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Trauma Surg Acute Care Open. 2019 Mar 6;4(1):e000211. doi: 10.1136/tsaco-2018-000211. eCollection 2019.

Helicopter versus ground ambulance: review of national database for outcomes in survival in transferred trauma patients in the USA.

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Health Sciences Center School of Health Professions, Texas Tech University, Lubbock, Texas, USA.
Department of General Surgery, Health Sciences Center School of Health Professions, Texas Tech University, Lubbock, Texas, USA.
Department of General Surgery, University Medical Center, Lubbock, Texas, USA.



Trauma care has improved substantially in the last decade. The emphasis of the Golden Hour in trauma care has encouraged the creation of faster transport and earlier prehospital intervention. Despite the clear time-saving advantage helicopter emergency medical services (HEMS) held over ground ambulances (GAs) in the past, advances in prehospital care over the last decade have created uncertainty as to whether HEMS transport is still associated with improved patient outcomes. We aimed to determine whether air transportation was associated with better outcomes compared with ground transportation. We hypothesized that air transportation is associated with better patient outcomes.


A retrospective review was performed on the National Trauma Data Bank in 2014 on patients transferred either by helicopter or ground ambulance. Demographic information, mean length of stay, mean ventilator days, and mortality rate was abstracted. All transferred patients and patients with missing information were excluded. χ2 test was performed to analyze categorical variables and independent t-test was performed to analyze continuous variables. A logistic regression was performed to ascertain the effects of Glasgow Coma Scale score, mechanism of injury (blunt vs penetrating), age, gender, Injury Severity Score (ISS), and method of transportation (HEMS vs GA) on the likelihood of mortality.


A total of 469 407 transferred trauma patients were analyzed. Mortality appeared to be increased in trauma patients transported by helicopter ambulance (6.0%) versus GA (2.9%) (p<0.001). However, after adjusting for age, ISS, and gender, trauma patients who were transferred by helicopter were 57.0% less likely to die than those transferred by GA (95% CI 0.41 to 0.44, p<0.0001).


The results of this study demonstrate that despite improvements in trauma care, patients have improved survival if transported by helicopter ambulance.

Level of evidence and study type:

Level IV; Therapeutic/Care Management.


ambulance; golden hour; helicopter; mortality; trauma

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