Appropriate helicopter transport of urban trauma patients

Objective: Inappropriate use of helicopter transport of trauma patients in urban areas increases costs, risk of injury, and unavailability for appropriate flights. We evaluated the effect of an emergency medical service (EMS) system audit of helicopter trauma scene flights (TSFs) on appropriateness of TSFs. Methods and Design: Retrospective cohort. Setting: Defined urban area with two Level I trauma hospitals. Participants: Consecutive TSFs 2 years before (PRE) and 2 years after (POST) audit. Intervention: EMS system audit established criteria for appropriate TSFs. Main Results: The total number of trauma system entries were similar for the two periods: PRE (1989) = 2862; POST (1990 and 1991) = 2787 and 2772. The total number of TSFs decreased after audit (PRE = 122; POST = 50). The proportion of inappropriate (INAPPRO)/total TSFs did not change (62% vs. 66%; χ² = 0.04; p = 0.85). There was no difference between appropriate (APPRO) and INAPPRO TSFs for mean vital signs, mechanism of injury, Trauma and Injury Severity Score (TRISS) and Injury Severity Score (ISS), mean length of stay, and proportion of survivors. Scene and transport time intervals were similar. For both PRE and POST periods, 26 APPRO patients (45%) were admitted to non- intensive care unit wards. Conclusions: An EMS system audit with general awareness of audit criteria decreased the rural number of TSFs and hence the number of INAPPRO TSFs in this urban trauma system population. However, the proportion of TSFs that were considered INAPPRO did not change. Criteria for urban TSFs should he based on markers of critical physiologic patient status matched to unique care that the helicopter personnel can provide (e.g., advanced airway management).