title: Ankle Fractures and Modality of Hospital Transport at a Single Level 1 Trauma Center: Does Transport by Helicopter or Ground Ambulance Influence the Incidence of Complications?
abstract: In an era of concern over the rising cost of health care, cost-effectiveness of auxiliary services merits careful evaluation. We compared costs and benefits of Helicopter Emergency Medical Service (HEMS) with Ground Emergency Medical Service (GEMS) in patients with an isolated ankle fracture. A medical record review was conducted for patients with an isolated ankle fracture who had been transported to a level 1 trauma center by either HEMS or GEMS from January 1, 2000 to December 31, 2010. We abstracted demographic data, fracture grade, complications, and transportation mode. Transportation costs were obtained by examining medical center financial records. A total of 303 patients was included in the analysis. Of 87 (28.71%) HEMS patients, 53 (60.92%) had sustained closed injuries and 34 (39.08%) had open injuries. Of the 216 (71.29%) GEMS patients, 156 (72.22%) had closed injuries and 60 (27.78%) had open injuries. No significant difference was seen between the groups regarding the percentage of patients with open fractures or the grade of the open fracture (p = .07). No significant difference in the rate of complications was found between the 2 groups (p = 18). The mean baseline cost to transport a patient via HEMS was $10,220 + a $108/mile surcharge, whereas the mean transport cost using GEMS was $976 per patient + $16/mile. Because the HEMS mode of emergency transport did not significantly improve patient outcomes, health systems should reconsider the use of HEMS for patients with isolated ankle fractures.
authors.affiliation: Health Policy Fellow, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greenberg
authors.affiliation: Medical Student, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Rivka C
authors.initials: RC
authors.lastname: Ihejirika
authors.affiliation: Medical Student, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Vasanth
authors.initials: V
authors.lastname: Sathiyakumar
authors.affiliation: Medical Student, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Lang
authors.affiliation: Medical Student, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Dagoberto
authors.initials: D
authors.lastname: Estevez-Ordonez
authors.affiliation: Medical Student, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Prablek
authors.affiliation: Medical Student, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Chern
authors.affiliation: Health Policy Fellow, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Rachel V
authors.initials: RV
authors.lastname: Thakore
authors.affiliation: Surgeon and Professor, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: Surgeon and Assistant Professor, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: David
authors.initials: D
authors.lastname: Joyce
authors.affiliation: Surgeon and Assistant Professor, The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN. Electronic address: Manish.Sethi@Vanderbilt.edu.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000191:economics / Q000706:statistics & numerical data*; D000552:Ambulances / Q000191:economics / Q000706:statistics & numerical data; D064386:Ankle Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D014187:Transportation of Patients / Q000191:economics / Q000379:methods*; D014193:Trauma Centers; D014481:United States; D055815:Young Adult
keywords: GEMS; HEMS; ambulance; complication; emergency transportation; injury