Good read.
We've known for a long time that the Golden Hour was not actually a thing. Severely traumatized patients with devastating injuries requiring truly urgent surgical intervention probably do benefit from more rapid transport. Think a tracheobronchial disruption from a car crash that requires lung isolation or a femoral artery destroyed by a .40 cal. These injuries cause death in a matter of minutes if not controlled surgically. I think this explains why there have been studies showing improved rates of survival when trauma patients in urban areas are thrown into a police car or POV and sped to a busy level one ED that happened to only be 4 minutes away, vs. waiting for EMS arrival, assessment, packaging, treating, and transport.
The vast majority of injuries though - even serious ones - really aren't all that time sensitive. CNS injury makes up the majority of serious civilian traumas and a very large percent of of HEMS transports, but how time sensitive are most TBI's, really? Generally, they are devastating injuries at the time of initial insult, or they are not. Secondary injury can be prevented by a well-trained ground crew just as well as a HEMS crew.
Also consider the fact that in areas that do the most HEMS transports, transport by HEMS often doesn't even save all that much time. 10 minutes? 20 minutes? 30? How likely really is that time savings to make a difference? These patients need expeditious transport to an appropriate facility with solid supportive care provided enroute, and as long as that's done, the vast majority of the time, a few minutes just isn't going to make a difference.
