"Golden Hour" and Other Myths from the EMS Helicopter Industry

Why does the public accept the EMS helicopter industry’s horrible safety record? Because the industry has sold the idea that it’s critical to deliver trauma victims to a hospital within the first “golden hour” after an injury.  While the industry acknowledges that the EMS helicopter accident rate is high, it argues that many more lives are saved by EMS helicopters than are lost.    

The logic is appealing.  But it doesn’t wash. Here’s why.

  • The Need for Speed.  Though helicopters are fast, when it comes to getting the patient to a hospital, a ground ambulance is often faster. At least in urban areas, ground ambulances are more widely distributed than EMS helicopters. That means a ground ambulance is more likely to be stationed closer to the trauma victim. A well-positioned ground ambulance can often get to the trauma victim and deliver him to a nearby hospital quicker than a helicopter can. By and large, a helicopter’s speed advantage is limited to rural environments, where ground ambulances are fewer and farther between. The helicopter’s speed advantage is overrated.
  • “Life Flights” That Aren’t.  At 12 year-old was airlifted from summer camp to a hospital in Austin, Texas after she hit her head in the shower. The bill for the flight was $16,000. Upon arrival at the emergency room, she was treated, and then sent back to her summer camp.  Such stories aren't unusual.  In fact, some studies show a third of all patients delivered to emergency room by helicopter are released without ever being admitted to the hospital.
  • Pricey Shuttles.  Many EMS helicopter flights are inter-hospital transfers merely shuttling patients between hospitals. Operators love these profitable gigs. One calls the transfer patients “golden trout,” and encourages pilots to “hook” every one they can, regardless of how bad the weather conditions. No matter that, since the patient is already at a hospital, these transfers seldom classify as “emergencies.”

This is not to say that EMS helicopters never make a difference for trauma victims.  But much less often then the industry would have us believe.  One study showed that, at most, only 22% of those transported by EMS helicopter to Silicon Valley hospitals could be considered to have "possibly" benefited from the air ambulance. Other studies suggest that, even in cases involving serious trauma, helicopter transport improves the patient’s outcome less than 5% of the time. That means that 95% of the time the helicopter exposes the critically injured patient to an unnecessary risk. 

The industry has oversold the need for EMS helicopters. The benefits simply do not outweigh the risks.

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Comments (7) Read through and enter the discussion with the form at the end
Cloudesley Shovell - January 10, 2011 9:48 AM

Good stuff, Mike.

Ross - March 18, 2012 7:40 AM

While in some urban areas medical helicopters might sometimes be over utilized, the author fails to acknowledge the need for transport to a higher level or specialty hospital. Additionally, the author doesnt fully acknowledge the huge advantages of helicopters in a rural setting. I live in a county larger than Delaware and Rhode Island combined...there is one EMS agency stationed in one location for that entire area (there is another at the northern part of the county but they operate in very small area). We have a level 5 trauma center and transport times for that are anywhere between 5 minutes to 8 hours (backcountry). With a helicopter, patients can get to a level 1 trauma center in less time than it takes to get to our level 5. Additionally, the golden hour is commonly being used now as a general rule of thumb. No, patients dont just drop off after 60 minutes, but tell the patient found in the backcountry with internal bleeding who went into cardiac arrest as a result of hypovolemic shock that a short transport time is unnecessary

ibrahim - March 24, 2012 5:57 AM

I must disagree. I live in South Africa. In our rural areas a road transport often leaves areas without ALS for up to twelve hours.The use of helicopter EMS gets the patient to definitive care within two hours and keeps the emergency services intact in the rural region. While helicopter services may be over-utilised in some cases, to make blanket statements regarding them overall lacks insight. Studies regarding silicon valley would be applicable to silicon valley and the administrators there would need to evaluate HEMS use. To use that as an argument against the industry as a whole does not apply. The mortality rate from world war 2 for major trauma cases was in the region of 4.4%. In Vietnam war the mortality rate had dropped to 1.7% and a large contribute to this improvement was the use of helicopters to get patients to definitive care quickly. The way in which HEMS is utilised is the key factor. It can be overutilised, just as ICU could. This does not mean that the benefit of HEMS is not significant

Mike Danko - March 24, 2012 7:23 AM

No one would suggest that helicopters are *never* appropriate for EMS transport. As both Ross and ibrahim point out, in some rural environments they can make a huge difference. The point is that the HEMS industry has grown tremendously. Overall, the risks outweigh the benefits. There are, of course, always individual exceptions.

Groete.

MSD

chris westley - January 9, 2013 7:06 AM

This is definitely a campaign by an aviation lawyer to drum up business. Not all operators are renegades, nor do they all drum up business. Shame on you! The helicopter is just one more tool to get a patient to definitive care.

Mike Danko - January 24, 2013 8:44 AM

And that tool, as a general rule, is over-utilized.

Alison Kesler - March 30, 2013 10:42 PM

There are some valid points to this article, however, there are also some large misconceptions as well. This problem is multi-faceted involving so many factors, I just can't list them all....
Beginnning with over-utilization, I would have to agree. That being said, often, in rural (and I mean mountainous and rugged rural) EMS, it can take upwards of 2-3 hours to get critically ill/injured patients to definitive care. Rural hospitals are just that....rural. They do not have the capacity to take care of folks who need either a coronary vessel opened or surgery for trauma, OR deliver a high hisk baby. Sometimes, helicopters are called to transport a less critical patient because if they don't, the area will not have ambulance coverage for 5-6 hours at a time. While I agree that this promotes over utilization, what other options do those rural hospitals have? They have neither the staff, nor budget to manage this problem the way health care is set up....muti-faceted....
Instead of generalizing rural EMS as renegades who like to hook every patient, how about looking deeper into the root of the problem?

I think there are some programs that push the envelope. Some programs who are not CAMTS certified do not have to report certain mechanical issues, for example, either that, or they choose not to. It's a disgrace, I agree wholeheartedly. I guarantee that there are some programs out there whose sole pupose is for everyone to go home safely at the end of the day and to provide the utmost in patient care....which, by the way, involves pain management, which is something I didn't read anything about in the article.

All helicopter programs are NOT created equal.
I tried to be succint, but not sure I suceeded...
Respectfully submitted.

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