Elsevier

Burns

Volume 28, Issue 1, February 2002, Pages 70-72
Burns

Helicopter transportation of burn patients

https://doi.org/10.1016/S0305-4179(01)00069-9Get rights and content

Abstract

Analysis of 437 consecutive acute burn patients transported to our burn center revealed 339 transported by ground and 98 by helicopter. There were 18 air transport patients from within a 25-mile-radius, and 80 flown further than 25 miles. Mean age was the same in all groups (P>0.05). Percent total body surface area (TBSA) burned was 8.26% in ground transport patients, significantly less than the 20.35% (within 25 miles) and 21.40% (greater than 25 miles) seen in helicopter transports (P<0.0001). Three percent of ground transport patients and 28% of helicopter patients had inhalation injury (P<0.0001). There was no difference in incidence of inhalation injury among helicopter groups (28 vs. 29%, P=0.8). In patients with coexistent inhalation injury, the mean TBSA burned was significantly larger when compared with the TBSA of burns without inhalation injury (P<0.001). Air transported groups contained patients whose status was not critical based upon lack of inhalation injury and small burn size, and who could have been transported by ground. Non clinical factors such as insurance status, desire to keep ground ambulances in their community, and competing helicopter services reluctant to refuse to transport a patient appears to be factors in choosing air ambulance transportation. Regional single helicopter services and regional cooperative ground ambulance services should reduce use of helicopter transport of burn patients when it is not clinically indicated.

Introduction

Since its introduction as an ambulance during the Korean War, helicopter flight to burn centers has become a common occurrence. Helicopter delivery of burn patients accounts for an ever-increasing percentage of our admissions. On an anecdotal basis we have noted flights from nearby and distant hospitals that transferred patients with minimal burns. On occasion we have had patient transfers from nearby hospitals delayed many hours while waiting for weather conditions to clear so that helicopter transport of a patient could be accomplished instead of using ground ambulance transfer. In view of the great expense, and potential risk to patient and crew, we believe that understanding of the factors that influence the choice of helicopter transport of burn patients can help bring a more rational use of this service.

Section snippets

Study design

Records of all burn patients transported to our burn center in the past 15-month-period were reviewed. Burn surface area, history of smoke inhalation, age, and method and distance of transportation were analyzed in each case. Statistical analysis was done using GraphPad InStat version 3.01 for Windows 95/NT, GraphPad Software, San Diego, California, USA, www.graphpad.com. Unpaired, two-tailed t-test or Fisher exact test were used in all cases.

Results

There were 437 patients transported to our burn center during this time period. Of these, 339 were transported by ground and another 98 by helicopter. Of the air transport patients, 18 came from within a 25-mile-radius, and 80 were flown further than 25 miles. They ranged in age from 3 months to 97 years with a mean age of 33.4±20.7 (S.D.) years in the ground transports, and 38.7±16.8 and 39.2±23.3 years in helicopter transports (less than and greater than 25 miles flown, respectively), (mean

Discussion

Outcome studies comparing helicopter and ground ambulance transported patients have yielded conflicting results [1], [2], [3]. Brathwaite et al. [4] suggested reappraisal of helicopter transport when Advanced Life Support personnel are available at the trauma scene. No clinical benefit of helicopter transport of acute burn patients to a burn center was found by Baack et al. [5] Our studied group of patients contained many who could have been safely, and speedily, transferred to our burn center

Summary

We believe that many burn patients transported to our burn center by helicopter could be safely transported in a ground ambulance staffed by trained para-medical crew. The overutilization of air transport for most burn patients is multifactorial and is minimally based on clinical findings. A single regional helicopter service that is governed by a board of representatives of trauma, burn, and tertiary referral centers would allow for the creation of protocols for air transport that could be

Acknowledgements

We would like to thank P.J. Manni and Devora E. Hathaway, for their assistance in the preparation of this paper.

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