A. Clinical

1. General

• Trauma victims need to be delivered as soon as possible to a regional trauma center.
• Stable patients who are accessible to ground vehicles probably are best transported by ground.

2. Specific

Patients with critical injuries resulting in unstable vital signs require the fastest most direct route of transport to a regional trauma center in a vehicle staffed with a team capable of offering critical care enroute. Often this is the case in the following situations:

• Trauma Score < 12;
• Glasgow Coma Scale score < 10;
• Penetrating trauma to the abdomen, pelvis, chest, neck, or head;
• Spinal cord of spinal column injury, or any injury producing paralysis of any extremity if any lateralizing signs;
• Partial or total amputation of an extremity (excluding digits);
• Two or more long bone fractures or a major pelvic fracture;
• Crushing injuries to the abdomen, chest, or head;
• Major burns of the body surface area, or burns involving the face, hands, feet or perineum, or burns with significant respiratory involvement or major electrical or chemical burns;
• Patients involved in a serious traumatic event who are less than 12 or more than 55 years of age;
• Patients with near-drowning injuries, with or without existing hypothermia; and /or
• Adult patients with any of the following vital sign abnormalities:
  1.) systolic blood pressure < 90 mmHg;
  2.) respiratory rate < 10 or > 35 per min;
  3.) heart rate < 60 or > 120 per min; or
  4.) unresponsive to verbal stimuli.

B. Operational situations in which helicopter use should be considered:

1. Mechanism of injury:

• Vehicle roll-over with unbelted passengers;
• Vehicle striking pedestrian at > 10 miles per hr;
• Falls from > 15 feet;
• Motorcycle victim ejected at > 20 miles per hr;
• Multiple victims.

2. Difficult access situations:

• Wilderness rescue;
• Ambulance egress or access impeded at the scene by road conditions, weather, or traffic.
  

Submitted by the Air Medical Services Committee
Reviewed by the Standards and Clinical Practice Committee (Chair: Bart Tortella, MD)
Discussion written by: Nicholas Benson, MD, Daniel Hankins, MD, and David Wilcox, MD
Approved by the NAEMSP Executive Committee, 20 October 1990
Adapted to Position Paper format by Herbert G. Garrison, MD
January - March 1992