title: Cost-effective use of helicopters for the transportation of patients with burn injuries.
abstract: We performed a retrospective review to analyze the use of helicopters for the transportation of patients with burn injuries to determine whether a more cost-effective approach could be developed without impairing the quality or delivery of health care. Charts were reviewed for all patients with burn injuries who were transported by helicopter to our hospitals during a 2-year period. Patients with inhalation injuries, with burn injuries received more than 24 hours before admission or more than 200 miles from our burn center, with more than 30% total body surface area (TBSA) burned, or with associated trauma injuries were excluded. Control patients with burn injuries who were transported by ambulance were identified and matched to the patients with burn injuries transported by helicopter for the percentage of TBSA burned, the percentage of third-degree burns, transport mileage, and age. The outcome was evaluated by comparison of length of stay, days on ventilator, and mortality rate. Comparisons were performed with Student t test. The transportation charge was determined for the patients transported by helicopter who we believed were eligible for transport by ambulance. Forty-seven of 85 patients transported by helicopter matched the inclusion criteria and had survived. There was no statistically significant difference between the percentage of TBSA burned, the percentage of third-degree burns, length of stay, days on ventilator, age, or transport mileage. There was, however, a significant difference in the time from the injury to admission to the hospital, as well as in the charge for transportation. Patients who had less than 30% TBSA thermal cutaneous injuries without evidence of inhalation injury, and who are less than 200 miles from a burn center may be safely transported by ambulance. Ambulance transportation may take additional time; however, stricter protocols for helicopter transportation of patients with burn injuries will result in potentially substantial savings without affecting outcomes for patients.
authors.affiliation: Shriners Hospital for Children, Northern California, Sacramento 95817, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: De Wing
authors.forename: T
authors.initials: T
authors.lastname: Curry
authors.forename: E
authors.initials: E
authors.lastname: Stephenson
authors.forename: T
authors.initials: T
authors.lastname: Palmieri
authors.forename: D G
authors.initials: DG
authors.lastname: Greenhalgh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000401:Aircraft / Q000191:economics*; D000552:Ambulances; D002056:Burns / Q000191:economics / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014187:Transportation of Patients; D016896:Treatment Outcome; D014218:Triage