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Interfacility Transports in a Largely Rural State: Incident Descriptives and Associated Factors for Air Transports

Author: Morgan Anderson | |

Associate Authors: Chad Pore | Joseph House | Douglas G. Butler, Jr.

Introduction
As EMS continues to face the burden of limited resources, it is important to analyze transport services for IFT to understand when and how they are being utilized, especially in differing population densities. Purpose is to describe differences in patients and variables associated with ground and air transports for IFT within Kansas (KS).

Methods

A retrospective analysis was performed of all IFT electronic patient care records within the state of KS from 2020 to 2021. This data was analyzed for descriptives of gender, age, race, provider primary impressions, initial Glasgow Coma Scale score (GCS), initial patient acuity, KS region, scene county location, procedure performed, medication given, and IFT destination state were extracted. Chi-square analysis and multivariable logistic regression model (aOR, 95% CI) was used to assess for statistical significance.

Results

There were 76,641 IFTs, with almost 13% transported by air (47% helicopter and 53% fixed wing). A majority of air IFT patients were male (57%), mean age of 50.8 ± 26.7, White (72%), had an initial acuity of critical or emergent (95%) and had a destination within KS (68%). A logistic regression model found the odds of utilizing air IFT compared to ground IFT was higher in pediatric patients (≤ 17 years) (aOR 2.5, 95% CI 2.3-2.8) compared to geriatric (≥ 65 years); stroke-
related (aOR 6.0, 95% CI 5.3-6.7) and respiratory-related provider primary impression (aOR, 2.1, 95% CI 1.9-2.3) compared to other impressions; a GCS of 3-8(severe) (aOR, 3.6, 95% CI 3.3-4.0) compared to 15 (normal); and a scene location of frontier (aOR 15.2, 95% CI 13.4-17.3), rural (aOR 11.6, 95% CI, 10.4-13.0) or densely settled rural county (aOR 8.6, 7.6-9.7) areas compared to urban areas.

Conclusion

Within KS, air IFT appears to be used more for pediatric patients, stroke, or respiratory-related incidents, severely ill/injured (GCS 3-8) patients, and within rural areas. Further analysis of mileage associated with en route/transport times traveled by EMS and transferring/transferred facility capabilities can help provide insight into specific needs for rural communities. Identifying factors which may influence ground vs air transport for IFT patients will help ensure resources are available and being used efficiently.