What question did this study set out to answer?

The aim is to compare the effectiveness of helicopter emergency medical services and ground emergency medical services for severe trauma in mountainous areas.

April 1, 2026Open Access

Helicopter versus GROUND emergency medical services in mountainous trauma care: a comparative cohort study on time efficiency, golden hour achievement, and clinical outcomes in the Qinba region

Key Points

The aim is to compare the effectiveness of helicopter emergency medical services and ground emergency medical services for severe trauma in mountainous areas.
Single-center retrospective cohort design.
Involved patients with Injury Severity Score (ISS) ≥ 16.
Conducted propensity score matching for age, sex, APACHE II, and ISS scores.
Primary outcome measured was major in-hospital complications.
Comparison of time metrics and clinical outcomes post-transport.
HEMS achieved 71.43% golden hour compliance compared to 2.60% with GROUND (p < 0.001).
Transport time averaged 15 minutes for HEMS versus 105 minutes for GROUND (p < 0.001).
24-hour mortality was lower in HEMS (1.30%) than GROUND (10.39%) (p = 0.039).
HEMS led to fewer complications and shorter ICU and hospital stays.
HEMS associated with better discharge neurological status (GOS scores).

Abstract

To compare the time efficiency and clinical outcomes of helicopter emergency medical services (HEMS) versus ground emergency medical services (GROUND) for severe trauma in the mountainous Qinba region, with a focus on achieving the "golden hour" and its impact on patient prognosis. This single-center retrospective cohort study included severe trauma patients (Injury Severity Score ISS ≥ 16) transported by HEMS or GROUND between January 2018 and September 2025. Propensity score matching (1:1) was performed using age, sex, APACHE II, and ISS scores to control for confounding. The primary outcome was a composite of major in-hospital complications. "Golden hour" compliance was defined as completion of critical imaging (FAST/CT) and admission to the operating room or intensive care unit within 60 min of the emergency call. Time metrics, mortality, organ dysfunction (SOFA), length of stay, and discharge neurological status (GOS) were compared. After matching, 77 well-balanced pairs were formed. HEMS achieved a significantly higher golden hour compliance rate than GROUND (71.43% vs. 2.60%, p < 0.001). HEMS significantly reduced transport time (median 15 vs. 105 min, p < 0.001) and total call-to-hospital arrival time (46 vs. 158 min, p < 0.001). Clinically, HEMS was associated with lower 24-h mortality (1.30% vs. 10.39%, p = 0.039), lower composite major complication rate (7.88% vs. 26.33%, p = 0.026), lower SOFA scores (median 12 vs. 20, p < 0.001), shorter ICU (5.62 vs. 9.78 days, p < 0.001) and hospital stays (13.44 vs. 21.34 days, p < 0.001), and higher GOS scores at discharge (4.0 vs. 2.64, p < 0.001). Multivariable Cox regression identified HEMS as an independent protective factor for better outcomes. ROC analysis showed perfect discrimination of HEMS vs. GROUND by transport time and total arrival time (AUC = 1.000). In mountainous regions, HEMS markedly improves golden hour attainment, translating into reduced early mortality, fewer complications, milder organ dysfunction, shorter hospitalizations, and better neurological recovery. These findings support the integration of HEMS into trauma systems in geographically challenging areas.

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