Effective use of the air ambulance for pediatric trauma

BACKGROUND: The purpose of this study was to compare outcomes of pediatric trauma patients transported by helicopter from the injury scene (IS group) to a trauma center and those transported by air after hospital stabilization (HS group). METHODS: A retrospective analysis of pediatric trauma patients (<19 years of age) transported by air ambulance and admitted to a pediatric trauma center was conducted. Outcomes compared were mortality and length of stay. Patients were subdivided into minor (Injury Severity Score [ISS] < 15) and major (ISS > 15) trauma. TRISS analysis was performed to verify the overall quality of the care. RESULTS: Eight hundred forty-two HS and 379 IS patients were included. The mean age, median ISS, and distribution of penetrating and blunt injuries did not differ significantly between the groups. The overall death rate was significantly lower for the interfacility transfer patients (HS group, 5.5%; IS group, 8.7%; p < 0.05). Mean intensive care unit (ICU) and hospital length of stay did not differ significantly. HS patients with major trauma had significantly less mortality (HS group, 15.5%; IS group, 26.7%; p < 0.05) and shorter mean ICU stays (HS group, 118.3 hours; IS group, 149.1 hours; p < 0.05) than IS major trauma patients. No differences were seen in patients with minor trauma. TRISS analysis showed improved survival for all patients compared with Major Trauma Outcome Study norms. CONCLUSION: Retrospective analysis was not able to demonstrate any benefit to direct transport from the scene to a trauma center. Hospital stabilization before transfer by air ambulance may improve survival and shorten ICU stays for patients with major trauma.     

Extracorporeal membrane oxygenation for transport of hypoxaemic patients with severe ARDS

Conventional inter-hospital transfer of patients with severe acute respiratory distress syndrome (ARDS) in need of extracorporeal membrane oxygenation (ECMO) may be risky and in severe hypoxaemic patients may be associated with cerebral hypoxia and death. Therefore, we began a phase 1 study to evaluate the feasibility, complications and outcome of inter-hospital transport of these patients using veno-venous ECMO. Eight patients with severe ARDS and a PaO2/FIO2 < 6.7 kPa at a PEEP > or = 10 cm H2O were placed on a mobile ECMO at the referring hospital. The 495 (SD 123) km inter-hospital transport via a special ground ambulance took 341 (151) min. After transfer, blood-gas tensions were improved in spite of less optimal ventilator settings, compared with data before the start of ECMO. No significant complications occurred. Six patients survived and were discharged from hospital; two patients died because of multiple organ failure. We conclude that initiation of ECMO in hypoxaemic patients before inter-hospital transfer is feasible and enables safe transport to an ECMO centre.      

Impact of discontinuing a hospital-based air ambulance service on trauma patient outcomes

BACKGROUND: The clinical benefit of aeromedical transportation of injured patients in the civilian population has been debated. The purpose of this study was to examine the effects of discontinuing a hospital-based helicopter transport program on trauma patient outcomes, with the hypothesis that the loss of an air ambulance would result in increased transport time and increased mortality among severely injured patients. METHODS: Data on injury severity and patient outcomes were collected prospectively for the 12 months immediately preceding and 24 months following discontinuation of the helicopter ambulance service. Transport time, mortality rate, and hospital length of stay was compared. RESULTS: The number of trauma patient admissions decreased 12%, with a 17% decrease in admissions of severely injured patients. Transport time decreased, with no change in mortality. CONCLUSION: Discontinuation of a hospital-based air ambulance service did not increase transport time or increase mortality for trauma patients.     

