Time is of the essence during a medical emergency, and helicopter transport often is essential to saving a patient teetering near death.
Unfortunately, Black, Asian and Hispanic people with life-threatening injuries are significantly less likely than white patients to be airlifted to a trauma center, according to a study published Jan. 22 in JAMA Surgery.
“Trauma is one of the leading causes of death in the U.S. and helicopter transport can make the difference between life and death by getting patients to the right care as quickly as possible,” said senior researcher Dr. Olubukola Nafiu, vice chair of research in anesthesiology at the Montefiore Medical Center and Albert Einstein College of Medicine in Bronx, N.Y.
The study’s results highlight “inequities in emergency care,” Nafiu added in a news release.
Severe trauma is best treated within what doctors call the “golden hour” after an accident, but more than a quarter of U.S. residents require helicopter transport to get them to a trauma center under that deadline, researchers said in background notes.
For the study, researchers analyzed records for more than 341,000 severely injured adults treated at 458 U.S. trauma centers between 2016 and 2022.
Nearly 22 percent of white patients requiring urgent surgery or ICU care received helicopter transport to a trauma center, results show.
By comparison, only 7 percent of Asian patients, 9 percent of Black patients and 11 percent of Hispanic patients were airlifted, even though their injuries were comparable to those of the white patients, researchers said.
These disparities persisted throughout the study period, “challenging the effectiveness of current efforts to expand helicopter ambulance programs,” researchers wrote in their paper.
“Even against a backdrop of increasing awareness of health care disparities in the US, we found no evidence that the racial and ethnic gaps in use of helicopter transport were narrowing over time, indicating that the recent expansion of helicopter ambulances has not translated into equitable access for all racial and ethnic groups,” the researchers added.
Access to air ambulance transport might be expanded by providing better training and tools to paramedics, researchers wrote.
“The role of EMS personnel in determining the optimal transport strategy cannot be overstated,” researchers wrote.
For example, applying evidence-based triage tools in a colorblind way could ensure that “patients who are most likely to benefit from helicopter transport, including potentially underserved racial and ethnic minority patients, will be more likely to receive it,” researchers wrote.
In an accompanying editorial, Dr. Cherisse Berry agreed that “eliminating disparities in access to care, particularly time-sensitive emergency care, is critical to achieving health equity for everyone.”
“Expeditious transport of critically injured patients by emergency medical services to verified trauma centers for definitive care can be the difference between survival, severe disability, and death,” wrote Berry, a surgeon with the Rutgers New Jersey Medical School in Newark. “Thus, in the trauma care chain of survival, the prehospital phase of care is the most critical link in minimizing disability and preventable death after injury.”
What are some inequities in emergency medicine?
Inequities in emergency care persist due to systemic factors. Racial and ethnic minorities often experience longer wait times, less thorough evaluations, and lower-quality treatment compared to white patients, even with similar conditions. Implicit bias, stemming from unconscious stereotypes, can influence clinical decision-making. Socioeconomic disparities play a role, as under-resourced communities often lack adequate emergency facilities, leading to overcrowding and delays. Geographic location matters; rural areas may have limited access to specialists and advanced care. Language barriers can also hinder effective communication, impacting diagnosis and treatment.
Furthermore, insurance status and ability to pay can influence the care received. Addressing these inequities requires multi-pronged approaches, including implicit bias training for healthcare providers, increased funding for underserved communities, improved language access services, and policies that promote equitable access to quality emergency care for all.
More information
The Council on Foreign Relations has more on the “golden hour” for trauma care.
SOURCE: Montefiore Medical Center and Albert Einstein College of Medicine, news release, Jan. 22, 2025