Critical care air transportation of the severely injured: Does long distance transport adversely affect survival?

The authors report the outcomes of 118 adult trauma patients transported a mean distance of 340 miles (range 100 to 800 miles) by one fixed-wing aeromedical services in the Northwest U.S. between February 1982 and March 1984. These patients were compared to a control group of 50 trauma patients who were ground-transported within Seattle, WA between April 1984 and June 1984. Age and trauma type (trauma, head trauma, or burn) were not significantly different for the two groups. The Glasgow Coma Scores (GCS) and Injury Severity Scores (ISS) for the two groups were not significantly different (equal 12 ± 4 GCS; 19 ± 12 Air vs. 20 ± 14 Ground ISS). Mortality was 19% for Air vs. 18% for Ground (p = 0.05). The probability of detecting an increase in mortality with the air- vs. ground-transported patients was 0.78. For the air transported patients, the best predictors of mortality were ISS (F:38.22), age (F:8.33), trauma type (F:4.01), and distance flown (F:1.27). The authors note that the level of care (physician specialist and ICU-qualified registered nurse on board) provided by the aeromedical service studied may not be generalizable to all such services. The authors conclude that, especially for outlying hospitals in a regional trauma system, long-range (<800 miles) aeromedical transport of severely injured patients does not worsen their outcome as measured by hospital mortality.