PREHOSPITAL CARE Appropriate use of helicopters to transport trauma patients from incident scene to hospital in the United Kingdom: an algorithm

Accepted for publication 11 February 2004 . . . . . . . . . . . . . . . . . . . . . . . A recent review article has raised a number of important practical issues for clinicians attending the scene of a road traffic accident, many of which have been amplified by other correspondents. 3 One matter that remains unclear, however, is the most suitable mode of transport to move injured patients from the scene to hospital. A retrospective review of 1000 trauma deaths in the UK in 1988 made recommendations that prehospital and hospital delivered care for seriously injured patients should be improved, along with better transport systems to major centres. Increasingly, ambulance services in the UK may have the services of an air ambulance available as an additional resource. Police, search and rescue, and military helicopters, with potentially limited medical equipment and clinical resources, may also be available to transport patients in an emergency. The decision to use a helicopter is not straightforward, and a number of important geographical, physiological, and pathological factors need to be considered. The transfer of a seriously injured patient by helicopter may be hazardous and transportation by road may often be a safer option. Other factors, including the clinical skills and experience of the helicopter crews, also need to be considered. Currently only one UK air ambulance, for example, is funded and manned for all its operational hours by a doctorparamedic team trained in prehospital critical care. Knowledge of the resources at and journey times to local district and regional hospitals, and the location of their helipads or nearest landing sites, also needs consideration. A detailed estimate of total transport time from scene to hospital is required to ascertain whether road or air ambulance transfer will offer the fastest mode of transport to hospital. When a helicopter is requested by a ground crew already on scene helicopter mobilisation and flight times may delay transfer times further. Road ambulance transfer is often a faster mode of transport than secondary air ambulance transfer in the UK. We have failed to identify in the literature any comprehensive guidance on these issues suitable for field use. A telephone survey of England’s air ambulances by one of the authors (JB) confirmed that air ambulance paramedics usually have to rely on their ‘‘professional judgement’’ to make potentially complex transport decisions. Our algorithm considers the variables described and attempts to guide decision making in a logical and systematic way.