HEMS cut saved money and lives, says study
According to a new study, changes to the trauma triage protocol in Maryland resulted in decreased use of helicopter transport for trauma patients and improved patient outcomes, saving lives and money.
The results of an 11-year study on the impact of statewide field triage changes to Maryland’s helicopter emergency medical services (Maryland’s Helicopter Emergency Medicine Services Experience from 2001-2011: System Improvements and Patients’ Outcomes) have been published in the Annals of Emergency Medicine, published by the American College of Emergency Physicians (ACEP). According to the study, changes to the trauma triage protocol in Maryland resulted in decreased use of helicopter transport for trauma patients and improved patient outcomes, saving lives and money, said ACEP.
Lead study author Dr Jon Mark Hirshon, of the University of Maryland School of Medicine in Baltimore, explained: “Purported benefits of HEMS are derived from enhanced crew expertise and decreased time to deliver seriously injured patients to trauma centres. However, by shifting to a new protocol that increased ground transports and decreased air transport for less critical patients, we improved patient outcomes while saving the state considerable money. Those are wins all around.”
ACEP noted that over the study period, overall EMS transport of trauma patients increased by 21 per cent. However, helicopter transport of trauma patients decreased by 49 per cent and ground transport of trauma patients increased by 33 per cent. During the study period, HEMS patient acuity increased though expected mortality did not.
Researchers studied records for all patients in Maryland’s Trauma Registry recorded as directly admitted to the hospital from the scene or transferred to trauma centres between 1 July 2000 and 30 June 2011, said ACEP. They focused in particular on what happened after significant field triage changes were instituted in July 2004, July 2007 and October 2008. Those changes first recommended then later required that patients within a 30-minute drive of a trauma centre be transported by ground rather than helicopter and that a physician authorise aeromedical transport for patients in certain trauma categories, regardless of the distance to a trauma centre.
“Aeromedical transport costs five to 15 times what ground transportation costs and can also be very dangerous,” said Hirshon. “After nine fatal helicopter EMS crashes killed 35 people in 2008, the NTSB took action and the state of Maryland did, too. New field triage protocols were associated with fewer flights but better expected outcomes, despite having more seriously injured patients. Future research is required to confirm our findings and determine when helicopter EMS can offer the most benefit.”