To the Editor: Dr Galvagno and colleagues found improved trauma survival if patients with major trauma were transported by helicopter instead of ground emergency medical services (EMS).1 We think the study has major limitations.
A primary criterion for helicopter dispatch is a faster anticipated time from 911 call to trauma center arrival compared with ground transport. In this study, patients ineligible for helicopter EMS (such as those injured in motor vehicle crashes 2 miles from a trauma center) were not excluded from the control group and time or distance from the trauma center was not taken into account. Previous research suggests a road distance of more than 10 miles or an expected time of more than 45 minutes from 911 call to hospital arrival by ground ambulance is the minimum at which helicopter transport could be faster.2 Prospective data from 3656 patients transported to 51 US level I and II trauma centers found the median time from 911 call to hospital arrival by ambulance of patients with major trauma was 36 minutes (interquartile range, 28-47 minutes), indicating that 75% of these times were less than 47 minutes.3 This suggests that the majority of patients transported by ground EMS in the study may not have been eligible for helicopter EMS because they were injured too close to the hospital.
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