title: Ten years of helicopter emergency medical services in Germany: do we still need the helicopter rescue in multiple traumatised patients?
abstract: BACKGROUND
  Helicopter emergency medical service (HEMS) has been established in the preclinical treatment of multiple traumatised patients despite an ongoing controversy towards the potential benefit. Celebrating the 20th anniversary of TraumaRegister DGU(®) of the German Trauma Society (DGU) the presented study intended to provide an overview of HEMS rescue in Germany over the last 10 years analysing the potential beneficial impact of a nationwide helicopter rescue in multiple traumatised patients.
  
  
  METHODS
  We analysed TraumaRegister DGU(®) including multiple traumatised patients (ISS ≥ 16) between 2002 and 2012. In-hospital mortality was defined as main outcome. An adjusted, multivariate regression with 13 confounders was performed to evaluate the potential survival benefit.
  
  
  RESULTS
  42,788 patients were included in the present study. 14,275 (33.4%) patients were rescued by HEMS and 28,513 (66.6%) by GEMS. Overall, 66.8% (n=28,569) patients were transported to a level I trauma centre and 28.2% (n=12,052) to a level II trauma centre. Patients rescued by HEMS sustained a higher injury severity compared to GEMS (ISS HEMS: 29.5 ± 12.6 vs.
  27.5 ± 11.8). Helicopter rescue teams performed more on-scene interventions, and mission times were increased in HEMS rescue (HEMS: 77.2 ± 28.7 min. vs. GEMS: 60.9 ± 26.9 min.). Linear regression analysis revealed that the frequency of HEMS rescue has decreased significantly between 2002 and 2012. In case of transportation to level I trauma centres a decrease of 1.7% per year was noted (p<0.001) while a decline of 1.6% per year (p<0.001) was measured for level II trauma centre admissions. According to multivariate logistic regression HEMS was proven a positive independent survival predictor between 2002 and 2012 (OR 0.863; 95%-CI 0.800-0.930; Nagelkerkes-R(2) 0.539) with only little differences between each year.
  
  
  CONCLUSIONS
  This study was able to prove an independent survival benefit of HEMS in multiple traumatised patients during the last 10 years. Despite this fact, a constant decline of HEMS rescue missions was found in multiple trauma patients due to unknown reasons. We concluded that HEMS should be used more often in case of trauma in order to guarantee the proven benefit for multiple traumatised patients.
authors.affiliation: Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany. Electronic address: handruszkow@ukaachen.de.
authors.forename: Hagen
authors.initials: H
authors.lastname: Andruszkow
authors.affiliation: Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany. Electronic address: fhildebrand@ukaachen.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
authors.affiliation: Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany. Electronic address: Rolf.Lefering@uni-wh.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany. Electronic address: hpape@ukaachen.de.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Unfallklinik, Frankfurt, Germany. Electronic address: aerztlicher.direktor@bgu-frankfurt.de.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hoffmann
authors.affiliation: Department of Trauma and Orthopedic Surgery, BG Unfallklinik, Frankfurt, Germany. Electronic address: uwe.schweigkofler@bgu-frankfurt.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schweigkofler
mesh_terms: D017732:Air Ambulances / Q000191:economics / Q000458:organization & administration; D000401:Aircraft; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration / Q000639:trends; D055416:Evidence-Based Emergency Medicine; D005260:Female; D005858:Germany / Q000453:epidemiology; D006301:Health Services Needs and Demand; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration* / Q000639:trends
keywords: GEMS; HEMS; Helicopter; Multiple trauma; Survival