The study authors tried to control for variables that potentially could produce different results, but in all of the variations the data indicated that helicopters improved outcomes for air-ambulance patients. “That's why we thought the study was a very important one,” Haider says.
One thing that might have affected the results in favor of HEMS, and should be investigated further, is the fact that air ambulances are staffed generally with more-qualified personnel, he says. A ground ambulance might be staffed with some combination of emergency medical technicians and paramedics, while helicopter ambulances usually have at least one registered nurse with emergency training and may have a doctor on board.
The database used for the study didn't include a large number of rural patients, so that is another of the areas that further study would be worth pursuing, Haider says. “My hunch is that it would help in rural situations,” he says.
It might be possible to improve even further the care provided in rural and urban EMS by giving ground-based responders better technology to help them decide whether to call in a helicopter, Haider notes. There are cases where helicopter-transported patients are sent home the next day, indicating the chopper wasn't necessary, as well as instances where families sued over the death of a helicopter patient resulting from an accident, arguing that the flight wasn't necessary given the level of trauma, he says. Better decisionmaking technology would probably make a difference in making the right call, and could save money, he says.
Decisionmaking for ground-based responders can be tricky, particularly for rural EMS providers that often rely on volunteers who may not have the same experience or training compared with EMS personnel in urban settings. Complicating factors can be the ground vs. air time difference, the weather and the availability of a helicopter, says Dr. Jeff Slepin, a regional medical director for EmCare Physician Services based in Pensacola, Fla.
More air-ambulance services are placing helicopters in rural areas as opposed to relying on aircraft based near the trauma center to reduce the total time required to get patients to the hospital, industry experts say.
Increasing access to trauma care via helicopter would be welcome in rural parts of the country, as those regions are having a tough time recruiting specialists, such as surgeons (Read the March 26, 2012, story, "Looking for an oasis”). Seconds can count in terms of saving lives in EMS, and “I think air transport in rural areas becomes all the more important,” says Sandra Podley, CEO at Havasu Regional Medical Center in Lake Havasu City, Ariz. “I've seen air transport in rural areas to be key from so many different angles,” she says.