Use of helicopter EMS and the impact on out of hospital time: A comparison of scene versus interfacility trauma transfers for patients in hemorrhagic shock

Purpose: Prompt identification coupled with rapid transport of critically injured trauma patients to designated trauma centers is well documented to decrease morbidity and mortality. The purpose of this study was to compare differences in time of arrival to a trauma center between those transported directly from the scene by helicopter EMS (HEMS) to those transported by ground EMS to the nearest hospital and later flown to a trauma center. Methods: A two and one half year retrospective review of adult trauma patients transported by a HEMS program to a trauma center with American College of Surgeons defined Class III or IV hemorrhagic shock was conducted. The time between injury and transfer of patient care from the flight crew to the trauma center staff was defined as pre-trauma center time. Results: Mean times for scene transports were 88.4 minutes (95% confidence level (CI) = 81.3-95.6) compared with an interfacility mean time of 265.2 minutes (95% CI = 221.2-309.2). A t-test was performed at the 0.05 level of significance resulting in a t-value of 8.1060 and a p <0.0001 providing a statistically significant difference in mean times between the two groups. Conclusions: An EMS provider's decision to transport patients with Class III or IV hemorrhagic shock to a non-trauma center in our sample resulted in a mean increase of 2.95 hours to definitive care at a trauma center. First responders and ED personnel should be cognizant of this delay and work to reduce transfer times to specialty care trauma centers.