Impact of helicopter transport and hospital level on mortality of polytrauma patients

BACKGROUND: Despite numerous studies analyzing this topic, specific advantages of helicopter transport of blunt polytrauma patients as compared with ground ambulances have not yet been identified unequivocally. METHODS: Four possible pathways in 403 polytrauma patients (Injury Severity Score [ISS] > 16) who were in reach of the helicopter emergency medical service (HEMS) Dresden were analyzed as follows: HEMS-UNI group (n = 140), transfer by HEMS into a university hospital; AMB-REG group (n = 102), transfer by ground ambulance into a regional (Level II or III) hospital; AMB-UNI group (n = 70), transfer by ground ambulance into the university hospital; and INTER group (n = 91), transfer by ground ambulance into a regional hospital, followed by transfer to the university hospital. Scores used were the ISS and the TRISS. Tests used for statistical analysis included chi2 and Fisher's tests. Statistical significance was set at p > 0.05. RESULTS: Age, gender, and mean ISS (range, 33.3-35.6) revealed extensive homogeneity of the groups. Mortality of the AMB-REG group was almost doubled (41.2%) compared with HEMS-UNI (22.1%) patients (p = 0.002). The AMB-UNI group displayed the lowest mortality (15.7%, p = not significant). TRISS analysis (PRE-Chart) revealed identical outcome for AMB-UNI and HEMS-UNI patients. Rescue time averaged 90 +/- 29 minutes for HEMS-UNI patients, 68 +/- 25 minutes for AMB-UNI patients, and 69 +/- 26 minutes for the AMB-REG group. CONCLUSION: Primary transfer by HEMS into a Level I trauma center reduces mortality markedly. In principle, this benefit can be attributed to superior preclinical therapy, primary admission to a Level I trauma center, or both. However, the identical probability of survival of the AMB-UNI and HEMS-UNI groups in this and comparable studies does not confirm generally better survival rates on account of a more aggressive on-site approach.     

The influence of the primary management on the outcome of severe traumatic brain injury: role of neurosurgeons

OBJECTIVE: To evaluate the influence of the primary management on the outcome in severe head-injured-patients, we retrospectively studied the patients transported to our hospital directly and the those referred from other hospitals. METHODS: The subjects include 83 patients with severe head injury with a Glasgow coma scale (GCS) score of 8 or lower at the time of arrival at the emergency room during the periods of between January, 2003 to March, 2006. Forty nine patients were transported directly (direct group) and 34 referred from other hospitals (transfer group). The patients in direct group was transported by a helicopter or an ambulance car, and the patients in transfer group were carried by an ambulance car. The variables analyzed in these 2 groups of patients were the initial GCS score, injury severity score (ISS), and the presence or absence of light reflex or shock at the time of transportation, the time periods from the injury and primary management, the time from the injury and operation in surgical patients, the type of primary managements and outcomes. RESULT: The number of patients with shock was significantly larger in the transfer group than that in the direct group. The shock was considered to be developed during the transportation. The outcomes were then significantly poorer in the transfer group than those in the direct group. There was no significant difference between the time from the injury and primary management in these 2 groups, but the primary management seemed to be more appropriate in the direct group compared to that in the transfer group. These findings suggested that outcomes of severe high-impact head injuries, such as injuries caused by a traffic accident, would be markedly affected by the primary treatment. CONCLUSION: The doctor-helicopter system, in which emergency physicians arrive at the site shortly after the occurrence of injury, and start primary examination, will influence outcomes of multiple injuries accompanying severe head injury. Severe head-injured patients by high-impact injury should be transported as early as possible to the emergency medical center, and neurosurgeons have an important role in the primary management.     

The effects of air ambulance admissions on orthopaedic trauma services in a single hospital

