Overutilization of helicopter emergency medical services compared to ground transport in moderate-severe penetrating abdominal trauma & associated outcomes.

BACKGROUND

Helicopter emergency medical services (HEMS) play a crucial role in trauma transport, accounting for approximately 550,000 transportations annually. However, HEMS holds a disproportionate share of trauma causes, highlighting its potential overutilization.

METHODS

This retrospective cohort study utilized the ACS-TQIP-PUF dataset (2017-2020) to evaluate outcomes in adult (≥18 years) trauma patients in hemorrhagic shock with moderate-to-severe (AIS abdomen ≥ 2, ISS ≥ 15) penetrating abdominal injuries who activated massive transfusion protocol and were transported from scene to the hospital via either HEMS or GEMS. Patients were stratified by scene time and trauma center level. Primary outcomes included mortality, and secondary outcomes included transfusion requirements, intervention rate, and complications.

RESULTS

Patients transported via Ground Emergency Medical Services (GEMS) compared to HEMS were associated with significantly higher odds of 24-hour mortality (2.028, 95% CI: 1.1853.472, p = 0.010, SE: 0.274). However, no significant association with in-hospital mortality (1.355, 95% CI: 0.901-2.038, p = 0.144, SE: 0.208) was observed. Patients with a scene time of < 10 min demonstrated comparable outcomes, with no significant association with 24-hour or in-hospital mortality.

CONCLUSION

This national analysis demonstrates that outcomes of adult patients in hemorrhagic shock with penetrating abdominal trauma requiring massive transfusion and scene time of less than 10 min were comparable for those transported by ground versus helicopter emergency services transport. These findings highlight the necessity for pre-hospital transport protocols that ensure proper resource allocation and utilization.