April 17th, 2012
10:51 AM ET
For patients suffering from major trauma, being transported by helicopter improves survival, according to a new study out Tuesday in the Journal of the American Medical Association.
Trauma transport strategy has entered the spotlight after tragedies like the 2011 attack on former Rep. Gabrielle Giffords and the 2009 death of actress Natasha Richardson.
In the study, researchers looked at more than 200,000 patients with serious injuries who were admitted to a level I or II trauma center and were transported by helicopter or ground ambulance. They found increased survival with helicopter travel over ground ambulance. While the percentage was small, 1.4 percent to 1.5 percent depending on the trauma level, in every 65-69 severely injured patients taken to a level I or II trauma hospital, one life was saved.
"The first responder or EMS agency that is evaluating you as a patient and making a decision that you would go by helicopter versus ground is basing it on a wide range of scenarios," says Dr. Alex Isakov, Director of Emory University's section of prehospital and disaster medicine. He says guidelines do exist on when to send a patient to a trauma center, but "what they fail to answer is whether a patient should be transported in a helicopter or not."
The study did not consider whether speed or flight crew capabilities played a part in the increased association with survival with use of helicopters, says Haider. Likewise, cost was not a considered factor. Each jurisdiction is different says senior study author Dr. Adil H. Haider of the Johns Hopkins University School of Medicine, in Baltimore. The cost can be hefty, ranging from $5-to $15,000 per trip, but most insurance companies do cover it. States such as Maryland are state-run, so patients don't get a bill.
"If we can better identify patients who would benefit from it, maybe there is a more precise way to determine who those patients are who would really and truly benefit," says Haider.
For patients like actress Richardson - who was on a ski getaway at Mount Tremblant in Eastern Canada - some experts say having access to a helicopter could have played a role in saving her life. Richardson suffered from a brain bleed but she was hours away via ambulance and there wasn't a MEDVAC available.
More recently ex-congresswoman Giffords was taken to the trauma center via ground ambulance after suffering a gunshot wound to the head.
First responders were instructed to airlift her, but the helicopter didn't arrive in time.
Medics made the split second decision to send her by ground ambulance and just twelve minutes later she arrived at the trauma center at the University Medical Center of Tucson.
Isakov says in a situation like Giffords, "for a severely injured patient where you could get there within 12 minutes, in general most people would agree that ground transport is the appropriate form."
The study only included patients who with severe injuries, for example at minimum a patient with a broken leg and a pierced lung due to a car crash, but many patients were much more severely injured that, says Haider. The main outcome measure was survival to discharge from the hospital.
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