Emergency air ambulance admissions to the authors' hospital have increased five-fold from 18 in 1992-1993 to 92 in 1998-1999. The service implications for hospitals receiving air ambulance admissions is unknown. AIM: An audit/analysis of all emergency air ambulance admissions to the authors' hospital between August 1998-July 1999. METHOD: Admissions identified from computer records. The case notes were then retrospectively analysed. Data was collected on accident location, admitting specialty, number of orthopaedic procedures and their operative time, and length of inpatient stay. RESULTS: There were 92 patients brought in by air ambulance. Hospital notes were available for 82 and a further 8 had A&E case notes only available for analysis. A total of 34 (38%) were admitted under the orthopaedic surgeons, 28 (31%) under the neurosurgeons, 10 (11%) under the plastic surgeons, 2 (2%) under the general surgeons and 2 (2%) under the physicians. Nine patients were discharged home from the A&E department, two died in A&E and five were transferred to other hospitals. Four of the neurosurgical patients needed orthopaedic input. The admitted patients required 122 orthopaedic procedures taking 120 h of theatre time. The total orthopaedic inpatient stay was 628 days, of which 145 days were in the intensive care or high dependency units. A total of 28 (80%) of the orthopaedic patients came from outside the hospital's catchment area. CONCLUSIONS: Admissions by air ambulance place a high demand on orthopaedic services and often originate from outside the hospital's catchment area. Additional resources may be required by hospitals receiving trauma patients by this route.     

Experience with spinal injuries in New South Wales

Two hundred and two patients with acute and severe spinal injuries were treated in various hospitals in New South Wales during 1977 and 1978. Of these, 132 (65%) were cervical, 60 (30%) thoracic, eight (4%) lumbar and two were inadequately recorded. A major concurrent injury to the head was present in every third patient, to the chest in every fourth patient, and to the limbs in every fifth patient. The outcomes of patients reported in this series make it one of the worst in the literature. Sixty-nine (34%) patients died in hospital; of the 133 survivors, only 22 (11%) have resumed work, the remainder being partially or totally disabled. It is estimated that another 302 patients died before arrival in hospital. In country areas, the time lags between accident and ambulance notification, and between notification and arrival at hospital, were uncertain in many cases, but periods in excess of 2 hours were recorded in 28 (14%). One-man ambulances or private vehicles were used in at least 43 cases (21%). After admission, 139 patients were transferred to other hospitals for definitive treatment, arriving after an average time of 22 h (median time 9 h); for such patients, the original hospital presumably served as a first aid station. A case control study suggests that preventable delay in transport, inappropriate treatment, and failure to correct shock may have been causative factors in 16 deaths in this series. Reduction of the time lag between accident and institution of definitive treatment will save lives, and may avoid some crippling neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mapping the continuum of care to surgery following traumatic spinal cord injury

BackgroundTraumatic spinal cord injury (SCI) is a devastating injury, frequently resulting in paralysis and a lifetime of medical and social problems. Reducing time to surgery may improve patient outcomes. A vital first step to reduce times is to map current pathways of care from injury to surgery, identify rapid care pathways and factors associated with rapid care pathway times.MethodsA retrospective review of the Alfred Trauma Service records was undertaken for all cases of spinal injury recorded in the Alfred Trauma Registry over a three year period. Patients with an Abbreviated Injury Scale (AIS) code matching 148 codes for spinal injury were included in the study. Information extracted from the Alfred Trauma Registry included demographic, clinical and key care timelines.ResultsOf the 342 cases identified, 119 had SCI. The average age of SCI patients was 52 years, with 84% male. The vast majority of SCI patients experienced multiple concurrent injuries (87%). Median time from injury to surgery was 17 h r 28 min for SCI patients in comparison to 28 h r 23 min for non-SCI patients. Three pathways to surgery were identified following Trauma Centre presentation- transfer to surgery direct from trauma unit (median time to surgery was 4 h 17 min.), via Intensive Care (median time to surgery was 24 h 33 min) and via the ward (median time to surgery 28 h r 35 min.) SCI was independently associated with the fastest pathway - direct transfer from trauma unit to surgery - with 41% of SCI cases transferred directly to surgery from the trauma unit.ConclusionNotwithstanding that the vast majority of SCI patients presented with other traumatic injuries, half of all SCI cases reached surgery within 18 h of injury, with 25% within 9 h. SCI was independently associated with direct transfer to surgery from the trauma unit. SCI patients achieve rapid times to surgery within a complex trauma service. Furthermore, the trauma system is well positioned to implement further time reductions to surgery for SCI patients.     

