Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the US

Sridhar Sri eInterview with: M. Kit Degado, MD, MS

Instructor, Emergency Medicine
Affiliated Faculty, Centers for Health Policy/Primary Care and Outcomes Research
Stanford University School of Medicine
[email protected] What are the main findings of the study?

Dr. Degado:

  • We found that if an additional 1.6% of patients flown by helicopter survive or if there is any improvement in disability outcomes, then helicopter EMS should be considered cost-effective over transporting patients by ground EMS.
  •  As an example, lets say that a helicopter service transports 200 patients per year from the scene of injury to trauma centers.  And of these patients 100 patients have serious injuries and the other 100 are found to not have serious injuries.  If among the 100 patients with serious injuries, 2 more patients are saved that would have otherwise died if transported by ground ambulance, our study indicates that the investment in the helicopter service is not only effective, but cost-effective.
  • Second, we found that better selecting the right patients to transport is the absolute best way to improve the cost-effectiveness of this expensive critical care resource.
  •  Third, helicopter EMS companies should be allowed to charge more money for patients transported in remote and rural areas as these patients have the highest risk of dying, and therefore the higher potential benefit can offset the higher costs of maintaining services in these areas.
  • Fourth, as long as there is any benefit from helicopter transport, then this far outweighs the potential risk of crashing because that risk is quite low. Were any of the findings unexpected?

Dr. Degado:

  • One unexpected finding is that helicopter trauma evacuations can be considered cost-effective even if no additional lives are saved, as long as there is an overall improvement in disability outcomes – for example an increase in the proportion of survivors who have normal neurological outcomes after a brain injury. What should clinicians and patients take away from your report?

Dr. Degado:

  •   Hopefully this study will motivate emergency personnel to continue to use helicopter EMS for patients with serious injuries, especially in rural areas where it is needed most.  And at the same time, hopefully it will create a motivation to reduce the amount of times helicopters are called for when patients end up having only minor injuries, thereby reducing the number of times patients with minor injuries may get stuck with a costly bill for a service they likely didn’t need.
  •  And hopefully policies seeking to better select the right patients for air transport will give flight personnel who risk their lives to save others the piece of mind knowing that they are doing because the patients they are evacuating really do need their services. What recommendations do you have for future research as a result of this study?

Dr. Degado:

  • First, we need to more rigorously study whether helicopter EMS improves outcomes. Because of limitations of available data, almost all studies to do have been retrospective analyses of inpatient trauma registry data looking only at the outcome of survival to hospital discharge.  What we really need is a multicenter, prospective study that collects data on both survival and quality of life to at least a year beyond injury.  To do this type of study there needs to be the type of funding available that is commonly given towards other common diseases such as heart attacks and stroke.  And despite the fact that trauma is the number one killer below the age of 45, and that helicopter EMS is used over 44,000 times per year for trauma evacuations at a cost of nearly $300 million, there has not been any federal research funding towards studying this problem.  This needs to change.
  • Secondly, we need to figure out whether the practice of autolaunching helicopters based solely on the information transmitted over the 911 call makes sense, rather than waiting for first responders to see the patients and make the call then.  In the situation of autolaunching, once the helicopter arrives, sometimes the crew may find patients who are awake, talking and have stable vital signs.  The challenge is getting helicopters to patients who need them in a rapid fashion so the flight team can intervene and make a difference, but also know based on certain criteria who isn’t sick enough to require air transport.  If the benefit of the faster response time outweighs the expenditure of resources on those patients who may not actually need helicopter transport, then autolaunching makes sense. If not, the practice should be reconsidered.


Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

Delgado MK, Staudenmayer KL, Wang NE, Spain DA, Weir S,

Owens DK, Goldhaber-Fiebert JD.

Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA; Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, CA; Stanford Investigators for Surgery, Trauma, and Emergency Medicine (SISTEM), Stanford University School of Medicine, Palo Alto, CA.

Ann Emerg Med. 2013 Apr 9. pii: S0196-0644(13)00203-5.
doi: 10.1016/j.annemergmed.2013.02.025.
[Epub ahead of print]

Last Updated on March 19, 2014 by Marie Benz MD FAAD