Over centuries of medical care, those in the know at any given time felt confident that what they were doing to help people was, in fact, helpful. Many a doctor has laid hands on a child in her sick bed, administered a medicine, and reassured worried parents that all would be well. We modern-day doctors are no exception in believing that the treatments we give are the correct approach.

In looking back, we know that many treatments used in the past were not helpful, and some were actually harmful. Arsenic and bloodletting come to mind immediately.

A critical question to ask today is, “What treatments commonly used today will be thought of as useless or harmful by future generations of doctors?” Dextromethorphan? Thrombolytics for stroke? NSAIDs in the elderly? Coumadin? Botox?

What about the use of medical helicopters?

The use and number of medical helicopters has grown rapidly over the past two decades. According to the Adams Atlas & Database of Air Medical Services, there are now 840 rotary wing aircraft in operation. According to the Association of Air Medical Services, these services make more than 500,000 flights per year.

Enormous sums have been spent on helicopters, fuel, maintenance, pilots, nurses, paramedics, and training. With all this money being spent, it must be clear that helicopters are really good things to have—and they most certainly are directly responsible for saving the lives of hundreds of thousands of people per year. Or maybe not.

Helicopters are credited with saving many lives in war. Wounded are evacuated quickly to field hospitals where critical treatment is given. The logical conclusion was to apply this to civilian medical care. Is this logical?

In war, roads are bad and people shoot at you on the way to the hospital. This is not the case in America. In war, most injuries are blast or penetrating. Here at home, most of the trauma that comes by air is blunt. These differences may prove to be quite important.

One study shows that when an air medical service was discontinued, there was no change in trauma mortality or transport times (J. Trauma 2002;52:486-91). This is very interesting, but it may not apply universally. In the West, where transport times are long, helicopters may make a difference. In Maryland, where they have a statewide trauma system that flows to shock trauma in Baltimore, helicopters probably do make a difference.