I Just Want to Fly

Who survives more often?  The traumatically injured person who's transported by helicopter or the one transported by ambulance? That's the question posed on this week's YouTube, and one Rick and I are willing to bet, as we talk about in this week's PodMed, that almost everyone would choose the helicopter. That's the right answer, at least for some of the  folks who are traumatically injured, according to a study conducted by Adil Haider and colleagues both here at Johns Hopkins and at the University of Maryland, published in JAMA. But just how good is it, and at what cost? 

 Data was gathered from the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank, and represented almost 62,000 patients transported by helicopter and over 160,000 transported by ground.  All of the patients whose data was included in this analysis had injury severity scores of 15 or higher, which is pretty severely injured.  All of the patients were transported to Level I or II trauma centers. The results indicate that those transported by helicopter had about a 16% improved chance of survival compared with those transported by ground.

Lots of other statistics for comparison purposes are used in this paper and are well worth considering.  What is the cost of helicopter transportation versus ground?  In Maryland, each use of the helicopter costs about $5000, with national averages in the $3000 to $5000 range.  When the fact that about 65 helicopter transports are used to save one life is taken into account, that means each saved life costs about $325,000.  Hmmmm.  Not sure where to go with this one other than to reflect on healthcare expenditures and the increasing scrutiny they are coming under.

What is it about helicopter transport that makes it superior to ground transport when it comes to improved survival?  Often people speculate that it's the helicopter's faster speed, bringing patients in to receive comprehensive care in the shortest possible time.  But when distances are within 20 miles of the trauma center, that may not be true, since the helicopter must take off and land twice, and when it reaches the center everyone must wait until the rotors stop to access the patient.

Adil Haider, one of the study's authors, says he thinks a major factor may be the training of helicopter crews.  Indeed, to even be considered for such a crew one must bring a wealth of knowledge and experience, rendering such teams the pinnacle of expertise in emergency care outside the hospital. Studies to specifically examine factors such as this may shed light on how to improve the system in general, he says.

Finally, a nod of gratitude to our military on this one, as the first use of helicopters in healthcare was to evacuate the wounded and dead from areas of conflict.  This of course is a sobering reflection on lessons from war that continue today: how to manage closed head injuries better, understanding post-traumatic stress disorder, development of better prostheses.  Would that war wasn't the stimulus needed!

Other topics this week include how to best treat sciatica and the cost of protecting those at risk from HIV infection in Annals, and three different types of radiation treatment for prostate cancer in JAMA.  Until next week, y'all live well.

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