WHICH GROUPS OF PATIENTS BENEFIT FROM HELICOPTER EVACUATION

Background The evacuation of emergency cases by air, usually by helico pter, is controversial because of the cost of the programme, the possi bility of an accident (especially in an urban area), and unproven bene fit. But such evacuations cannot be studied by a random intervention l eg, air versus ground ambulance). We used an expert-panel approach to estimate the health outcome for patients transferred by emergency heli copter compared with the potential outcome if they had gone by surface ambulance. Methods The helicopter programme is based at the Universit y Hospital of Tromso in northern Norway. 370 case-reports of helicopte r evacuation from rural areas were screened by anaesthetists for routi ne and case-specific data. Two expert panels assessed the cases for po tential additional health benefit arising from the fact of helicopter evacuation. The panels used a modified Delphi technique to reach conse nsus in life-years gained. One panel met for cases aged under 15 and p regnant women, the other for older cases. Findings 240 of the 370 case s were male (65%); the age range for both sexes was 0-86 years. The mo st common diagnosis for the 55 cases aged under 15 was infection (49%) ; in older patients, cardiovascular disease dominated (50%). Trauma ac counted for just under a fifth of cases in both groups. On average, th e patients arrived 69 min (range 0-615) earlier in hospital than if th ey had gone by ground transport. For 283 cases, the initial screening by the anaesthetists indicated no additional benefit compared with tha t obtainable by ground-ambulance transport. The main reason was that n o treatment was given during the flight or early on in hospital that c ould not have been given otherwise. 90 cases entered the expert panel system. Of these 90, 49 cases were judged to have received no addition al benefit. This left 41 (11% of the total of 370 evacuated) who were judged to have benefited, gaining 290.6 life-years. 96% of the total n umber of life-years gained was achieved in nine patients, six of whom were aged below 7 (four were aged 0-7 months). The life-year-gain per adult patient with cardiovascular disease was 0.54. Interpretation We conclude that an emergency helicopter service can provide considerable health benefits for selected patients, at least in this rural setting . Given the costs and risks of such a service, the benefits for most p atients are small.