By David Rogers - Daily News
Updated: 8:06 p.m. Saturday, April 21, 2012
Posted: 7:48 p.m. Saturday, April 21, 2012
A large-scale Johns Hopkins Medicine study comparing survival rates of severely injured patients indicates those transported by helicopter are 15 percent to 16 percent more likely to survive than those transported by ground ambulance.
The study is the first study of its size to employ advanced statistical techniques including propensity score matching to ensure researchers were doing an “apples to apples” comparison, according to one of the study’s leaders, Dr. Adil H. Haider, co-director of the Center for Surgery Trials and Outcomes Research at Johns Hopkins School of Medicine.
“It’s adjusted based on injury severity, vital signs, age and a host of other factors,” Haider said from Baltimore.
The study examined mortality rates to the point of hospital discharge among 223,475 patients older than 15 who had sustained blunt or penetrating trauma — from a car accident, electrocution, knife wound and other traumatic events — that required transport to a level 1 or level 2 trauma center.
The study analyzed 2007-2009 records from the American College of Surgeons National Trauma Data Bank, and included 61,909 patients transported by helicopter and 161,566 transported by ground ambulance. After adjusting for case severity and other factors, the study determined that the survival rate was 16 percent higher for patients transported by air to level 1 trauma centers and 15 percent for patients transported by air to level 2 trauma centers. Air transport has become an issue the past several years because of its higher cost, Haider said.
The ability of a helicopter to get to a trauma center more quickly than a ground ambulance is likely not the only factor influencing survival rates, Haider said.
“Helicopter crews come from the ground crews,” he said. “Usually they have extensive training, including training in intensive care units and in emergency rooms.”
Air flights also tend to have the latest medical technology, Haider said. “The helicopter is expensive so it usually has the most advanced technology,” he said.
The use of the helicopter also is a signal to a trauma center that a patient urgently needs a high level of care, he added.
Palm Beach County’s medical emergency air-transport program
Echoing Haider’s observations, William Crafa, an emergency medical technician and flight nurse for the county’s medical emergency air-transport system, said Trauma Hawk crews have a high level of experience.
His flight partner, Steve Wilson, has a substantial 28 years of experience as an EMT/paramedic, Crafa said. “Of the six EMTs that work here full time, he is the fifth most senior. The other guys have more experience,” Crafa said.
A nurse and a paramedic attend every Trauma Hawk flight. Onboard medical personnel are required by the county to have 4,100 hours of critical-care experience prior to joining the Trauma Hawk team, Crafa said.
Among the advanced technology aboard Trauma Hawk is a device that provides blood pressure readings every 2 seconds, Crafa said. That helps medical staff quickly determine if a patient is on medications that affect blood pressure. The Trauma Hawks also carry fluid warmers that allow medics to give critically injured patients 2 to 3 liters of intravenous fluid quickly, he said. Crafa said the two helicopters also carry advanced ventilators.
Those devices, the staff’s training and the copter’s ability to get to a trauma hospital quickly (St. Mary’s Medical Center or Delray Medical Center) can make the difference in life and death, he said.
Crafa and Wilson recently responded to a call to help a man who had been shot at close range to the chest. The man was dying in front of them, Crafa recalled.
“My partner and I recognized right away he needed to go. We loaded him into Trauma Hawk. We were able to intubate him — give him an advanced airway — and were able to control external bleeding from the chest wound,” Crafa said.
After the man was treated at St. Mary’s in the intensive care unit, he was sent to a lower-level care unit. “That was when I was able to speak to him. It was amazing that he actually survived. Without Trauma Hawk and the ground crew and the trauma team at St. Mary’s, he wouldn’t have survived,” Crafa said.
“If he had to go by ground ambulance, the transport time would have been too long.”
Established Trauma Hawk landing zones in Palm Beach include The Breakers’ golf course, the playing field south of the Palm Beach Day Academy and the Par 3 golf course in the South End.
