Study: Reducing HEMS for trauma patients saved money and lives

An 11-year study found that changing the protocol for aeromedical transport in Maryland benefited patient outcomes while saving money

WASHINGTON — Changes to the trauma triage protocol in Maryland resulted in decreased use of helicopter transport for trauma patients and improved patient outcomes, saving lives and money.  

The results of an 11-year study of the impact of statewide field triage changes to Maryland’s helicopter EMS (HEMS) were recently published in Annals of Emergency Medicine.

"Purported benefits of HEMS are derived from enhanced crew expertise and decreased time to deliver seriously injured patients to trauma centers," said lead study author Jon Mark Hirshon. "However, by shifting to a new protocol that increased ground transports and decreased air transport for less critical patients, we improved patient outcomes while saving the state considerable money. Those are wins all around."

Over the study period, overall EMS transport of trauma patients increased by 21 percent. However, helicopter transport of trauma patients decreased by 49 percent and ground transport of trauma patients increased by 33 percent. During the study period, HEMS patient acuity increased though expected mortality did not.

Researchers studied records for all patients in Maryland’s Trauma Registry recorded as directly admitted to the hospital from the scene or transferred to trauma centers between July 1, 2000 and June 30, 2011. They focused in particular on what happened after significant field triage changes were instituted in July 2004, July 2007 and October 2008.  

Those changes first recommended, then later required, that patients within a 30-minute drive of a trauma center be transported by ground rather than helicopter and that a physician authorize aeromedical transport for patients in certain trauma categories, regardless of the distance to a trauma center.

"Aeromedical transport costs five to 15 times what ground transportation costs and can also be very dangerous," Hirshon said. "After nine fatal helicopter EMS crashes killed 35 people in 2008, the NTSB took action and the state of Maryland did, too."

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