European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
Guideline adherence in helicopter versus ground emergency medical services: an indication-based analysis of 129,783 patients from the TraumaRegister DGU®.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Faul Philipp, Hagebusch Paul, Lefering Rolf, Schweigkofler Uwe, Aras Irem, Egert Anna, Koch Daniel Anthony
Аннотация
BACKGROUND: Helicopter emergency medical services (HEMS) are associated with higher intervention rates and improved access to specialized trauma centers compared with ground emergency medical services (GEMS). However, it remains unclear whether these differences reflect increased intervention intensity alone or more consistent implementation of guideline-recommended care. This study aimed to compare rates of selected guideline-recommended prehospital trauma interventions between HEMS and GEMS using a nationwide trauma registry.
METHODS: This retrospective multicenter cohort study was based on data from the TraumaRegister DGU® (TR-DGU) from 2016 to 2024. Adult patients (≥ 16 years) with severe trauma, defined as maximum Abbreviated Injury Scale (MAIS) ≥ 3, receiving physician-staffed prehospital care and primary admission to German trauma centers were included. After exclusion of secondary transfers, missing key data, and treatment in local trauma centers (level 3), 129,783 patients remained, of whom 25.0% were transported by HEMS. Rates of selected interventions recommended by the German S3 guideline on the treatment of polytrauma/severe injuries were assessed using predefined indication-based subgroups derived from available registry variables as surrogates for potential clinical indications to improve comparability between transport modalities. Analyses were performed descriptively.
RESULTS: Patients transported by HEMS were younger and more severely injured than those transported by GEMS (mean ISS 23.5 vs. 20.8; ISS ≥ 16: 72.9% vs. 65.4%) and more frequently presented with impaired consciousness and shock. Across all predefined indication-based subgroups, HEMS was associated with higher rates of the evaluated interventions, including advanced airway management in patients with impaired consciousness (96.5% vs. 82.9%), overall chest tube placement in patients with thoracic injuries consistent with pneumothorax (50.5% vs. 40.9%), with substantially higher rates of prehospital chest tube placement in HEMS (14.0% vs. 5.5%), pelvic stabilization in patients with pelvic injuries of AIS severity 3-5 (56.7% vs. 44.0%), cervical spine immobilization in cervical spine injuries (84.1% vs. 77.7%), and tranexamic acid administration in suspected major bleeding (48.7% vs. 22.8%).
CONCLUSION: In this nationwide trauma registry analysis, HEMS was consistently associated with higher rates of selected guideline-related interventions across predefined indication-based subgroups. By focusing on patients with predefined guideline-related indications, the present study aimed to improve comparability between HEMS and GEMS beyond crude intervention frequencies. Nevertheless, the observed differences should be interpreted in the context of the observational study design and residual indication-related confounding. Higher intervention rates do not necessarily indicate superior guideline adherence or quality of care in individual patients.
LEVEL OF EVIDENCE: III, retrospective comparative cohort study.
METHODS: This retrospective multicenter cohort study was based on data from the TraumaRegister DGU® (TR-DGU) from 2016 to 2024. Adult patients (≥ 16 years) with severe trauma, defined as maximum Abbreviated Injury Scale (MAIS) ≥ 3, receiving physician-staffed prehospital care and primary admission to German trauma centers were included. After exclusion of secondary transfers, missing key data, and treatment in local trauma centers (level 3), 129,783 patients remained, of whom 25.0% were transported by HEMS. Rates of selected interventions recommended by the German S3 guideline on the treatment of polytrauma/severe injuries were assessed using predefined indication-based subgroups derived from available registry variables as surrogates for potential clinical indications to improve comparability between transport modalities. Analyses were performed descriptively.
RESULTS: Patients transported by HEMS were younger and more severely injured than those transported by GEMS (mean ISS 23.5 vs. 20.8; ISS ≥ 16: 72.9% vs. 65.4%) and more frequently presented with impaired consciousness and shock. Across all predefined indication-based subgroups, HEMS was associated with higher rates of the evaluated interventions, including advanced airway management in patients with impaired consciousness (96.5% vs. 82.9%), overall chest tube placement in patients with thoracic injuries consistent with pneumothorax (50.5% vs. 40.9%), with substantially higher rates of prehospital chest tube placement in HEMS (14.0% vs. 5.5%), pelvic stabilization in patients with pelvic injuries of AIS severity 3-5 (56.7% vs. 44.0%), cervical spine immobilization in cervical spine injuries (84.1% vs. 77.7%), and tranexamic acid administration in suspected major bleeding (48.7% vs. 22.8%).
CONCLUSION: In this nationwide trauma registry analysis, HEMS was consistently associated with higher rates of selected guideline-related interventions across predefined indication-based subgroups. By focusing on patients with predefined guideline-related indications, the present study aimed to improve comparability between HEMS and GEMS beyond crude intervention frequencies. Nevertheless, the observed differences should be interpreted in the context of the observational study design and residual indication-related confounding. Higher intervention rates do not necessarily indicate superior guideline adherence or quality of care in individual patients.
LEVEL OF EVIDENCE: III, retrospective comparative cohort study.