Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Curr Opin Crit Care. 2011 Dec;17(6):596-600. doi: 10.1097/MCC.0b013e32834c5655.
Traumatic injury continues to be a significant cause of morbidity and mortality in the year 2011. In addition, the healthcare expenditures and lost years of productivity represent significant economic cost to the affected individuals and their communities. Helicopters have been used to transport trauma patients for the past 40 years, but there are conflicting data on the benefits of helicopter emergency medical service (HEMS) in civilian trauma systems. Debate persists regarding the mortality benefit, cost-effectiveness, and safety of helicopter usage, largely because the studies to date vary widely in design and generalizability to trauma systems serving heterogeneous populations and geography. Strict criteria should be established to determine when HEMS transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate helicopter transport into their triage model.
Research suggests that HEMS improves mortality in certain subgroups of trauma patients, both after transport from the scene of injury and following interfacility transport. Studies examining the cost-effectiveness of HEMS had mixed results, but the majority found that it is a cost-effective tool. Safety remains an issue of contention with HEMS transport, as helicopters are associated with significant safety risk to the crew and patient. However, this risk may be justified provided there is a substantial mortality benefit to be gained.
Recent studies suggest that strict criteria should be established to determine when helicopter transport is warranted and most likely to positively affect patient outcomes. Individual trauma systems should conduct an assessment of their resources and needs in order to most effectively incorporate HEMS into their triage model. This will enable regional hospitals to determine if the costs and safety risks associated with HEMS are worthwhile given the potential benefits to patient morbidity and mortality.
综述目的：在 2011 年，创伤仍然是发病率和死亡率的一个重要原因。此外，医疗保健支出和生产力损失给受影响的个人及其社区带来了巨大的经济成本。在过去的 40 年里，直升机一直被用于运送创伤患者，但在民用创伤系统中，直升机紧急医疗服务（HEMS）的益处存在相互矛盾的数据。关于直升机使用的死亡率益处、成本效益和安全性的争论仍然存在，主要是因为迄今为止的研究在设计和对服务于不同人群和地理环境的创伤系统的普遍性方面差异很大。应该制定严格的标准来确定何时需要 HEMS 转运，并最有可能对患者的预后产生积极影响。个别创伤系统应评估其资源和需求，以便最有效地将直升机转运纳入其分诊模式。
最新发现：研究表明，HEMS 可改善某些创伤患者亚组的死亡率，无论是在从受伤现场转运后还是在院内转运后。检查 HEMS 成本效益的研究结果喜忧参半，但大多数研究发现它是一种具有成本效益的工具。直升机转运的安全性仍然是一个有争议的问题，因为直升机对机组人员和患者都存在重大安全风险。然而，如果可以获得实质性的死亡率益处，那么这种风险可能是合理的。
总结：最近的研究表明，应该制定严格的标准来确定何时需要直升机转运，并最有可能对患者的预后产生积极影响。个别创伤系统应评估其资源和需求，以便最有效地将 HEMS 纳入其分诊模式。这将使地区医院能够确定考虑到患者发病率和死亡率的潜在获益，与 HEMS 相关的成本和安全风险是否值得。
