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 Trauma transport strategy entered the spotlight after tragedies like the attack on former Rep. Gabrielle Giffords.
April 17th, 2012
10:51 AM ET
Study: Chopper trauma transport improves survival chancesFor 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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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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In many cases just putting the person in a car or truck would be even faster. Of course there is a risk in using an available car or truck but so is waiting for an ambulance or helicopter. Too many times the police insist upon a ambulance when they have a car right at the scene of the accident that could be use to transport the victim. Some injuries that involve spinal injury require an ambulance but that is the minority. I guess it is better to wait for an ambulance and let the victim die than to deprive the ambulance company of their cut of the accident payments.
Completely agree with you C.S. and I know this from the inside..as you may as well. Anybody who thinks there is not a profit margin in every aspect of the U.S. healthcare system is simply not paying attention – or choosing not to pay attention. It's very sad!
Ambulances are equpped with life-saving equipment that most automobiles and certainly not any squad car I've been around don't have. That is why they wait. Also, ambulance crews have training that police officers and even most first responders do not have. Thus, they will wait for trained people and proper equipment to arrive. The only time they don't is if time really is paramount to get the injured to a Trauma One facility and in most cases they will head towards the amublance to shorten the amount of time needed. And, yes, our health care system has turned into 'a money maker' but patient care and patient cure should remain first and foremost in our system.
As a member of a rescue unit we are a completely volunteer organization. All our members are state certified EMT's and paramedics and we continue to train for any type of emergency situation. Like many other EMS units we do not charge for services and enjoy what we do for free. The use of choppers is crucial for trauma patients in that golden hour. The use of choppers is required for rural areas and when the nearest trauma center is 35 miles away. So before your thrown into the back of a squad car for the sake of time and money and transported by non trained professionals you better hope the facility that your going to can actually save your ass.
EMS and critical care transport systems always lose money- these are not income streams, and in nearly every health system every transport incurs incremental costs that outweigh any potential revenue gained. It is in their best interest to NOT transport people whenever possible. So please, don't look for conspiracies where none exist.
Get to da chopppa!!!! ahhhh!!!!
The use of air versus ground should only come into play if transportation by ground would place the injured in a situation where the 'Golden Hour' would be broken or subject the patient to additional injuries that would not occur when using ground transportation. I lived in a rural area of Arizona where it was one and one-half hours drive by ambulance at the legally allowed speed to a Trauma One center. Fifteen minutes via air. There were many live-saving air transports. In the city I live in now, there is a dangerous section of roadway between an 'intake' hospital and the Trauma One center. Lots of short air transports. Gabby's life and sanity were saved by the quick thoughts of the emergency team on the ground to get her to the Trauma One as quickly and safely as possible. We see the results. The helicopter for her was used to transport three other people, one of whom passed on. But it did save lives as two of them might not have made it if they were ground transported. Having been involved in serious injury situations, you have to make the decision on which transport or even to transport. Fortunately, the responding medical personnel made a proper decision in Gabby's and many other cases.
I had a brain bleed on 5/28/11. When I was taken to the small hospital via ambulance, my family was informed that there was nothing they could do for me locally. I would have to be flown to Tucson AZ for brain surgery. The drive would've been 90 minutes. Thankfully, I was transported via helicopter (Care Flight) to Tucson (65 miles away). I was uninsured and unemployed at the time. The bill for Care Flight came out to $22,0000.00 Not cheap. Also, it is one of those medical bills that will not be "waived" or "written off" due to no insurance. I believe all of the companies that the chopper trauma teams are with are "for profit". The company did reduce the bill by 1/2. So, I'm on the hook for 60 months to pay this bill off.
Had I not been care flighted, I would have died. I'm truly grateful that I was able to have been flown to the hospital, but paying for the bill is something else, as I was laid off 1 month ago. Yep – 2nd layoff in 12 months. Life is incredible!
Good Grief – Why are we even having this conversation????????
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