The Johns Hopkins-led study was conducted in part because of the issue of cost-effectiveness, Haider said.
The Health Care District of Palm Beach County has, since 1991, paid for the hangar used to house the county’s two Trauma Hawk helicopters at the Palm Beach International Airport, paid for the copters’ maintenance and fuel, as well as pilots’ salaries and other expenses while contracting with the Palm Beach County Fire-Rescue Department for the paramedics and nurses who staff the flights, said Robin Kish, Health Care District spokeswoman. In FY 2010-11, the system transported 720 patients via 704 flights, Kish said.
The annual cost of the air medical program is $5.5 million, Kish said.
On the issue of cost-effectiveness, Haider, the Johns Hopkins researcher, said there is always room for improvement. “What the study shows is the helicopter is very effective with the most critically injured patients. We need to improve our ability to ensure that we are going to pick the most severely injured patients,” he said.
‘Golden hour’
Dr. Michael West, a trauma surgeon at St. Mary’s, said the study supports the notion that speedy transport, combined with advanced lifesaving techniques, helps patients survive the critical “golden hour” following a traumatic injury.
“This study shows that on a large scale that there is a benefit and a statistical increase in survivability by using helicopter transport,” Brown said. “What occurs in that first 60 minutes will significantly play a role in how the patient does ultimately and in his or her survivability.”
Crafa, the flight nurse and paramedic, said it is difficult to put a price on a life.
“If you are the one being saved or the loved one of someone being saved, it’s an invaluable service,” he said.
Like Haider, Crafa said speedier transport to a trauma center, advanced care en route along with skilled intervention by a hospital’s trauma staff can minimize the long-term effects of a severe injury.
“If we get you to the hospital faster, there is less damage from the trauma or the cardiac event or stroke event you’ve had. That leads to shorter hospital times and less permanent damage and you get back to work, back to your family, back to your life quicker with less damage,” Crafa said. “On the front end it may be more expensive, but hopefully we can save you that on the back end.”
The report, “Association between helicopter vs. ground emergency medical services and survival for adults with major trauma,” was published Monday in JAMA, the Journal of the American Medical Association.
http://www.palmbeachdailynews.com
The study is the first study of its size to employ advanced statistical techniques including propensity score matching to ensure researchers were doing an “apples to apples” comparison, according to one of the study’s leaders, Dr. Adil H. Haider, co-director of the Center for Surgery Trials and Outcomes Research at Johns Hopkins School of Medicine.
“It’s adjusted based on injury severity, vital signs, age and a host of other factors,” Haider said from Baltimore.
The study examined mortality rates to the point of hospital discharge among 223,475 patients older than 15 who had sustained blunt or penetrating trauma — from a car accident, electrocution, knife wound and other traumatic events — that required transport to a level 1 or level 2 trauma center.
The study analyzed 2007-2009 records from the American College of Surgeons National Trauma Data Bank, and included 61,909 patients transported by helicopter and 161,566 transported by ground ambulance. After adjusting for case severity and other factors, the study determined that the survival rate was 16 percent higher for patients transported by air to level 1 trauma centers and 15 percent for patients transported by air to level 2 trauma centers. Air transport has become an issue the past several years because of its higher cost, Haider said.
The ability of a helicopter to get to a trauma center more quickly than a ground ambulance is likely not the only factor influencing survival rates, Haider said.
“Helicopter crews come from the ground crews,” he said. “Usually they have extensive training, including training in intensive care units and in emergency rooms.”
Air flights also tend to have the latest medical technology, Haider said. “The helicopter is expensive so it usually has the most advanced technology,” he said.
The use of the helicopter also is a signal to a trauma center that a patient urgently needs a high level of care, he added.
Palm Beach County’s medical emergency air-transport program
Echoing Haider’s observations, William Crafa, an emergency medical technician and flight nurse for the county’s medical emergency air-transport system, said Trauma Hawk crews have a high level of experience.
