title: An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.
abstract: BACKGROUND
  Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport.
  
  
  OBJECTIVE
  The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation.
  
  
  METHODS
  A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council.
  
  
  RESULTS
  Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local adaptation.
  
  
  CONCLUSIONS
  Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Brown
authors.forename: Zoë J
authors.initials: ZJ
authors.lastname: Oliver
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Spaite
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Lawner
authors.forename: Ritu
authors.initials: R
authors.lastname: Sahni
authors.forename: Tasmeen S
authors.initials: TS
authors.lastname: Weik
authors.forename: Yngve
authors.initials: Y
authors.lastname: Falck-Ytter
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Wright
authors.forename: Eddy S
authors.initials: ES
authors.lastname: Lang
mesh_terms: D017732:Air Ambulances / Q000191:economics / Q000592:standards; D032921:Consensus; D055416:Evidence-Based Emergency Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D014187:Transportation of Patients / Q000191:economics / Q000379:methods / Q000592:standards*; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods / Q000592:standards*; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*