1. Evaluation of Air Medical Transport of Trauma Patients in Kansas
Paul Harrison, MD
GM Berg1,2; M Simmons3; D Clark1; D Spaeth1 ;
S Pauly2; L Thompson2; RE Crowe2
1Wesley Medical Center; 2KU School of Medicine-Wichita; 3EagleMed Air Transport
Kansas Chapter of American College of Surgeons - September 12, 2010

2. Air Medical Transport in Kansas
Recognized for speed and efficiency
Benefits rural communities unable to sacrifice ground transport
Provides necessary ALS services
Kansas
98/105 counties are rural
Patients may travel up to 3 hours for trauma care
Purpose
Pilot evaluation of air medical transport in Kansas

3. Methods Retrospective chart review (1/1/07 to 12/31/08)
EagleMed
Wesley Medical Center Trauma Services
Hierarchical (exclusive) stratification
Glasgow Coma Scale
Vital sign data
Anatomy of injury
Risk by age
ALS requirement for transport
Specialist needed
Patient loaded miles and travel time
ED dismissals
Glasgow Coma Scale = 13 or less
Vital Sign
Adult: Systolic BP <90mmHG; Respiratory Rate <10 or >29
Pediatric (age 0-2): Systolic BP <70mmHg; Respiratory Rate <15 or >40; Heart Rate <80 or >180
Pediatric (age 3-5): Systolic BP <80mmHg; Respiratory Rate <10 or >30; Heart Rate <60 or >170
Pediatric (age 6-16): Systolic PB <90mmHg; Respiratory Rate <10 or >25; Heart Rate <60 or >160
Age Risk
Adult: 56 or older
Pediatric: 4 or less
ALS Requirement
Patient needed ALS services; ground transport only BLS credentialed
Patient loaded miles = based on air transport miles; not equivalent with ground transport mileage
Patient travel time in minutes
ED dismissals: hierarchical categorization evaluation

4. Demographics Demographic All (N=483) Adult (n=409) Pediatric (n=74)
Male (f, %)
305(63.1)
266(65.0)
39(52.7)
Age (mean, SD)
39.7(22.9)
45.1(20.6)
10.9(5.4)
White (f, %)
422(87.4)
359(87.8)
63(85.1)
Clinical Characteristic
ISS (mean, SD)
16.9(16.2)
17.4(16.9)
14.3(11.5)
GCS (mean, SD)
11.7(5.1)
11.6(5.1)
11.9(5.1)
Trauma Level 1 (f,%)
158(38.6)
133(32.5)
25(33.8)
Injury Characteristic
Blunt (f, %)
450(93.6)
381(93.6)
69(93.2)
MVA (f, %)
Fall (f, %)
218(45.1)
106(21.9)
190(46.4)
92(22.5)
28(37.8)
14(18.9)
Outcomes
Mortality
50(10.4)
43(10.5)
7(9.5)

5. Adult – Medical Necessity
Category (Exclusive)
Frequency (%)
N=246
Medically Necessary (Urgent)
GCS (<14)
Vital Sign (BP or RR)
Anatomy of Injury
124 (50.4)
19(7.7)
15(6.1)
Medically Necessary (Risk)
Age >55
22(8.9)
Medically Necessary/Non-urgent
ALS Required for Transport
39(15.9)
Specialist or Tx Needed/Non-urgent
27(11.0)
Missing incoming vital sign data 163 of 409 (39.9)
Glasgow Coma Scale = 13 or less
Adult Vital Sign: Systolic BP <90mmHG; Respiratory Rate <10 or >29
Age Risk: 56 or older

6. Pediatric – Medical Necessity
Category (Exclusive)
Frequency (%)
N=37
Medically Necessary (Urgent)
GCS (<14)
Vital Sign (BB, RR, Pulse)
Anatomy of Injury
20(54.1)
3(8.1)
Medically Necessary (Risk)
Age <5
1(2.7)
Medically Necessary/Non-urgent
ALS Required for Transport
7(18.9)
Specialist or Tx Needed/Non-urgent
Missing incoming vital sign data 37 of 74 (50.0)
Glasgow Coma Scale = 13 or less
Vital Sign
Pediatric (age 0-2): Systolic BP <70mmHg; Respiratory Rate <15 or >40; Heart Rate <80 or >180
Pediatric (age 3-5): Systolic BP <80mmHg; Respiratory Rate <10 or >30; Heart Rate <60 or >170
Pediatric (age 6-16): Systolic PB <90mmHg; Respiratory Rate <10 or >25; Heart Rate <60 or >160
Age Risk: 4 or less

7. Travel Time and Distance
Travel time in minutes (mean, SD)
Hour Categories (Frequency, %)
60 min or less
Greater than 60 minutes
42.5(16.7)
426(88.2)
54(11.2)
Distance
Loaded patient nautical miles (mean, SD)
Mile Categories (Frequency, %)
(52.8)
239(49.5)
185(38.3)
36(7.5)
Air speed is dependent on many factors including wind conditions, cargo weight, type of aircraft, and others.

8. ED Dismissals Pediatric (n=2) MOI ISS MILES GCS VITALs INJ AGE ALS TX
13, Male
Fall 4 89 15 -- N Y
14, Female
MVA 6
Adult (n=10)
17, Female 3 95
18, Male 1
19, Male 2 82
23, Male 5
100
26, Male
102 14
32, Male
Mach
139
49, Male 71
65, Male 54
82, Male
106
86, Male 17
Evaluated the ED dismissals individually:
Of the 12:
0 qualified by GCS
0 qualified by vital sign data (3 missing)
1 qualified by anatomy of injury
3 adults qualified by age risk (>55)
6 required air transport due to need for ALS services and ground only BLS certified
All required higher level of treatment or specialist as determined by sending physician....but does this necessitate air transport?
CODING:
VITALs
N = did not qualify by vital signs (BP, RR, HR)
= missing vital sign data
AGE:
Pediatric N = not under age 5
Adult N = not over age 55
Adult Y = over age 55
ALS
Y = did require ALS transport
N = did NOT require ALS transport
TX (Treatment or specialist needed)
Y = sending physician recommended specialist/specialist treatment
N = did not recommend specialist/specialist treatment
Miles are patient loaded miles