectiveness estimates. The cost estimates comprise direct operating costs and additional survivors' hospital costs. The effectiveness estimates were calculated with the TRISS methodology from literature sources and data from a cohort of patients transported by helicopter during 1994 and 1995. Sensitivity analysis and discounting were used. Cost per life saved and discounted cost per year of life in 1995 US dollars were the main outcome measures. RESULTS: The reported literature survival benefit ranges from 1 to 12 additional survivors per 100 patients flown. Transport costs were $2,214 per patient, and each additional survivor's hospitalization averaged $15,883. For the base case (5 additional survivors per 100 patients flown), cost per life was $60,163 and discounted cost per year of life $2,454. Sensitivity analysis revealed that discounted cost per year of life could be as high as $9,677 or as low as $1,400 and that it was most dependent on the surviving benefit. These results are comparable to a reported median discounted cost per year of life of %19,000 for other commonly used lifesaving medical interventions. CONCLUSION: Assuming that helicopter air medical transport provides a substantial survival benefit for trauma patients, our findings suggest that this service is a cost-effective option for the treatment of trauma patients. The magnitude of the survival benefit is the most important factor determining cost-effectiveness.
and
Diaz, Marco A. MD; Hendey, Gregory W. MD; Bivins, Herbert G. MD
When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance Transport Times. Journal of Trauma-Injury Infection & Critical Care. 58(1):148-153, January 2005.
Department of Emergency Medicine, St. Mary Medical Center (M.A.D.), Long Beach, and Department of Emergency Medicine, UCSF Fresno, University Medical Center (G.W.H., H.G.B.), Fresno, California.
Abstract
Background: A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted.
Methods: The 911-hospital arrival intervals for three transport methods were compared: ground, helicopter dispatched simultaneously with ground unit, and helicopter dispatched nonsimultaneously after ground unit response.
Results: Compared with ground transports, simultaneously dispatched helicopter transports had significantly shorter 911-hospital arrival intervals at all distances greater than 10 miles from the hospital. Nonsimultaneously dispatched helicopter transport was significantly faster than ground at distances greater than 45 miles, and simultaneous helicopter dispatch was faster than nonsimultaneous at virtually all distances. Ground transport was significantly faster than either air transport modality at distances less than 10 miles from the hospital.
Conclusion: Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.
and
A cost and outcomes comparison of a novel integrated pediatric air and ground transportation system.
Safford SD, Hayward TZ, Safford KM, Georgiade GS, Rice HE, Skinner MA.
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
BACKGROUND: The purpose of this study is to compare air transportation of critically ill pediatric patients with a mixed air-ground transportation system by evaluating timeliness, safety, and cost. The setting was a tertiary care "hub" center with three outlying-referral "spoke" facilities. STUDY DESIGN: Our study included 96 children transported between June and December 1997, with 45% constituting surgical admissions and 55% medical admissions. Data collected at the outlying facilities, en route, and at our institution included vital signs, laboratory values, and Glasgow coma scores. We evaluated transport time, transport cost, Pediatric Risk of Mortality scores, and Pediatric Index of Mortality of the children during transportation using ANOVA statistical analysis. We also compared adverse events in transportation, total hospital length of stay, and mortality at 24 and 72 hours in both the air and ground transport groups to determine differences in predicted and observed mortality. RESULTS: A total of 96 children were transported (48% by ground and 52% by air) between June and December 1997. The time at the referring facility was significantly shorter in the ground group than in the air group (air, 55.4 minutes versus ground, 36.7 minutes, p < 0.01). Total transport time differed by only 27 minutes between groups. No difference was identified in morbidity or mortality between air and ground groups. Actual mortality was not significantly different from predicted mortality in either group. The cost of ground transportation was significantly lower (air, $4,236 versus ground, $1,566). When our system of a combined air and ground group transport system is compared with a hypothetical 100% air transport system, we saved an average of more than $240,000 annually. CONCLUSIONS: We have demonstrated that a "hub-and-spoke" ground transportation system supplements air transportation in a safe, timely, and cost-effective manner.
So what is the gist? Air medical transport is overused, but does have a role in EMS. It can reduce mortality and morbidity in the trauma patient, can extend the "reach" of cath labs to outlying facilities ("regionalized" STEMI protocols - show up at a small town hospital, get flown to a tertiary center with a door-to-balloon time from the first ED door of < 120 minutes), and can serve as "back-up" ALS for rural services.
To the OPs question of risk versus benefit, that itself requires more study. The Candian experience (note: there are virtually no EMS helicopter crashes in Canada) suggests that the crew, aircraft, and equipment might change the risk benefit analysis drastically. In Canada, EMS helicopter missions are required to be flown IFR, with two pilots, and NVGs are required for night-time operations. This is
far more restrictive than the U.S. standards, which allow VFR, single pilot missions in non-NVG equipped aircraft. Also allowed are operations from aircraft which are not even certified for IFR operations.
- H