Rose Melanie K, Cummings G R, Rodning Charles B, Brevard Sid B, Gonzalez Richard P
Department of Surgery, Division of Trauma and Surgical Critical Care, Center for the Study of Rural Vehicular Trauma, University of South Alabama, Mobile, Alabama 36619, USA.
Am Surg. 2012 Jul;78(7):794-7.
Helicopter transport for trauma remains controversial because its appropriate utilization and efficacy with regard to improved survival is unproven. The purpose of this study was to assess rural trauma helicopter transport utilization and effect on patient survival. A retrospective chart review over a 2-year period (2007-2008) was performed of all rural helicopter and ground ambulance trauma patient transports to an urban Level I trauma center. Data was collected with regard to patient mortality and Injury Severity Score (ISS). Miles to the Level I trauma center were calculated from the point where helicopter or ground ambulance transport services initiated contact with the patient to the Level I trauma center. During the 2-year period, 1443 rural trauma patients were transported by ground ambulance and 1028 rural trauma patients were transported by helicopter. Of the patients with ISS of 0 to 10, 471 patients were transported by helicopter and 1039 transported by ground. There were 465 (99%) survivors with ISS 0 to 10 transported by helicopter with an average transport distance of 34.6 miles versus 1034 (99.5%) survivors with ISS 0 to 10 who were transported by ground an average of 41.0 miles. Four hundred and twenty-one patients with ISS 11 to 30 were transported by helicopter an average of 33.3 miles with 367 (87%) survivors versus a 95 per cent survival in 352 patients with ISS 11 to 30 who were transported by ground an average of 39.9 miles. One hundred and thirty-six patients with ISS > 30 were transported by helicopter an average of 32.8 miles with 78 (57%) survivors versus a 69 per cent survival in 52 patients with ISS > 30 who were transported by ground an average of 33.0 miles. Helicopter transport does not seem to improve survival in severely injured (ISS > 30) patients. Helicopter transport does not improve survival and is associated with shorter travel distances in less severely injured (ISS < 10) patients in rural areas. This data questions effective helicopter utilization for trauma patients in rural areas. Further study with regard to helicopter transport effect on patient survival and cost-effective utilization is warranted.
创伤直升机转运仍存在争议，因为其在提高生存率方面的合理应用及疗效尚未得到证实。本研究旨在评估农村创伤直升机转运的应用情况及其对患者生存率的影响。对2007年至2008年这两年间所有从农村通过直升机和地面救护车转运至城市一级创伤中心的创伤患者进行了回顾性病历审查。收集了患者死亡率和损伤严重程度评分（ISS）的数据。从直升机或地面救护车转运服务与患者开始接触的地点到一级创伤中心计算距离。在这两年期间，1443例农村创伤患者通过地面救护车转运，1028例农村创伤患者通过直升机转运。在ISS为0至10的患者中，471例通过直升机转运，1039例通过地面转运。ISS为0至10的患者中有465例（99%）通过直升机转运存活，平均转运距离为34.6英里；而ISS为0至10通过地面转运存活的患者有1034例（99.5%），平均转运距离为41.0英里。ISS为11至30的421例患者通过直升机转运，平均转运距离为33.3英里，其中367例（87%）存活；而ISS为11至30通过地面转运的352例患者存活率为95%，平均转运距离为39.9英里。ISS>30的136例患者通过直升机转运，平均转运距离为32.8英里，其中78例（57%）存活；而ISS>30通过地面转运的52例患者存活率为69%，平均转运距离为33.0英里。直升机转运似乎并未提高重伤（ISS>30）患者的生存率。在农村地区，直升机转运并未提高生存率，且与轻伤（ISS<10）患者的较短转运距离相关。这些数据对农村地区创伤患者直升机的有效利用提出了质疑。有必要进一步研究直升机转运对患者生存率的影响以及成本效益的利用情况。
