Appropriate helicopter transport of urban trauma patients.
OBJECTIVE
Inappropriate use of helicopter transport of trauma patients in urban areas increases costs, risk of injury, and unavailability for appropriate flights. We evaluated the effect of an emergency medical service (EMS) system audit of helicopter trauma scene flights (TSFs) on appropriateness of TSFs.


METHODS
Retrospective cohort.


METHODS
Defined urban area with two Level I trauma hospitals.


METHODS
Consecutive TSFs 2 years before (PRE) and 2 years after (POST) audit.


METHODS
EMS system audit established criteria for appropriate TSFs.


RESULTS
The total number of trauma system entries were similar for the two periods: PRE (1989) = 2862; POST (1990 and 1991) = 2787 and 2772. The total number of TSFs decreased after audit (PRE = 122; POST = 50). The proportion of inappropriate (INAPPRO)/total TSFs did not change (62% vs. 66%; chi 2 = 0.04; p = 0.85). There was no difference between appropriate (APPRO) and INAPPRO TSFs for mean vital signs, mechanism of injury, Trauma and Injury Severity Score (TRISS) and Injury Severity Score (ISS), mean length of stay, and proportion of survivors. Scene and transport time intervals were similar. For both PRE and POST periods, 26 APPRO patients (45%) were admitted to non-intensive care unit wards.


CONCLUSIONS
An EMS system audit with general awareness of audit criteria decreased the total number of TSFs and hence the number of INAPPRO TSFs in this urban trauma system population. However, the proportion of TSFs that were considered INAPPRO did not change. Criteria for urban TSFs should be based on markers of critical physiologic patient status matched to unique care that the helicopter personnel can provide (e.g., advanced airway management).
Norton
R
R
Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.
Wortman
E
E
Eastes
L
L
Daya
M
M
Hedges
J
J
Hoyt
J
J
D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009922:Oregon; D010343:Patient Admission; D012189:Retrospective Studies; D016896:Treatment Outcome; D014504:Urban Health; D014600:Utilization Review; D014947:Wounds and Injuries / Q000145:classification / Q000628:therapy*