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Controversies In Prehospital Care: Air Medical Response

June 2005

Abstract

Trauma scenes may be dangerous and complex. EMS providers often need to perform many tasks more or less simultaneously. These tasks include ensuring their own safety, "getting a sense of the scene," evaluating patients' ABCs, and performing early stabilization. Frequently, EMS personnel must consider whether transport to a trauma care center is warranted, and in some venues, there is the additional consideration of transport mode: Should the helicopter be called?

Helicopter EMS (HEMS) use is characterized by ongoing debate and continuing attempts at triage refinement. The purpose of this article is to help the reader understand the debate, the recent literature, and the putative benefits of HEMS trauma transfers. An overview of relevant methodological material will be presented to provide a basis for understanding the HEMS literature. Next, the discussion will focus on the potential HEMS advantages to both individual patients and to regional EMS systems. As particular facets of HEMS are discussed (eg, rapid-sequence intubation, opioid pain therapy), the article will interweave representative evidence from the ground EMS literature.

Why should emergency physicians be interested in an article on HEMS' role in out-of-hospital trauma care? The answer is simple: the ever-increasing (and appropriate) scrutiny over use of air medical transport is bringing more and more ED practitioners into the HEMS utilization debate. Since US HEMS has its nascence in scene trauma transport, and since much of the available HEMS outcomes literature addresses "primary" (ie, scene) missions, such missions constitute an excellent focus for a HEMSbenefits overview.

The debate about air transport, though occasionally rancorous, reflects legitimate questions about which patients (if any) are helped by helicopter response. The relevance of the issue is emphasized by the growing frequency of helicopter utilization. For example, in a February 2005 e-mail newsletter, the Association of Air Medical Services stated about 700 US helicopters transported 300,000 patients in 2004.
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