His flight partner, Steve Wilson, has a substantial 28 years of experience as an EMT/paramedic, Crafa said. “Of the six EMTs that work here full time, he is the fifth most senior. The other guys have more experience,” Crafa said.
A nurse and a paramedic attend every Trauma Hawk flight. Onboard medical personnel are required by the county to have 4,100 hours of critical-care experience prior to joining the Trauma Hawk team, Crafa said.
Among the advanced technology aboard Trauma Hawk is a device that provides blood pressure readings every 2 seconds, Crafa said. That helps medical staff quickly determine if a patient is on medications that affect blood pressure. The Trauma Hawks also carry fluid warmers that allow medics to give critically injured patients 2 to 3 liters of intravenous fluid quickly, he said. Crafa said the two helicopters also carry advanced ventilators.
Those devices, the staff’s training and the copter’s ability to get to a trauma hospital quickly (St. Mary’s Medical Center or Delray Medical Center) can make the difference in life and death, he said.
Crafa and Wilson recently responded to a call to help a man who had been shot at close range to the chest. The man was dying in front of them, Crafa recalled.
“My partner and I recognized right away he needed to go. We loaded him into Trauma Hawk. We were able to intubate him — give him an advanced airway — and were able to control external bleeding from the chest wound,” Crafa said.
After the man was treated at St. Mary’s in the intensive care unit, he was sent to a lower-level care unit. “That was when I was able to speak to him. It was amazing that he actually survived. Without Trauma Hawk and the ground crew and the trauma team at St. Mary’s, he wouldn’t have survived,” Crafa said.
“If he had to go by ground ambulance, the transport time would have been too long.”
Established Trauma Hawk landing zones in Palm Beach include The Breakers’ golf course, the playing field south of the Palm Beach Day Academy and the Par 3 golf course in the South End.
The Johns Hopkins-led study was conducted in part because of the issue of cost-effectiveness, Haider said.
The Health Care District of Palm Beach County has, since 1991, paid for the hangar used to house the county’s two Trauma Hawk helicopters at the Palm Beach International Airport, paid for the copters’ maintenance and fuel, as well as pilots’ salaries and other expenses while contracting with the Palm Beach County Fire-Rescue Department for the paramedics and nurses who staff the flights, said Robin Kish, Health Care District spokeswoman. In FY 2010-11, the system transported 720 patients via 704 flights, Kish said.
The annual cost of the air medical program is $5.5 million, Kish said.
On the issue of cost-effectiveness, Haider, the Johns Hopkins researcher, said there is always room for improvement. “What the study shows is the helicopter is very effective with the most critically injured patients. We need to improve our ability to ensure that we are going to pick the most severely injured patients,” he said.
‘Golden hour’
Dr. Michael West, a trauma surgeon at St. Mary’s, said the study supports the notion that speedy transport, combined with advanced lifesaving techniques, helps patients survive the critical “golden hour” following a traumatic injury.
“This study shows that on a large scale that there is a benefit and a statistical increase in survivability by using helicopter transport,” Brown said. “What occurs in that first 60 minutes will significantly play a role in how the patient does ultimately and in his or her survivability.”
Crafa, the flight nurse and paramedic, said it is difficult to put a price on a life.
“If you are the one being saved or the loved one of someone being saved, it’s an invaluable service,” he said.
Like Haider, Crafa said speedier transport to a trauma center, advanced care en route along with skilled intervention by a hospital’s trauma staff can minimize the long-term effects of a severe injury.
“If we get you to the hospital faster, there is less damage from the trauma or the cardiac event or stroke event you’ve had. That leads to shorter hospital times and less permanent damage and you get back to work, back to your family, back to your life quicker with less damage,” Crafa said. “On the front end it may be more expensive, but hopefully we can save you that on the back end.”
The report, “Association between helicopter vs. ground emergency medical services and survival for adults with major trauma,” was published Monday in JAMA, the Journal of the American Medical Association.
http://www.palmbeachdailynews.com
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