Date of Award

Summer 6-17-2022

Access Type

Dissertation - Open Access

Degree Name

Doctor of Philosophy in Human Factors


College of Arts & Sciences

Committee Chair

Joseph R. Keebler

First Committee Member

Elizabeth H. Lazzara

Second Committee Member

Alex Chaparro

Third Committee Member

Albert J. Boquet

Fourth Committee Member

Rosemarie Fernandez


The helicopter as a method of emergency medical service transportation of trauma patients has a long history of effective use-cases dating back to its inception during the Vietnam war. Compared to ground-based emergency medical transit, helicopters have been able to reach severely injured patients in environments with challenging terrain features that ground-based medical services cannot traverse. Additionally, the helicopter offers quicker and more direct-route transit options that result in both quicker response and shorter transportation times compared to their ground-based alternative. Further, research has indicated that helicopter ambulance teams utilize paramedics with more experience than ground ambulance paramedics. Prior research has provided evidence that these factors contribute to the higher survivability rates and lower length of stay times for patients. While evidence of the increased patient health-related outcomes of helicopter-transported patients remains consistent, there is controversy in the relationship between the studied factors and patient outcomes. Specifically, conflicting reports of transportation time on patient outcomes as well as the lack of observed data on paramedic experience on helicopter medical transports have resulted in an inconclusive understanding of why helicopter patients receive better health outcomes compared to ground ambulance patients. One aspect of patient care that has yet to be investigated but is previously hypothesized to be a factor in contributing to better patient health outcomes is that of the emergency medical service to emergency department trauma center handoff where information transfer between helicopter medical teams and trauma teams may be higher than ground team. Therefore, the purpose of this investigation is to advance the understanding of the relationship between patient health outcomes and patient transportation modality. This research utilized 223 transcripts of emergency medical service to trauma center handoffs. Information given as well as information questioned by the EMS, trauma team, and patients during the handoff as well as the severity of the patient’s injury, resources utilized by the trauma team, modality of transportation, and other identified control variables were used to investigate the relationship between helicopter and ground ambulance and patient care outcomes from a handoff-perspective. Additionally, the moderating factors of the modality of transportation on the information given and information questioned were investigated. Results indicated that more descriptive handoffs during emergency medical service to trauma team patient transfer contributed to lower patient mortality and longer emergency department lengths of stay when accounting for relevant control variables. Alternatively, more information questioned, when controlling for similar variables, led to higher rates of mortality. Results further indicated that the modality of transportation and its moderating effects on the information given and information questioned had no effects on either patient mortality or emergency department length of stay. The implications of this investigation as well as the considerations for future work are discussed.