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Field studies: Great, but not last word News

July 10, 2012

EMS News in Focus
by Arthur Hsieh

Field studies: Great, but not last word

Helicopter study brings up several good points about EMS transport methods and research in general

By Arthur Hsieh

Editor's note: A few medical directors weigh in on a study that says trauma patients transported by air have a 16 percent improved chance of survival.

Debate has raged fast and furious about the efficacy of helicopter transport for trauma patients. Given the crash rate for medevacs through the years, it is important to justify the risk of flying critically injured patients to trauma centers in return for better outcomes.

The study referred to here brings up several good points about EMS transport methods and research in general.

First, being published in the Journal of the American Medical Association is a prestigious accomplishment and infers that the study was closely controlled and reviewed. In other words, it's a good study, based on the parameters the researchers specified.

In addition, the researchers looked at previous studies on the topic and improved upon them in terms of research techniques and controlling for "confounders" — issues that could inaccurately skew the results. This is the value of having multiple studies looking at the same core topic.

Also, the study contained a lot of patient records. Bigger numbers usually mean more accurate and more generalizable results.

Finally, while a study of past patient records is not the same as a prospective, randomly controlled study, the researchers clearly pointed out how difficult it would be to conduct such a study. Simply getting permission from patients and communities would be daunting, not to mention potentially unethical.

As both the physicians in the article as well as the researchers in the study point out, you can't just accept the conclusions blindly, nor can you assume that they absolutely apply to your own region.

Other factors beyond the study must be taken into account. Yet the data is compelling and adds another piece to the puzzle of determining best approaches to EMS field care.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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Micky Finn Micky Finn Tuesday, July 10, 2012 7:18:57 PM This is so old! In 1966 Illinois Govenor Olgelvie tried the Helicopter save the day approach. Then reality set in! Who is going to pay for it? The guy who dies enroute with no insurance, which in poor areas are about 99% of the trauma! Or, the guy with Insurance but his Insurance doesn't approve payment? Or how about you people who have run this into the ground? Maybe you'll pay? It doesn't work, and it's not the public demanding any of this, it's EMS again trrying to reinvent a broken down system that the public doesn't want to pay for! Doubt me? How many people are banging on FD or City Hall dorrs demanding anything? That's right, none!
Kristen Busick Nix Kristen Busick Nix Tuesday, July 10, 2012 9:05:28 PM The authors present a very thoughtful conceptual model. As a data source NTDB is lacking in some variables quite important for benchmarking from a. prehospital perspective: crew composition,
Kristen Busick Nix Kristen Busick Nix Tuesday, July 10, 2012 9:46:18 PM Distance to receiving facility and total prehospital time. Granted the large sample size may dampen the effect of any of these variables independently on the outcome measure, they are all potential confounders. Our ability to assess prehospital systems is limited by the variables we can measure. advocate. elements

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