ArticleThe journal of trauma and acute care surgery2025
How many minutes matter: Association between time saved with air medical transport and survival in trauma patients.
Article in The journal of trauma and acute care surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- No "Golden Hour" in Alaska: Characteristics and Implications of Medevac-centered Emergency Care.The western journal of emergency medicine · 2026Article
- Establishing a Consensus-Based Definition of Air Medical Transport Need for Rural Patients After Injury: Results from a Delphi Survey.Prehospital emergency care · 2026Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundAir medical transport (AMT) offers a survival advantage to trauma patients for several reasons, including time-savings over ground transport. Triage guidelines suggest AMT use when there are significant time-savings, but how much time needs to be saved to confer a benefit is unclear. Our objective was to define the time-savings threshold for which AMT has a survival benefit over ground transport.
methodsRetrospective cohort of adult trauma patients transported ≤40 miles by ground or air in the Pennsylvania Trauma Outcomes Study 2000 to 2017. Geographic information system network analysis generated the counterfactual transport mode times, and we calculated a time-savings of AMT for each patient. We used restricted cubic splines to allow for non-linear effects of time-saved within multilevel logistic regression to identify a threshold of AMT time-savings associated with survival. Subgroups of patients meeting physiologic or anatomic criteria from the National Field Triage Guidelines (NFTG) and those with a positive Air Medical Prehospital Triage (AMPT) Score were analyzed.
resultsThere were 280,271 patients included. The NFTG subgroup had survival advantage starting at 13 minutes of AMT time-saved (adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.30). The AMPT subgroup had survival advantage starting at 23 minutes with the greatest magnitude of improvement (adjusted odds ratio, 1.22; 95% confidence interval, 1.01-1.48). Among patients that did not meet either NFTG criteria or the AMPT score, no amount of time-saved by AMT was associated with survival ( p > 0.05). Sensitivity analysis accounting for injury severity in scene time showed the survival benefit starting at 17 minutes of AMT time-saved for the NFTG subgroup and remained 23 minutes in the AMPT subgroup.
conclusionAmong patients meeting physiologic or anatomic NFTG criteria, a ≥ 13- to 17-minute AMT time-savings threshold was associated with improved survival. There is heterogeneity among this threshold among different patient groups that may be due to other benefits of AMT, such as advanced capabilities. These findings can inform AMT triage guidelines. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.
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