Three types of vehicles are used during interhospital transport: ground ambulances, helicopters, and fixed-wing aircraft. The choice of a vehicle for a program is often dictated by the features of the anticipated population and the relative advantages and disadvantages of each mode of transportation.

AMBULANCES Ground ambulances are available at most medical centers but may require modification for optimal transport of pediatric patients. Their disadvantage is excessive travel time between hospitals when distances are great or when terrain, road conditions, or traffic congestion require slow travel. Their advantage is relatively low operating costs compared to other forms of transportation.

HELICOPTERS Helicopters provide the most rapid service when distances between hospitals are within approximately 150 mi. When landing facilities are available at both hospitals, helicopter transportation reduces transit time by at least two-thirds compared to ground ambulance. Noise and vibration levels are high, and it is rarely practical to stop the vehicle for the management of an emergency requiring a more stable environment. They also have a more confined patient care compartment compared to other vehicles. The impact of these problems can be minimized by extensive preparation of the patient prior to transport and sophisticated electronic monitoring. Because of their speed, helicopters are the vehicle of choice for programs transporting a high proportion of trauma patients for whom time to the receiving hospital is much more important than in-transit care. The major disadvantage of helicopters is the extremely high cost of operation. The purchase cost of a helicopter is usually in excess of $2,500,000; lease/operation contracts usually exceed $100,000 per month.

FIXED-WING AIRCRAFT Fixed-wing aircraft also offer the advantage of speed, which is five to six times that of ground ambulances. This advantage is only appreciated when distances exceed approximately 120 mi because of the additional time needed to transfer the patient and medical personnel between airports and hospitals. Fixed-wing aircraft are also much less costly to operate than helicopters.

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