Retrospective review of injury severity,interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

Background

Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport.

Methods

We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups.

Results

Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33–0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period.

Conclusion

Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport.     

Is the recommended target of 4 hours from head injury to emergency craniotomy achievable?

Guidelines recommend that head-injured patients who require life-saving decompressive surgery should undergo surgery within 4 h. To assess the compliance with this recommendation 100 consecutive head-injured patients admitted to a regional neurosurgical unit (RNU) were studied. Time points from head injury to craniotomy were documented and analysed. Twenty-four patients underwent emergency craniotomy, only one being operated on within 4 h. In this cohort of patients there was no relationship between timing of surgery and outcome. In order to investigate whether it is possible to reduce delays in transportation time, theoretical models were created to determine whether direct transfer to the RNU would be faster by land or air ambulance.     

Acute gastric dilation after trauma

A prospective study of 100 trauma patients admitted to the resuscitation room was performed. Acute gastric dilatation was confirmed radiologically in 17 patients. The mechanism of injury was blunt trauma in 91 patients and penetrating in nine. The mean Injury Severity Score was 17. Of those patients with acute gastric dilatation, 13 (76%) had no abdominal injury. Acute gastric dilatation was suspected clinically in nine of 17 patients (53%) in whom the diagnosis was confirmed radiologically. Nasogastric tubes were placed in 31 patients. Fifteen patients had a diagnostic peritoneal lavage and nine of these had nasogastric aspiration before the procedure. Of 28 patients secondarily transferred from another hospital, three (11%) had undergone nasogastric intubation before transfer, five (18%) had acute gastric dilatation on admission and four (14%) had radiological evidence of pulmonary aspiration. Complications associated with acute gastric dilatation included gastric haemorrhage in six patients (35%), pulmonary aspiration in two (12%) and prolonged ileus in one (6%). Placement of a nasogastric tube in the absence of a clear contraindication, either before inter-hospital transfer or soon after admission to the resuscitation room is strongly recommended in the management of the multiply injured patient.     

When is an anesthesiologist needed in a helicopter emergency medical service in northern Norway?

Background: A national air ambulance service, including helicopters and airplanes, was implemented in Norway in 1988. The main intention was to offer advanced medical services when needed. All helicopters are manned by anesthesiologists. Catchment areas for the 11 helicopters span from cities to scarcely populated areas, particularly in the north. Our aim was to assess what proportion of ambulance missions carried out by the rescue helicopter in Bodø, northern Norway, delivered advanced medical treatment needing the skills of an anesthesiologist. Methods: Flight and ambulance records (n = 2078) from 1988 and 1990–98 (10 years) were analyzed retrospectively. Inter‐hospital transfers (n = 147) and search‐ and rescue missions (n = 332) were not included. According to the level of medical treatment given missions were categorized into three groups (A, B and C). Treatment in groups A and B would not require an anesthesiologist. Results: Two thousand and seventy‐eight ambulance missions carried 2166 patients (114 per 100 000 per year). Median take‐off and on‐scene times were 29 and 55 min, respectively. Seven hundred and fifty‐five patients (35%) suffered from cardiovascular disease, 495 (23%) were injured and 250 (12%) were parturients. One hundred and seven patients (5.0%) received advanced prehospital emergency treatment requiring an anesthesiologist. Forty‐five of the 107 patients survived to discharge from hospital, amongst whom 28 had received intravenous nitroglycerin for angina or suspected myocardial infarction. Conclusion: In our rural area, with a widely scattered population, 95% of patients received medical treatment not requiring an anesthesiologist. A selective use of the anesthesiologist seems indicated.     

