Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Stanford study examines cost-effectiveness of helicopter transport of trauma victims

26.04.2013
Researchers at the Stanford University School of Medicine have for the first time determined how often emergency medical helicopters need to help save the lives of seriously injured people to be considered cost-effective compared with ground ambulances.

The researchers found that if an additional 1.6 percent of seriously injured patients survive after being transported by helicopter from the scene of injury to a level-1 or level-2 trauma center, then such transport should be considered cost-effective. In other words, if 90 percent of seriously injured trauma victims survive with the help of ground transport, 91.6 need to survive with the help of helicopter transport for it to be considered cost-effective.

The study, published online this month in the Annals of Emergency Medicine, does not address whether most helicopter transport actually meets the additional 1.6 percent survivorship threshold.

"What we aimed to do is reduce the uncertainty about the factors that drive the cost-effective use of this important critical care resource," said the study's lead author, M. Kit Delgado, MD, MS, an instructor in the Division of Emergency Medicine. "The goal is to continue to save the lives of those who need air transport, but spare flight personnel the additional risks of flying - and patients with minor injuries the additional cost - when helicopter transport is not likely to be cost-effective." (Helicopter medical services generally bill patients' insurance providers directly, but patients may have to pay some of the bill out of pocket, or, if they're uninsured, possibly all of it.)

The study comes at a time when finding ways to cut medical costs has become a national priority, and the overuse of helicopter transport has come under scrutiny. Previous studies have shown that, on average, over half of patients transported by helicopter have only minor, non-life threatening injuries. For these patients, transport by helicopter instead of ground ambulance is not likely to make a difference in outcomes, and the additional risk and cost of helicopter transport outweighs the benefit, Delgado said.

In 2010, there were an estimated 44,700 U.S. helicopter transports from injury scenes to level-1 and level-2 trauma centers, with an average cost of about $6,500 per transport. The total annual cost is around $290 million. (Level-1 and -2 trauma centers are hospitals equipped and staffed to provide the highest levels of surgical care to trauma patients; level-1 centers offer a broader array of readily available specialty care, and also are committed to research and teaching efforts.)

Yet emergency helicopter transport sits in a cost-efficiency conundrum: It is most needed in remote, rural areas where transport by ground can take far longer than by air. These areas also tend to have sparser populations and therefore fewer calls for aid, making it difficult to recoup the overhead costs of maintaining helicopter services, Delgado said.

In some areas of the country, however, helicopters are automatically launched based on the 911 call. "Once ground responders and the helicopter arrive, sometimes they may find patients who are awake, talking and have stable vital signs," Delgado said. "The challenge is getting helicopters to patients who need them in a rapid fashion so the flight team can intervene and make a difference, but also know based on certain criteria who isn't sick enough to require air transport."

Most health economists consider medical interventions that yield a year of healthy life - a measure known as a quality-adjusted life-year - at a cost of between $50,000 and $100,000 to be cost-effective in high-income countries, such as the United States, Delgado said. If society is willing to pay as much as $100,000 toward helicopter transport for each QALY gained by the seriously injured patients, then helicopter transport needs to reduce the mortality rate of these patients by a modest 1.6 percent compared with ground transport to meet this threshold, the study says. Or it needs to improve long-term disability outcomes, the study says.

"If future studies find helicopter transport leads to improved long-term quality of life and disability outcomes, then helicopter transport would be considered cost-effective, even if no additional lives were saved," Delgado said. "Only a handful of studies have examined outcomes other than death, without definitive results."

For severely injured patients, helicopter evacuation to a trauma center is preferable if it is faster than ground transport. However, helicopter transport is more expensive and poses rare, but often fatal, safety risks - specifically, the risk of crashing. Plus, it is often difficult for emergency responders to discern which patients would actually benefit from being flown in a helicopter rather than driven in an ambulance to a high-level trauma center. Until this study, the survival benefit needed to offset these potential drawbacks hasn't been clear.

"More accurately determining which patients have serious injuries and need to be flown is the most promising way to ensure you are getting a good value by using helicopter transport," Delgado said. "To do this, we should promote diligent use of the Centers for Disease Control's field triage guidelines among EMS responders. This would help ensure that injured victims who are transported by helicopter to a trauma center actually require trauma care. Secondly, we need to figure out whether the practice of autolaunching helicopters based on a 911 call makes sense. If the benefit of the faster response time outweighs the expenditure of resources on those patients who may not actually need helicopter transport, then autolaunching makes sense. If not, the practice should be reconsidered."

There is mixed evidence in the literature about the degree to which helicopter transport reduces mortality. It is therefore uncertain whether the routine use of helicopter transport is cost-effective for most patients in the United States when ground transport is also feasible. The study found that the cost-effectiveness also depends on regional variation in the costs of air and ground transport and the percentage of patients who are flown that have minor injuries.

"Of course, this study only applies to situations in which both ground and helicopter transport to a trauma center are feasible," Delgado added. "In situations where the only alternative is being taken by ground to a local nontrauma-center hospital or being flown to a trauma center, then clearly we want any patient with a suspicion of a serious injury flown to that trauma center."

The senior author of the study is Jeremy Goldhaber-Fiebert, PhD, assistant professor of health care research and policy. Other Stanford co-authors are Kristan Staudenmayer, MD, MS, assistant professor of surgery; N. Ewen Wang, MD, associate professor of emergency medicine; David Spain, MD, professor of surgery; and Douglas Owens, MD, MS, professor health research and policy.

The study was supported by the Agency for Healthcare Research and Quality, the National Institutes of Health (grants K23HD051595-02 and K01AG037593-01A1) and the Department of Veterans Affairs.

Information about Stanford's Division of Emergency Medicine, which also supported the work, is available at http://med.stanford.edu/emed.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Print media contact:
Sara Wykes
650-721-6263
(swykes@stanfordmed.org)
Broadcast media contact:
M.A. Malone
650-723-6912
(mamalone@stanford.edu)

Sara Wykes | EurekAlert!
Further information:
http://www.stanfordmed.org

More articles from Studies and Analyses:

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Salmonella as a tumour medication

HZI researchers developed a bacterial strain that can be used in cancer therapy

Salmonellae are dangerous pathogens that enter the body via contaminated food and can cause severe infections. But these bacteria are also known to target...

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

3rd Symposium on Driving Simulation

23.10.2017 | Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

 
Latest News

Microfluidics probe 'cholesterol' of the oil industry

23.10.2017 | Life Sciences

Gamma rays will reach beyond the limits of light

23.10.2017 | Physics and Astronomy

The end of pneumonia? New vaccine offers hope

23.10.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>