Emergency Medical Services
Background: Helicopter Emergency Medical Services (HEMS) and ground EMS (GEMS) are used for prehospital pediatric trauma transport. It is unclear if the method of transport is associated with prehospital and subsequent in-hospital critical care interventions. The objectives of this study were to determine if HEMS is associated with an increase in critical care interventions and to characterize the interventions.
Methods: We performed a retrospective cohort analysis of pediatric trauma patients using the North Carolina Trauma Registry. The study examined patients under 16 years of age with blunt or penetrating trauma who were transported directly from the scene to a NC Level I Trauma Center. Critical care was defined as requiring prehospital or in-hospital intubation, blood products, cardiopulmonary resuscitation (CPR), direct operating room (OR) admission from the emergency department, or intensive care unit (ICU) admission. Analysis was by Fisher’s exact test and multivariable logistic regression, which controlled for age, race, sex, Injury Severity Score, mechanism of injury, and transport method.
Results: We obtained 3161 records, with 12.4% (n=391) being HEMS transports and 87.6% (n=2770) GEMS. Blunt injury accounted for 93.5% (n=2954). In-hospital mortality was 2.5% (n=79). Critical care occurred in 31.9% (n=1009) overall and 55.8% (n=218) of HEMS patients and 28.6% (n=791) of GEMS (OR 3.2, 95%CI 2.5-3.9). Intubation occurred in 23.3% (n=91) of HEMS patients and 6.9% (n=192) of GEMS (OR 4.1, 95%CI 3.1-5.4). Blood products were given to 21.5% (n=56) of HEMS patients and 4.7% (n=95) of GEMS (OR 5.5, 95%CI 3.8-7.9). CPR occurred in 1.6% (n=6) of HEMS patients and 1.1% (n=29) of GEMS (OR 1.5, 95%CI 0.6-3.5). Direct OR admission occurred in 18.2% (n=71) of HEMS patients and 12.5% (n=345) of GEMS (OR 1.6, 95%CI 1.2-2.1). ICU admission occurred in 43.7% (n=171) of HEMS patients and 17.6% (n=488) of GEMS (OR 3.6, 95%CI 2.9-4.5). Multivariable logistic regression showed that HEMS patients had independently greater odds of receiving critical care than GEMS (OR 2.1, 95%CI 1.7-2.7).
Conclusion: Pediatric trauma patients transported by HEMS received more critical care interventions than those transported by GEMS, even after controlling for confounders. Further studies should evaluate the impact of transport mode and critical care interventions on patient outcomes.