DOI: 10.3886/e241983v1
title: Establishing a consensus-based definition of air medical transport need for rural patients after injury

description: Patients injured in rural America are more likely to die than
their urban counterparts. This is due in part to poor access to specialized
care such as regional trauma centers, and rural patients are more likely to be
taken to a non-trauma center as a result. For rural
patients, air medical transport (AMT) by helicopter is the only way to get
timely access to life-saving trauma care because of poor geographic access to
trauma centers. AMT brings life-saving care otherwise unavailable from ground
ambulances to the patient even before reaching a trauma center and gets the
patient to definitive care at a trauma center faster. AMT when used appropriately can mitigate
this under-triage and save lives after injury. In remote rural regions, use of
AMT may also preserve local emergency response resources for other patients.
Unnecessary use of AMT – over-triage – occurs in up to 60% of helicopter
flights for patients with only minor injuries and is also more common in rural
areas. A major driver of this inaccurate triage for AMT is the lack
of a standardize definition of what patients and/or circumstances warrant the
use of AMT, reflected in significant variation in the measures used in prior
literature for appropriate AMT. This makes it impossible to compared or build
on prior work, representing a critical barrier to improving air medical
triage of rural patients. Inaccurate AMT triage disproportionally
impacts patients in underserved rural areas and has serious negative
consequences: Under-triage of rural
patients increases the risk of death by not transporting them to a
facility that can treat their injuries. Over-triage, unnecessary AMT, increases cost, makes
this scarce resource unavailable for other patients that need it, and increases
risk to the patient and the crew. AMT crashes are a serious safety issue with a
third of crashes experiencing a fatality compared to just 1% of ground
ambulance crashes, an avoidable risk if the flight is unnecessary. Further, AMT fees are over $10,000 per
transport, creating a significant financial burden for patients and healthcare
systems. This proposal seeks
to develop the first definition of AMT need after injury through consensus from
multiple diverse perspectives with experts in prehospital trauma care and
regionalized care delivery. This project
will then validate the definition using actual patient outcomes. In Aim 1 we will use web-based real-time
modified Delphi methods to develop a consensus definition of criteria that
warrant AMT after trauma. In Aim 2 we will assess the multiple aspects
of validity for our consensus definition of AMT need. We will solicit feedback from rural EMS
professionals to assess face validity and refine the definition. We will then assess criterion validity by applying
the definition to patients in a state trauma registry to assess outcomes among
those that do and do not meet the definition. This proposal is foundational to developing
evidence-based air medical triage guidelines and will inform future work using
this consensus definition to prospectively validate, implement, and pilot an
air medical triage algorithm. Successful completion will improve outcomes and
trauma care value, reducing the disparities after injury in rural America by getting the
right patients the right care at the right time.
description: We will preserve and share aggregated data from the Delphi
panel and the EMS professional survey results as new data generated by this
proposal. Data from the PTOS data set
will not be available for sharing due to the data use agreements with the
Pennsylvania Trauma Systems Foundation which prohibits data sharing. This data
is however available to other researchers by application to the Pennsylvania
Trauma Systems Foundation.