EMS Myth #6: Air medical helicopters save lives and are cost-effective

I love helicopters. Riding in them is both unique and exhilarating. I have spent many hours in a helicopter providing emergency medical care in between police chases and other city activities. Many have called air medical helicopters nothing more than "flying billboards" for the hospitals that operate them. In this day of dwindling healthcare dollars, we must ask ourselves some hard questions: Do helicopters really make a difference in EMS? Do they provide a significant benefit for the patient? Are the risks worth any real benefit? Why do we not see a proliferation of helicopter operations in other countries like we are seeing in the U.S.? Unfortunately, any discussion of air medical helicopter efficacy often results in an emotional response by many. I have heard flight nurses say, "I know what I do makes a difference." Flight paramedics will often relay a story about a particular patient they feel benefited from helicopter transport. But, do helicopters really make a difference in patient care and the subsequent quality of the patient's life? To answer this, let's look at what the scientific literature says.

History

The use of civilian helicopters for transport of ill and injured patients has become an integral part of modern emergency care. Helicopter transport of emergency patients in the United States evolved from experience gained in the Korean and Vietnam Wars, when injured soldiers were transported from conflict areas to military medical facilities for definitive care.¹

The use of helicopters in the civilian sector began in the late 1960s, when helicopters were used in dual-purpose law-enforcement or military operations, but had a limited commitment to emergency medical response.^2,3 Civilian helicopters dedicated exclusively to patient care and transport were first introduced in the U.S. in 1972.^1,4 Over the last two decades, there has been a significant proliferation of helicopter operations in the U.S., most of which are hospital-based and many of which have more than one aircraft.⁵

The impetus for the development and proliferation of civilian helicopter ambulances was based on the concept of the "golden hour." First described by R Adams Cowley, the "golden hour" is the period immediately following injury when resuscitation and definitive care improve outcome.^6,7

Although outcome is better the sooner definitive care is provided, the actual concept of the so-called "golden hour" has been called into question.^8,9,10

The Scientific Evidence

Initial studies published in the 1980s were supportive of air medical transport of emergency patients.^11,12 However, more detailed recent studies have shown that this may no longer be the case. Several recent studies have shown that use of helicopters for trauma patients actually benefits only a small number of patients. Furthermore, these studies indicate that many EMS providers summon medical helicopters when the patient's condition may not warrant their use.

Researchers studied helicopter usage in the Silicon Valley region of California. In a retrospective review of 947 consecutive trauma patients transported to their trauma center, they found that only 22.8% of study patients possibly benefited from helicopter transport. They further found that 33.5% of patients transported by helicopter were discharged from the emergency department and not admitted to the hospital.¹³

In the Los Angeles area, researchers retrospectively evaluated helicopter transport of 189 pediatric trauma patients and found that 85% of patients were considered to have minor injuries. Of the patients transported by helicopter in their study, 33% were discharged home from the emergency department and not admitted to the hospital.¹⁴

In another pediatric trauma study, researchers in Washington, DC, found that approximately 85% of air transports in their study group of 3,861 injured children were considered over-triaged.¹⁵ A Boston study of 1,523 patients transported by helicopter found that 24% of patients transported from an accident scene were deemed inappropriate.¹⁶