Transport of winter resort injuries to regional trauma centers

McCowan, Christy L.; Thomas, Frank; Swanson, Eric R.; Hartsell, Stephen; Cortez, Janet; Day, Sue; Handrahan, Diana L.

doi:10.1016/j.amj.2005.10.005

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Volume 25, Issue 1 , Pages 26-34, January 2006

Transport of winter resort injuries to regional trauma centers

Christy L. McCowan, MD
- Emergency Department Clinical Operations, University of Utah Health Sciences Center, Salt Lake City, Utah
- Address for correspondence: Christy McCowan, MD, Moran Eye Center, 175 N Med– ical Dr East, Room 1150, Salt Lake City, UT 84132
Frank Thomas, MD
- IHC Life Flight Adult Services, Shock and Trauma ICU, LDS Hospital, University of Utah School of Medicine, Salt Lake City, Utah
Eric R. Swanson, MD
- University of Utah Health Sciences Center Air Med Program, University of Utah School of Medicine, Salt Lake City, Utah
Stephen Hartsell, MD
- Emergency Medicine Residency Program, University of Utah Health Sciences Center, University of Utah School of Medicine, Salt Lake City, Utah
Janet Cortez
- Trauma, University of Utah Health Sciences Center, Salt Lake City, Utah
Sue Day
- Trauma, LDS Hospital, Salt Lake City, Utah
Diana L. Handrahan, BS
- UCR Statistical Data Center, LDS Hospital, Salt Lake City, Utah

Introduction: This study examined the epidemiology of winter resort injuries presenting to regional trauma centers by helicopter (HEMS) or ground (GEMS) ambulance.

Methods: Five hundred seventy-five patients (GEMS 289; HEMS 286) were identified from trauma registries and HEMS transport records. Demographic data, hospital interventions, and discharge status were examined.

Results: HEMS patients had a significantly lower Glasgow coma score (GCS) and trauma score (TS), longer intensive care unit (ICU) length of stay (LOS), and more deaths than did GEMS patients (P < 0.05). Despite this, significantly more HEMS patients were discharged home from the emergency department (24.5% vs. 4.8%; P < 0.001). HEMS patients had more isolated head/facial injuries and multiple injuries, with less isolated extremity injuries than did GEMS patients (P < 0.05). Regardless of transport mode, patients with multiple injuries, thoracoabdominal injuries, or head injuries with a GCS ≤ 13 were more likely to require immediate interventions (intubation, chest tube, blood products). Patients with isolated extremity injuries rarely needed immediate care.

Conclusion: HEMS patients had a higher acuity and different injury pattern when compared to GEMS patients. Approximately 24.5% of HEMS patients were discharged home from the ED. This reflects significant overtriage of patients to HEMS. A prospective study examining the initial triage of patients injured at winter resorts would help to determine which subset of patients are best served by HEMS transport.