title: Helicopter versus ground emergency medical services for the transportation of traumatically injured children.
abstract: BACKGROUND
  Helicopter emergency medical services (HEMS) are a common mode of transportation for pediatric trauma patients. We hypothesized that HEMS improve outcomes for traumatically injured children compared to ground emergency medical services (GEMS).
  
  
  METHODS
  We queried trauma registries of two level 1 pediatric trauma centers for children 0-17 years, treated from 2003 to 2013, transported by HEMS or GEMS, with known transport starting location and outcome. A geocoding service estimated travel distance and time. Multivariate regression analyses were performed to adjust for injury severity variables and travel distance/time.
  
  
  RESULTS
  We identified 14,405 traumatically injured children; 3870 (26.9%) transported by HEMS and 10,535 (73.1%) transported by GEMS. Transport type was not significantly associated with survival, ICU length of stay, or discharge disposition. Transport by GEMS was associated with a 68.6%-53.1% decrease in hospital length of stay, depending on adjustment for distance/time. Results were similar for children with severe injuries, and with propensity score matched cohorts. Of note, 862/3850 (22.3%) of HEMS transports had an ISS<10 and hospitalization<1 day.
  
  
  CONCLUSIONS
  HEMS do not independently improve outcomes for traumatically injured children, and 22.3% of children transported by HEMS are not significantly injured. These factors should be considered when requesting HEMS for transport of traumatically injured children.
authors: University of Colorado School of Medicine, Department of Surgery, 12631 E. 17th Ave, C302, Aurora, CO 80045; Children's Hospital Colorado, Division of Pediatric Surgery, 13123 E. 16th Ave, B232, Aurora, CO 80045. Electronic address: Camille.Stewart@ucdenver.edu.
authors: Camille L
authors: CL
authors: Stewart
authors: Primary Children's Hospital, Division of Pediatric Surgery, 100 N Mario Capecchi Dr, Suite 2600, Salt Lake City, UT 84113. Electronic address: metzger2020@gmail.com.
authors: Ryan R
authors: RR
authors: Metzger
authors: University of Colorado School of Medicine, Department of Pediatrics, 13001 E. 17th Place, C290, Aurora, CO 80045. Electronic address: Laura.Pyle@ucdenver.edu.
authors: Laura
authors: L
authors: Pyle
authors: Children's Hospital Colorado, Department of Transport & EMS Outreach and Education, 13123 E. 16th Ave, B245, Aurora, CO 80045. Electronic address: Joe.Darmofal@childrenscolorado.org.
authors: Joe
authors: J
authors: Darmofal
authors: Primary Children's Hospital, Division of Pediatric Surgery, 100 N Mario Capecchi Dr, Suite 2600, Salt Lake City, UT 84113. Electronic address: Eric.Scaife@imail2.org.
authors: Eric
authors: E
authors: Scaife
authors: University of Colorado School of Medicine, Department of Surgery, 12631 E. 17th Ave, C302, Aurora, CO 80045; Children's Hospital Colorado, Division of Pediatric Surgery, 13123 E. 16th Ave, B232, Aurora, CO 80045. Electronic address: Steven.Moulton@childrenscolorado.org.
authors: Steven L
authors: SL
authors: Moulton
mesh_terms: D000293:Adolescent; D000401:Aircraft; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D057216:Propensity Score; D014187:Transportation of Patients / Q000379:methods*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*
keywords: Air transport; Helicopter emergency medical services; Pediatric trauma; Resource utilization