Evaluation of the New South Wales ambulance T1 major trauma transport protocol: A state-wide data linkage study

IntroductionPrehospital triage and transport protocols are critical components of the trauma systems. Still, there have been limited studies evaluating the performance of trauma protocols in New South Wales, such as the NSW ambulance major Trauma transport protocol (T1).ObjectivesDetermine the performance of a major trauma transport protocol in a cohort of ambulance road transportsMethodsA data-linkage study using routine ambulance and hospital datasets across New South Wales Australia. Adult patients (age > 16 years) where any trauma protocol was indicated by paramedic crews and transported to any emergency department in the state were included. Major injury outcome was defined as an Injury Severity Score >8 based on coded in-patient diagnoses, or admission to intensive care unit or death within 30 days due to injury. Multivariable logistic regression was used to determine ambulance predictors of major injury outcome.ResultsThere were 168,452 linked ambulance transports analysed. Of the 9,012 T1 protocol activations, 2,443 cases had major injury [positive predictive value (PPV) = 27.1%]. There were 16,823 major injuries in total giving a sensitivity of the T1 protocol of 2,443/16,823 (14.5%), specificity of 145,060/151,629 (95.7%) and a negative predictive value (NPV) of 145,060/159,440 (91%). Overtriage rate associated with T1 protocol was 5,697/9,012 (63.2%) and undertriage rate was 5,509/159,440 (3.5%). The most important predictor of major injury was the activation of more than one trauma protocol by ambulance paramedics.DiscussionOverall, the T1 was associated with low undertriage and high specificity. The protocol may be improved by considering age and the number of trauma protocols activated by paramedics for any given patient.     

Trauma deaths in the first hour: are they all unsalvageable injuries?

BACKGROUND: With the advent of trauma systems, time to definitive care has been decreased. We hypothesized that a subset of patients who are in extremis from the time of prehospital transport to arrival at the trauma center, and who ultimately die early after arrival, may in fact have a potentially salvageable single-organ injury. METHODS: We reviewed all deaths that occurred in the first hour after hospital admission. Trauma registry, medical records, and autopsy reports for 556 patients were evaluated. RESULTS: The median time to arrival was 39 minutes, and the median Injury Severity Score was 29. Blunt injuries (53%) were most commonly auto-accident injuries (134 of 285 patients; 47%). Penetrating wounds (42%) were mostly gunshot wounds to the chest (73 of 233 patients; 31%). For patients with initial vital signs, the most common cause of death was isolated brain injury (26 patients; 28%). Possibly survivable injuries (single organ or vessel) occurred in 35 (38%) patients, of which 4 were isolated spleen injuries (4%). CONCLUSIONS: Some patients with potentially survivable single organ injuries did not have associated head injuries. An aggressive approach is warranted on patients with detectable vital signs on at least one occasion in the field but who arrive at the trauma center in extremis.     

Air ambulance transfer of adult patients to a UK regional burns centre: Who needs to fly?

Introduction

Helicopter emergency medical services play a valuable role in the transfer of critically ill patients. This paper reviews the role of air ambulance services in the provision of regional burns care and suggests guidelines for their use.

Methods

A retrospective review of patients treated at the Midlands Adult Burns Centre over a 3-year period.

Results

27 adult burns patients were transported by air ambulance during the study period. Patients were aged 19–89 years (average 41.3 years) with an estimated burn size of 5–70% TBSA. Distance travelled was 11–79 miles (average 41.2 miles). All patients were appropriately referred to the burns centre according to national referral guidelines but in 7 cases (26%) it was felt that transport by air ambulance was not clinically indicated and land transfer would have been safe and appropriate.

Conclusion

Air ambulances offer a fast and effective means of transferring patients to a regional burns centre in selected cases. There is limited data for the beneficial effects of helicopters and survival benefit is seen only in the most severely injured patients. We suggest criteria for the use of air ambulances in burns patients in order to maximise the benefit and reduce unnecessary flights.     

