Black, Asian, Hispanic trauma patients less likely to get lifesaving helicopter transport, finds first-of-its-kind study

Severely injured Black, Asian and Hispanic children and adults are less likely than white patients to receive critical helicopter ambulance services, which can make the difference between life and death, according to a study presented at the ANESTHESIOLOGY 2024 annual meeting. It is the first to highlight disparities in the use of helicopter ambulance transport after severe trauma.

“Severely injured patients are more likely to survive if they get the right care within the ‘golden hour,’ the critical first hour after the trauma,” said Christian Mpody, M.D., Ph.D., lead author of the study and anesthesiology resident at Montefiore Medical Center, New York. “The reality is that current efforts to expand helicopter ambulance programs have yet to result in equitable care for patients of different races and ethnicities.”

Traumatic injuries, such as those from vehicle or fall-related accidents and violent attacks, are a leading cause of death in the United States among children and adults. Patients with serious injuries who require urgent surgery or admission to the intensive care unit (ICU) should be taken to a hospital that provides the highest level of trauma care.

Usually, the decision to dispatch helicopter transport is based on the information received about the patient during the 911 call. A priority level is then assigned along with a response to dispatch air or ground emergency medical services (EMS) transport. Additionally, non-medical factors can influence the decision, such as weather conditions and the availability of a helicopter, but race and ethnicity should not be among them, said Dr. Mpody.

Researchers assessed hospital transport records for 307,589 adults and 42,812 children who had a severe life-threatening injury and required urgent surgery or ICU admission between 2017 and 2022. They used data from the National Trauma Data Bank, which is based on more than 7.5 million records from more than 900 U.S. trauma centers.

They separately analyzed trauma patients who were not injured within 15 miles of the receiving hospital to ensure that their findings were not mostly explained by a subgroup of patients who sustained trauma near a hospital, which would eliminate the need for helicopter transport. They also ruled out other possible reasons for the difference, such as lack or type of insurance and severity of injury.

Overall, they found transport via helicopter ambulance was associated with a statistically significant higher rate of survival: 82.4% of patients transported by helicopter ambulance survived vs. 80.6% of those transported by ground ambulance.

They also found statistically significant evidence that race and ethnicity play a role in whether a trauma patient received helicopter transport—particularly among Black patients—and determined that the numbers didn’t improve over the five years of the study. Overall:

• White adults were twice as likely to be air transported compared to Black adults (25.4% of white adults were air transported vs. 12.6% of Black adults, 13.5% of Asian adults and 15.9% of Hispanic adults).
• White children were 50% more likely to be air transported compared to Black children (33.6% of white children were air transported vs. 20% of Black children, 22.4% of Asian children and 24% of Hispanic children).

The researchers recommend a multifaceted system-wide approach to address the racial and ethical disparities in helicopter transport, including:

• More closely adhering to evidence-based triage scores to help identify which trauma patients would benefit most from helicopter transport, reducing the chance that race or ethnicity would influence the decision.
• Reinforcing structured communication protocols to help EMS providers make unbiased decisions about the need for helicopter transport.

“We need to keep collecting and analyzing data to better understand and fix disparities in trauma care,” said Dr. Mpody. “By doing this, we can identify service gaps and develop targeted solutions. When it comes to disparities, we need to do the opposite of ‘see no evil, hear no evil, speak no evil’—we must see it, hear it and speak out to fix it.”

Provided by
American Society of Anesthesiologists