Air transport following surgical stabilization: an extension of regionalized trauma care

A 30-month retrospective review was performed of all trauma patients initially evaluated and operatively stabilized at Level III hospitals, with subsequent specialized air transport within 48 hours of injury to the regional Level I trauma center in Seattle. Nineteen patients were identified, with a mean ISS of 44 (range, 20-66). Mean transport time and distance were 2.4 hours and 456 miles, respectively. The estimated average ground transport time for the same patients was 23.8 hours. No deaths occurred during transport, and the overall survival rate was 58%. Transport charges averaged $4,162, which was 14% of the complete hospitalization cost. We conclude that: 1) patient survival after air transport was no different than that predicted for trauma victims with immediate access to a trauma center; 2) postoperative hemodynamic instability predicted a poor outcome; 3) the higher cost of air relative to ground transport is outweighed by significant time savings in these critically injured patients; and 4) air transport following operative stabilization represents an extension of regionalized trauma care to the isolated areas of Washington and Alaska.