It would seem quite logical to believe that using helicopters to transport the injured to hospitals would make a dramatic difference in their prognosis and survival. After all, what land vehicle has the mobility and speed of a whirlybird?
But at a recent conference in Las Vegas, Dr. Bryan Bledsoe, a professor of emergency medicine at the University of Nevada School of Medicine, took a contrarian view on the issue. He cited several studies that found that there was no improvement in outcome when injured patients were transported to hospitals by helicopter. http://www.ems1.com/print.asp?act=print&vid=815233
One study, for example, entitled “Helicopter Evacuation of Trauma Victims in Los Angeles: Does It Improve Survival?,” concluded that emergency helicopter transport only helps the worse off.
“EMS helicopter transportation of injured patients does not appear to improve overall adjusted survival after injury,” the study said. “There is, however, a potential benefit (of helicopter evacuation) for severely injured subgroups of patients due to the shorter prehospital times.” http://www.springerlink.com/content/u0g518567x348173/
Bledsoe, saying that the helicopter industy is unregulated and spinning out of control, noted that the number of medical helicopters has more than doubled in the past decade. And since there is this glut of helicopters, there is pressure to turn to them even in situations where their use, which is quite costly, is unwarranted, according to Bledsoe.
I, and others, couldn’t disagree more with Bledsoe and the studies he cited in his presentation. Based on my many years of experience with traumatic brain injury victims, I have long believed that the helicopter was one of the greatest breakthroughs in coma care.
Last year when actress Natasha Richardson tragically died of a brain injury sustained while skiing in Canada, I wrote that she would be alive if she had been airlifted by helicopter to get the proper medical attention — and necessary surgery. http://www.tbilaw.com/blog/tag/intracranial-pressure-monitoring
In that blog, I recalled how I had once asked a nurse what she believed to be the most important advance in medical science to help brain injured, expecting her to say the CT or MRI. But her answer was “the helicopter.”
I don’t think there can be any doubt that helicopters can often mean the difference between life and death for those with TBI
Even the Los Angeles study that Bledsoe cited conceded as much, when it said that those are are badly hurt and need swift care being the exception to the finding that helicopter evacuations do not make a difference for most patients.
Bledsoe’s conference remarks sparked a lively debate on the site, http://www.ems1.com, from EMS workers who posted comments on the story.
Many argued the case for medical helicopters. For example, once wrote, “It is true that helicopters by and of themselves don’t necessarily offer the ‘speed’ that we think of…On the other hand, often times the care that is provided during the on-scene and transport leg is equivilent or near-equivalent to what is provided initially at a receiving hospital.”
Other trauma workers maintained that the use of medical helicopters is imperative in rural areas — “out here in the boondocks,” as one put it — where an injured parient is far away from a medical facility. But these posters believed the aircraft should be used only sparingly in urban areas.
Some noted that “the smoothness of the ride” can be important in some medical emergencies, and a trip over rough terrain could kill the patient. What other choice is there, then, than a helipcopter?
Here’s a side note to this topic. The Wall Street Journal Monday ran a feature about the New York Police Department’s Aviation Unit. The story talks a log about Detective Erin Nolan, the first female NYPD pilot qualified to operate a large Bell 412 air-sea rescue helicopter. http://online.wsj.com/article/SB10001424052748703674704575234220104616034.html?KEYWORDS=NYPD+Aviation+unit
The story, “Up in the Air With One of the Finest’s Finest,” is fascinating, as reporter Ralph Gardner Jr. takes to the air with Nolan.
The NYPD unit does more than traditional rescue and medical tranport. It keeps watch over presidential motorcades and parades, looking for trouble in the crowd or on rooftops.
It spotted and rescued a windsurfer far out in the sea. “If it weren’t for Erin he’d be in England,” one of Nolan’s cop colleagues told The Journal.
And the NYPD Aviation Unit not long ago flew Manhattan detectives to Philadelphia and back, a 40-minute trip one-way, as part of the investigation of the recent Times Square bombing.
So emergency/medical copters do have a role in big cities such as New York, although it may be different than in most locales.
Gardner was accompanied on his helicopter trip by a Pultizer Prize winnning photographer, David Turnley. Turnley has worked for National Geographic, and told the reporter that more photographers at National Geogrpahic had been killed in helicopter crashes than anything else.
Be that as it may, when a person has suffered severe brain damage, the need to get swift medical care outweighs any concerns about helicopter safety.
And I think Professor Bledsoe should rethink his broad statements about helicopter evacuations not actually helping the injured.
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