(1714) Ideal Trauma Transport: Helicopter or Ground Ambulance? A Systematic Review and Meta-Analysis

Introduction: Trauma-related mortality remains a major global health concern. The benefits of helicopter emergency medical service (HEMS) versus ground emergency medical service (GEMS) as the ideal transport modality for the survival of trauma patients remain unclear.

Methods: Literature databases, PubMed and Google Scholar, were used to identify articles that mentioned trauma patients, survival or mortality data, and an EMS transport modality (helicopter or ground transport). Inclusion/exclusion screening was done through Rayyan and corroborated by multiple reviewers. Only articles written in English, published from 2014-2024, and adult populations were included. GEMS and HEMS transport for inter-facility (secondary) or non-trauma cases were excluded. The primary outcome was in-hospital mortality. The secondary outcome was the median injury severity score (ISS) and Glasgow Coma Scale (GCS). A separate analysis was done for day-1 and 30-day mortality.

Results: Of 628 articles, 29 were included for in-hospital mortality analysis. 15 articles were analyzed for ISS and 8 for GCS. In total, 3,703,741 patients were included for in-hospital mortality; 602,068 patients were transported via HEMS and 3,101,673 via GEMS. The use of HEMS was associated with an increased odds of in-hospital mortality compared to GEMS (OR= 1.27; 95% CI, 1.05-1.54, PI 0.62-2.60, I2= 99.1%). HEMS-transported patients had an average median ISS of 14.42 and GCS of 14.83, compared to GEMS-transported patients with an ISS of 10.21 and GCS of 14.83 (P = 0.02 for ISS, P= 0.34 for GCS). 5 articles were included for day-1 mortality and 3 articles were included for 30-day mortality. No significant difference in mortality was observed in the day-1 group (OR= 0.78; 95% CI, 0.32-1.88, PI 0.13-4.49, I2= 98.7%) or 30-day group (OR=1.13; 95% CI, 0.27-4.70, PI 0.17-7.46, I2= 95.5%).

Conclusions: Trauma patients transported by HEMS have higher in-hospital mortality odds and higher ISS scores than those transported by GEMS, with no difference in GCS. The mortality odds between HEMS and GEMS-transported patients showed no significant difference for day-1 or 30-day survival.