Does the potential for organ donation justify scene flights for gunshot wounds to the head?

OBJECTIVE

The goal of this study was to evaluate helicopter transport to an urban level I trauma center from the scene of injury for patients with self-inflicted gunshot wounds to the head.

DESIGN

This study is a retrospective review of the prehospital, hospital, and billing records.

MEASUREMENTS AND MAIN RESULTS

Despite the fact that 10 of 28 patients (36%) had an airway established by the medical flight crews, scene flights did not enhance survival. Twenty-seven of 28 patients (96%) died. The remaining patient's survival could not be attributed to the scene flight. We estimated that 27 of 28 patients would have arrived at the trauma center sooner if they had been transported by the first-responder emergency medical services ground unit. Flight service charges were approximately one-third of the hospital charges. As a group, patients with a self-inflicted gunshot wound to the head had the highest rate of organ donation in this trauma center (26%). Twenty-nine organs were harvested from the seven donors.

CONCLUSIONS

The use of helicopter scene flights from the scene of injury for patients with a self-inflicted gunshot wound to the head provides no medical advantage to the victims, but provides a high-yield source of desperately needed organs. The prompt establishment of an airway in the field may prolong patient survival long enough to allow evaluation for organ donation. Helicopter transport of these patients is justified only as a means of rapidly delivering the personnel capable of providing advanced airway skills to the scene. Patients requiring CPR in the field after isolated gunshot wounds to the head will not live long enough to become organ donor candidates; therefore, there is no benefit to helicopter transport for these patients.