As the crow flies

When it comes to trauma care, time is of the essence. Transportation of the injured patient from the scene of the medical emergency to definitive care may take on several forms. Using a method of transport that would significantly reduce travel time to the trauma center resulting in earlier care is an example of one of the underlying tenets of the American College of Surgeons’ Advanced Trauma Life Support® course, which describes the concept of the “golden hour.” The golden hour is the time period after an injury occurs during which a patient should be assessed and resuscitated to ensure a positive outcome.

Geographic disparities exist throughout the U.S. with respect to access to trauma care. Some regions, such as large urban areas, may have an ample number of trauma centers that can be accessed using only a ground transportation model. Patients injured in suburban, rural, and wilderness areas may be several hundred miles away from the closest medical care.

Obstacles to timely transport

Hospital discharge status

When looking at a map, the shortest distance between two points is a straight line. Because the earth is a sphere, however, this straight line is, in fact, a geodesic short arc, and the reality is that roads and highways often are less than direct. Natural resources (including lakes, rivers, valleys, and mountains) as well as manmade structures may cause roads to meander and take odd turns along the way from one point to the next. Additionally, the timeliness of ground transportation may be dependent on several factors. Roadways may become impassable due to natural disasters, or ground transport times may increase significantly due to heavy vehicular traffic during the normal morning or evening commute.

Helicopter transport

Helicopter transports from the scene to definitive care address several of the impediments to timely care that may exist with conventional ground transport.

To examine the occurrence of scene-to-trauma center helicopter transports in the National Trauma Data Bank® (NTDB®) research dataset for 2012, admissions medical records were searched using the fields “transport mode” (the mode of transport delivering the patient to your hospital) and “other transport mode” (all other modes of transport used during patient care event prior to arrival at your hospital, except the mode delivering the patient to the hospital). Transport mode field value of “helicopter ambulance” and another transport mode field value of “not applicable” (used to indicate that a patient had a single mode of transport and therefore this field does not apply to the patient) were selected. A total of 34,507 records were found; 31,058 records contained a hospital discharge status, including 21,512 patients discharged to home, 4,526 to acute care/rehab, and 2,997 sent to skilled nursing facilities; 2,023 died. These patients were 70.3 percent male, on average 38.8 years of age, had an average hospital length of stay of 7.9 days, an intensive care unit length of stay of 6.8 days, an average injury severity score of 15.6, and were on the ventilator for an average of 6.8 days. Of the 17,570 tested for alcohol, almost one-third were positive.

Air medical transport does have some consequences. It is costly, and several recent unfortunate incidents involving downed medical helicopters have occurred. Recent studies are starting to look at the value of helicopter transport to see if this higher-cost mode of transport results in improved outcomes. So far, it appears that in order to preserve the golden hour, the best way to get from point A to point B is “as the crow flies.” For certain situations, this direct route can be best accomplished with a helicopter ambulance.

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The NTDB Annual Report 2012 is available on the ACS website as a PDF file and as a PowerPoint presentation at www.ntdb.org. In addition, information regarding how to obtain NTDB data for more detailed study is available on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.


Acknowledgement
Statistical support for this article has been provided by Chrystal Caden-Price, data analyst, NTDB.


Sumwalt RL. National Transportation Safety Board. Current issues with air medical transportation: EMS helicopter safety. Available at: www.ntsb.gov/doclib/speeches/sumwalt/sumwalt_050411.pdf. Accessed May 17, 2013.

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