Hotvedt R, Kristiansen I S, Førde O H, Thoner J, Almdahl S M, Bjørsvik G, Berge L, Magnus A C, Mamen K, Sparr T, Ytre-Arne K
Department of Anaesthesiology, University Hospital of Tromsø, Norway.
Lancet. 1996 May 18;347(9012):1362-6. doi: 10.1016/s0140-6736(96)91010-7.
The evacuation of emergency cases by air, usually by helicopter, is controversial because of the cost of the programme, the possibility of an accident (especially in an urban area), and unproven benefit. But such evacuations cannot be studied by a random intervention (eg, air versus ground ambulance). We used an expert-panel approach to estimate the health outcome for patients transferred by emergency helicopter compared with the potential outcome if they had gone by surface ambulance.
The helicopter programme is based at the University Hospital of Tromsø in northern Norway. 370 case-reports of helicopter evacuation from rural areas were screened by anaesthetists for routine and case-specific data. Two expert panels assessed the cases for potential additional health benefit arising from the fact of helicopter evacuation. The panels used a modified Delphi technique to reach consensus in life-years gained. One panel met for cases aged under 15 and pregnant women, the other for older cases.
240 of the 370 cases were male (65%); the age range for both sexes was 0-86 years. The most common diagnosis for the 55 cases aged under 15 was infection (49%); in older patients, cardiovascular disease dominated (50%). Trauma accounted for just under a fifth of cases in both groups. On average, the patients arrived 69 min (range 0-615) earlier in hospital than if they had gone by ground transport. For 283 cases, the initial screening by the anaesthetists indicated no additional benefit compared with that obtainable by ground-ambulance transport. The main reason was that no treatment was given during the flight or early on in hospital that could not have been given otherwise. 90 cases entered the expert panel system. Of these 90, 49 cases were judged to have received no additional benefit. This left 41 (11% of the total of 370 evacuated) who were judged to have benefited, gaining 290.6 life-years. 96% of the total number of life-years gained was achieved in nine patients, six of whom were aged below 7 (four were aged 0-7 months). The life-year-gain per adult patient with cardiovascular disease was 0.54.
We conclude that an emergency helicopter service can provide considerable health benefits for selected patients, at least in this rural setting. Given the costs and risks of such a service, the benefits for most patients are small.
通过空中（通常是直升机）转运急症患者存在争议，原因在于该项目成本高昂、存在事故风险（尤其是在市区）以及其益处未经证实。但此类转运无法通过随机干预研究（例如空中转运与地面救护车转运对比）。我们采用专家小组方法来评估通过紧急直升机转运的患者的健康结局，并与假设他们通过地面救护车转运的潜在结局进行比较。
直升机转运项目以挪威北部特罗姆瑟大学医院为基地。麻醉医生对370例从农村地区直升机转运的病例报告进行筛查，以获取常规及特定病例数据。两个专家小组评估这些病例，看直升机转运这一事实是否会带来潜在的额外健康益处。小组采用改良的德尔菲技术就获得的生命年数达成共识。一个小组负责15岁以下患者及孕妇的病例，另一个负责年龄较大患者的病例。
370例病例中有240例为男性（65%）；男女年龄范围为0至86岁。15岁以下的55例患者中最常见的诊断是感染（49%）；年龄较大患者中，心血管疾病占主导（50%）。两组中创伤病例均占近五分之一。平均而言，与通过地面交通转运相比，这些患者到达医院的时间提前了69分钟（范围为0至615分钟）。对于283例病例，麻醉医生的初步筛查表明与通过地面救护车转运相比并无额外益处。主要原因是飞行途中或入院早期未给予无法通过其他方式给予的治疗。90例病例进入专家小组评估系统。在这90例中，49例被判定未获得额外益处。剩下41例（占370例转运总数的11%）被判定从中受益，共获得290.6个生命年。获得的生命年总数的96%来自9名患者，其中6名年龄在7岁以下（4名年龄在0至7个月）。成年心血管疾病患者的生命年增益为0.54。
我们得出结论，紧急直升机服务至少在这种农村环境中能为部分患者带来可观的健康益处。鉴于此类服务的成本和风险，对大多数患者而言益处不大。