Stabilization of spinal injury for early transfer

We have reviewed the means of transport and type of stabilization used for all patients with acute spinal cord injuries (SCI) transferred to our center since 1985 to determine what effect these variables may have had on change in level of impairment and probability of neurologic improvement after arrival. Sixty-one patients were reviewed, 47 males and 14 females, with a mean age of 34 years. Twenty-five patients (41%) were transported by ground ambulance, 33 (54%) by helicopter, three (5%) by fixed-wing aircraft. Forty-three patients (70.5%) had cervical spine injuries, 11 (18%), thoracic spine injuries, and seven (11.5%), lumbar spine injuries. Fifty-one patients (84%) were transferred within 24 hours of injury. A variety of standard methods of stabilization were used during transport. No patient suffered ascending level of injury as a result of early transfer. Level of function improved before discharge in 26 of 61 patients (43%); patients transported within 24 hours were more likely to show improvement (25/51) than those transported after 24 hours (1/10). There was no significant difference in the probability of improvement between ground (8/25) or air (18/36) transport. Skeletal traction was used before transfer in only four of 43 patients with cervical spine injuries, and was maintained as a method of long-term stabilization in two patients. We conclude that acute SCI patients can be safely transported by air or ground using standard precautions. Distance and extent of associated injury are the best determinants of mode of transport. Skeletal traction does not appear to be a prerequisite for safe, early transfer of SCI patients.     

Paediatric admissions to the British military hospital at Camp Bastion, Afghanistan

INTRODUCTION

International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume.

METHODS

All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination.

RESULTS

Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1–26 days) and there were 7 deaths.

CONCLUSIONS

Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice.     

Interhospital transfer of liver trauma in New Mexico: a state of austere resources

Background

There is debate in the trauma literature regarding the effect of prolonged prehospital transport on morbidity and mortality. This study analyzes the management of hepatic trauma patients requiring surgery and compares the outcomes of the group that was transferred to the University of New Mexico Hospital (UNMH) from outside institutions, to the directly admitted group.

Materials and methods

The UNMH Trauma Database was queried from 2005–2012. Of 674 patients who sustained liver injuries, 163 required surgery: 46 patients (28.2%) underwent interhospital transfer, and 117 (71.8%) were directly admitted. Variables examined included transfer status, trauma mechanism, transport type, injury severity score (ISS), liver injury grade, and associated injuries. Outcome variables included length of stay (LOS) and 30-day mortality. Outcomes of the transfer group (TG) and direct admit group (DAG) were compared.

Results

Both TG and DAG had the same median age (31 y, P = 0.33). The blunt-to-penetrating ratio was the same for each group (48% blunt: 52% penetrating, P = 1.0). Median ISS was 25 for the TG and 26 for the DAG. Grade III or higher injury occurred in 29 (63%) of the TG and in 68 (58%) of the DAG (P = 0.56). Median hospital LOS was 14 d for TG and 9 d for DAG (P = 0.15). Median intensive care unit LOS was 4 d for both groups (P = 0.71). Thirty-day mortality was 20% in each group (P = 0.27). Using a multiple logistic regression model for the outcome of mortality, only age, ISS, and liver injury grade, not transfer status or transport type, had a significant effect on mortality.

Conclusions

There was no significant difference in liver injury grade, ISS, LOS, and mortality between TG and DAG. In the patient population of our study, transfer status did not affect outcome.     

Helicopter Emergency Ambulance Service (HEAS) transfer: an analysis of trauma patient case-mix, injury severity and outcome

INTRODUCTION

A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome.

PATIENTS AND METHODS

Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes were reviewed.

RESULTS

There were 156 trauma patients transferred (total 193) in the study period with 111 cases identified for analysis with a mean age of 33 years (range, 1–92 years). Average Injury Severity Score on admission was 12 (range, 1–36). Forty-five patients were discharged home from the emergency department, 24 cases had operation, 10 patients required ICU care and 2 were pronounced dead in the emergency department. Average hospital stay following HEAS transfer was 2.97 days (range, 0–18 days).

DISCUSSION

Helicopter ambulance transfer in the acute setting is of debated value. Triage criteria are at fault if as many as 41% of patients transferred are being discharged home from casualty having incurred the financial cost of helicopter transfer. We suggest that the triage criteria for helicopter emergency transfer should be reviewed.