Abstract 13837: Helicopter Emergency Medical Service Transport Time Savings for ST-elevated Myocardial Infarctions
Introduction: Decreasing time to percutaneous intervention (PCI) has been shown to dramatically improve outcomes in STEMI patients. Helicopter EMS (HEMS) STEMI transports are frequent, and incur high-profile costs, so it is important to ascertain HEMS cost-effectiveness for STEMI cases. This study aimed to work towards characterizing HEMS-for-STEMI cost-effectiveness by estimating time savings (i.e. decrease in interfacility transport time) associated with HEMS use as compared to ground transport. Secondarily, the study assessed whether HEMS-associated STEMI case time savings were similar in different HEMS programs located in different regions of the U.S.
Methods: The study was a prospective, non-interventional multi-center analysis of all interfacility HEMS flights for primary PCI gathered consecutively from 4 participating HEMS services from Nov 1, 2012 to Oct 31, 2013, with the primary endpoint of transport time obtained from run sheets. Previously validated methods using Google Earth were used to calculate ground EMS transport times. Time savings were calculated and compared HEMS-vs-ground and also between HEMS programs. Analysis was performed with STATA 13MP (StataCorp, College Station TX), and included Shapiro-Wilk testing (for normality), nonparametric sign-rank testing (for HEMS-vs-ground comparisons), and Kruskal-Wallis testing (for times comparisons between HEMS programs).
Results: The study assessed 262 interfacility transfers. The overall median time saved using HEMS compared was a statistically (p < .0001) and clinically significant 31 minutes (IQR: 15-47). Average time saved did differ across the 4 participating HEMS services (p < .0001); median (IQR) time savings for the four programs were 15 (10-31), 24 (18-32), 40 (17-47), and 47 (34-75).
Conclusions: Using an evidence-based rough guide of 10% STEMI mortality reduction per half-hour time savings, HEMS use in the study services appears - on average - to be likely to substantially improve outcome. The variability between HEMS services could lead to quality improvement efforts. If replicated for different HEMS services, the time savings (as surrogate endpoint for outcomes improvement) can be a useful factor in calculating cost-effectiveness.
Author Disclosures: J.J. Soulek: None. A.O. Arthur: None. A. Wang: None. A.P. Reimer: None. M. Simmons: None. M. Brunko: None. S.H. Thomas: None.
- © 2014 by American Heart Association, Inc.