Air Medical Prehospital Triage Score and Racial and Ethnic Disparities in Air Transport After Injury

Importance The Air Medical Prehospital Triage (AMPT) score may attenuate disparities observed in recent data that demonstrated significantly lower odds of prehospital air medical transport (AMT) use among injured patients of minoritized race and ethnicity groups compared to non-Hispanic White patients. Objective To evaluate if using the AMPT score is associated with a reduction in racial and ethnic disparities in prehospital AMT use or a mortality benefit in patients who meet AMPT criteria. Design, Setting, and Participants This was a retrospective cohort study of the Pennsylvania Trauma Outcomes Study database from January 2000 to December 2020. Participants included injured patients aged 16 years and older who underwent ground or helicopter emergency medical service transport from the scene of injury, excluding those with transport distances less than 5 miles from the trauma center. Race and ethnicity were reported as per the dataset, which used patient self-report. Data were analyzed from February to August 2025. Exposure AMPT-assigned transport mode. Main Outcomes and Measures Actual prehospital transport mode (air vs ground) and AMPT-assigned transport mode were evaluated; in-hospital mortality was assessed by AMPT triage assignment. Socioenvironmental context was evaluated using the Area Deprivation Index (ADI), Social Deprivation Index (SDI), and Distressed Communities Index (DCI). Results The study cohort included 307 831 patients (mean [SD] age, 50.0 [25.3] years; 185 288 [60.2%] male; 2727 [0.9%] non-Hispanic Asian, 30 570 [10.2%] non-Hispanic Black, 8471 [2.8%] Hispanic/Latino, 253 491 [84.5%] non-Hispanic White, 4643, and [1.6%] other [including Alaskan Native, American Indian, and Asian, and Pacific Islander]). Non-Hispanic Asian, Non-Hispanic Black, and Hispanic/Latino patients were significantly less likely to undergo prehospital AMT compared to White patients. When assigning prehospital transport mode based on the AMPT score, no significant associations were observed between race and ethnicity and AMT use. Prehospital air vs ground transport was associated with 24% lower odds of mortality among patients who had an AMPT score of 2 or greater (adjusted odds ratio [aOR], 0.76; 95% CI, 0.58-0.99; P = .40). As ADI, DCI, and SDI scores increased, AMT use varied by race and ethnicity. Causal mediation analyses demonstrated that 38% (mediation effect, 0.38; 95% CI, 0.35-0.42), 40% (mediation effect, 0.40; 95% CI, 0.38-0.43), and 13% (mediation effect, 0.13; 95% CI, 0.11-0.18) of the effect of race and ethnicity on prehospital transport mode were explained by ADI, DCI, and SDI scores, respectively. Conclusions and Relevance The results of this cohort study indicate that standard use of the AMPT score during air medical triage may improve equity in prehospital AMT use.