The utility of helicopter transport of trauma patients from the injury scene in an urban trauma system

Background. Continuing controversy surrounding the value of scene helicopter evacuation of urban trauma victims led to the present study. Methods. A retrospective review was performed of all patients brought to our trauma center from the injury scene by helicopter from 1990 to 2001. Results. The study included 947 consecutive patients, 911 with blunt trauma and 36 with penetrating injuries. The mean Injury Severity Score (ISS) was 8.9. Fifteen patients died in the emergency department, 312 patients (33.5%) were discharged home from the emergency department (mean ISS, 2.7), and 620 patients were hospitalized (mean ISS, 11.4). Three hundred thirty-nine of the hospitalized patients (54.7%) had an ISS less than or equal to 9; 148 patients had an ISS greater than or equal to 16. Eighty-four patients (8.9%) required early operation, mostly for open extremity fractures; only 17 patients (1.8%) underwent surgery for immediately life-threatening injuries. For 54.7% of the patients, the helicopter was judged to be clearly faster than would have been possible by ground transport. In 140 additional patients (14.8%) with prolonged scene time, the helicopter was probably faster than ground ambulance. Considering faster transport time and either the need for early operation or hospitalization with an ISS greater than or equal to 9 as advantageous, a maximum of 22.8% of the study population possibly benefited from helicopter transport. Conclusion. The helicopter is used excessively for scene transport of trauma victims in our metropolitan trauma system. New criteria should be developed for helicopter deployment in the urban trauma environment.