Adopting the pre-hospital index for interfacility helicopter transport: a proposal

Background: Interfacility helicopter transport is expensive without proven outcome benefit in trauma patients. Our objectives were to determine the fastest method of rural to urban interfacility transport, and develop a triage tool to identify patients most in need of rapid transport. Methods: Retrospective cohort study. Adults ISS greater than or equal to 12 transported from January 1996 to December 1998. Transport time variables,were compared between geographical zones. A pre-transport index (PTI) identified two patient cohorts in which outcome was assessed. Results: Air ambulance was faster than ground transport, with helicopter overall superior to fixed-wing (< 225 km range). Seventy-two percent of patients with PTI < 4 (n = 196) had no outcome indicating severe injury versus 29% of the PTI greater than or equal to 4 cohort (n = 15 1). Mortality for PTI < 4 was 1.4% versus 22% for PTI greater than or equal to 4. Conclusion: Interfacility helicopter transport of severely injured rural trauma patients was the overall fastest method within a 225 km range. PTI > 4 identifies patients most in need of this fast but expensive method of transport. (C) 2002 Elsevier Science Ltd. All rights reserved.