title: Helicopter transport:  help or hindrance?
abstract: OBJECTIVE
  Traumatic injury continues to be a significant cause of morbidity and mortality in the year 2011. In addition, the healthcare expenditures and lost years of productivity represent significant economic cost to the affected individuals and their communities. Helicopters have been used to transport trauma patients for the past 40 years, but there are conflicting data on the benefits of helicopter emergency medical service (HEMS) in civilian trauma systems. Debate persists regarding the mortality benefit, cost-effectiveness, and safety of helicopter usage, largely because the studies to date vary widely in design and generalizability to trauma systems serving heterogeneous populations and geography. Strict criteria should be established to determine when HEMS transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate helicopter transport into their triage model.
  
  
  RESULTS
  Research suggests that HEMS improves mortality in certain subgroups of trauma patients, both after transport from the scene of injury and following interfacility transport. Studies examining the cost-effectiveness of HEMS had mixed results, but the majority found that it is a cost-effective tool. Safety remains an issue of contention with HEMS transport, as helicopters are associated with significant safety risk to the crew and patient. However, this risk may be justified provided there is a substantial mortality benefit to be gained.
  
  
  CONCLUSIONS
  Recent studies suggest that strict criteria should be established to determine when helicopter transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate HEMS into their triage model. This will enable regional hospitals to determine if the costs and safety risks associated with HEMS are worthwhile given the potential benefits to patient morbidity and mortality.
authors: Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA. rplevin@uw.edu
authors: Rebecca E
authors: RE
authors: Plevin
authors: Heather L
authors: HL
authors: Evans
mesh_terms: D000401:Aircraft / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D009026:Mortality / Q000639:trends; D010360:Patient Transfer; D016019:Survival Analysis; D014218:Triage / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries