Direct Trauma Center Access by Helicopter Emergency Medical Services is Associated With Improved Survival After Severe Injury

Objective: Evaluate the association of survival with helicopter transport directly to a trauma center compared with ground transport to a non-trauma center (NTC) and subsequent transfer.Summary Background Data: Helicopter transport improves survival after injury. One potential mechanism is direct transport to a trauma center when the patient would otherwise be transported to an NTC for subsequent transfer.Methods: Scene patients 16 years and above with positive physiological or anatomic triage criteria within PTOS 2000-2017 were included. Patients transported directly to level I/II trauma centers by helicopter were compared with patients initially transported to an NTC by ground with a subsequent helicopter transfer to a level I/II trauma center. Propensity score matching was used to evaluate the association between direct helicopter transport and survival. Individual triage criteria were evaluated to identify patients most likely to benefit from direct helicopter transport.Results: In all, 36,830 patients were included. Direct helicopter transport was associated with a nearly 2-fold increase in odds of survival compared with NTC ground transport and subsequent transfer by helicopter (aOR 2.78; 95% CI 2.24-3.44, P<0.01). Triage criteria identifying patients with a survival benefit from direct helicopter transport included GCS <= 13 (1.71; 1.22-2.41, P<0.01), hypotension (2.56; 1.39-4.71, P<0.01), abnormal respiratory rate (2.30; 1.36-3.89, P<0.01), paralysis (8.01; 2.03-31.69, P<0.01), hemothorax/pneumothorax (2.34; 1.36-4.05, P<0.01), and multisystem trauma (2.29; 1.08-4.84, P=0.03).Conclusions: Direct trauma center access is a mechanism driving the survival benefit of helicopter transport. First responders should consider helicopter transport for patients meeting these criteria who would otherwise be transported to an NTC.