Traumatic injuries are one of the leading causes of death in the U.S. The “golden hour” concept points out the critical first hour after an injury for optimizing survival. Helicopter air ambulances significantly reduce time to treatment and has improved trauma outcomes since their introduction in the 1970s. However, evidence has shown that trauma outcomes exhibit racial and ethnic disparities, raising concerns about whether race, like other non-clinical factors, affects the deployment of life-saving interventions such as air transport. Eradicating these disparities is key to ensuring equity in trauma care.
This is a population-based study that utilized data from the National Trauma Data Bank (NTDB), which compiled more than 6 million trauma records from over 900 U.S. trauma centers. The study focused on patients with severe injuries (injury severity score >15) who required urgent surgical intervention or intensive care at level I or II trauma centers with helicopter services. The study included racial and ethnic categories such as black, white, Asian, and Hispanic. Major outcomes included transport mode (helicopter versus ground ambulance) and mortality.
The analysis used log-binomial regression models, which estimated differences in transport use and outcomes across racial and ethnic lines, adjusting for various confounding factors. The analysis revealed significant racial and ethnic disparities in the use of helicopter air ambulances. Black and Asian patients were less likely to be airlifted, compared to White patients, despite the obvious survival benefits of air transport for severe trauma. These disparities were most pronounced in teaching hospitals and level I trauma centers, this is an issue of concern about potential barriers to equity in larger and more advanced hospitals. The gap in helicopter transport between racial and ethnic groups was not closed during the study period, indicating an ongoing problem that questions the current efforts to increase helicopter ambulance services.
This study included data from 341,286 patients treated at 458 level I or II trauma centers equipped with helicopter service. The mean age was reported to be 47±20 years, 71.6% (n = 243,936) were males, while 28.4% were females (n = 96,633) patients. Asian patients were less likely to receive helicopter transport than white patients (6.8% vs 21.8%), with an adjusted relative risk (aRR) of 0.38 (95% confidence interval (CI), 0.30-0.48; P < 0.001). This difference appeared most pronounced in teaching hospitals (aRR, 0.29; 95% CI, 0.21-0.40; P < 0.001) and level I trauma centers (aRR, 0.33; 95% CI, 0.24-0.44; P < 0.001).
Black patients had fewer helicopter transports (8.7% vs 21.8%; aRR, 0.42; 95% CI, 0.36-0.49; P < 0.001), especially in teaching hospitals (aRR, 0.41; 95% CI, 0.33-0.50; P < 0.001) and level I trauma centers (aRR, 0.40; 95% CI, 0.34-0.49; P < 0.001). A similar, although less significant, difference was seen for Hispanic patients. Helicopter transport was associated with reduced mortality risk as compared to ground transport (37.7% vs 42.6%; aRR, 0.87; 95% CI, 0.85-0.89; P < 0.001).
The analysis highlights that racial and ethnic minority populations, particularly black and hispanic patients, were less likely to get helicopter services, especially in urban centers with larger hospitals. This trend may indicate that nonclinical factors, rather than clinical ones, such as institutional practices or implicit biases, may be influencing the final decision in emergency medical services (EMS) systems.
This study highlights the need for further research into inequalities in trauma care, especially to expand the scope of helicopter air ambulance use in the U.S. Even though the accessibility of helicopter transport has improved, a significant disparity remains between racial and ethnic groups.
A multifaceted approach is proposed to address this problem, including improving reporting systems, enhancing triage protocols, and continuing training for EMS personnel. Therefore, addressing these disparities is essential to ensuring all trauma patients have equal access to life-saving care, irrespective of their race or ethnicity.
Reference: Mpody C, Rudolph MI, Bastien A, et al. Racial and ethnic disparities in the use of helicopter transport after severe trauma in the US. JAMA Surg. 2025. doi:10.1001/jamasurg.2024.6402
