title: Requiring on-line medical command for helicopter request prolongs computer-modeled transport time to the nearest trauma center.
abstract: BACKGROUND
  Rapid transport from scene to closest trauma center requires optimal use of public safety first responder (FR), basic life support (BLS), advanced life support (ALS), and transport resources (ground or air). In some parts of this regional emergency medical services (EMS) system, on-scene ALS requires contact with on-line medical command (OLMC) to obtain authorization for air medical helicopter (AMH) dispatch, because some EMS medical directors believe that this may decrease overutilization of AMH services.
  
  
  OBJECTIVE
  The hypothesis of this study was that requiring prior OLMC for AMH dispatch prolongs mean time to a trauma center versus either FR or BLS request for AMH.
  
  
  METHODS
  Computer mapping programs were used to model the most rapid driving time to the closest trauma center from 167 actual AMH responses to the scene of a motor vehicle accident. In an OLMC-ALS model, only OLMC-ALS can request an AMH. In a BLS model, BLS units arrive on the scene and the crew requests simultaneous dispatch of an ALS response and an AMH. In the FR model, on arrival at the scene, a FR requests simultaneous dispatch of a BLS unit, an ALS unit, and an AMH.
  
  
  RESULTS
  The OLMC-ALS model resulted in a longer mean value for time to trauma center by an AMH than did the computer model for all ground transport settings. The FR model yielded a shorter mean time for AMH compared with the mean values for time to trauma center for all settings. Differences in mean values for time in urban settings were small (ground: 42 minutes, air: 36 minutes), whereas those for the suburban (ground: 52 minutes, air: 41 minutes), and those for rural (ground: 69 minutes, air: 47 minutes) were significant clinically. For the BLS model, these differences persisted, but were significant clinically only in the rural setting (ground: 68 minutes, air: 53 minutes).
  
  
  CONCLUSIONS
  Optimal use of AMH requires balancing the need for early helicopter dispatch to fully exploit its speed advantage with the disadvantage of expensive overutilization. This computer model indicates that the best person to request AMH varies by venue: in urban settings, the OLMC physician should request AMH dispatch; in suburban venues, BLS should request AMH dispatch; and in rural venues, FRs should request AMH dispatch.
authors.affiliation: New Jersey Trauma & Emergency Medical Services Research Center, UMDNJ-University Hospital, Department of Surgery, Newark, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Tortella
authors.forename: R F
authors.initials: RF
authors.lastname: Lavery
authors.forename: M
authors.initials: M
authors.lastname: Kamat
authors.forename: M
authors.initials: M
authors.lastname: Ramani
mesh_terms: D017732:Air Ambulances; D003198:Computer Simulation; D004631:Emergency Medical Service Communication Systems / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D009862:Online Systems / Q000592:standards*; D015397:Program Evaluation; D013997:Time Factors; D014193:Trauma Centers