scholarly journals P056: Rural versus urban pre-hospital and in-hospital mortality following a traumatic event in Québec, Canada

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S97
Author(s):  
R. Fleet ◽  
F. Tounkara ◽  
S. Turcotte ◽  
M. Ouimet ◽  
G. Dupuis ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trauma Care ◽  
Traumatic Event ◽  
Small Towns ◽  
Rural Hospitals ◽  
Trauma Patients ◽  
Trauma Centres ◽  
Level 1 ◽  
Statistics Canada ◽  
Level 2

Introduction: Trauma remains the primary cause of death in people under 40 in Québec. Although trauma care has dramatically improved in the last decade, no empirical data on the effectiveness of trauma care in rural Québec are available. This study aims to establish a portrait of trauma and trauma-related mortality in rural versus urban pre-hospital and hospital settings. Methods: Data for all trauma victims treated in the 26 rural hospitals and 32 Level-1 and Level-2 urban trauma centres was obtained from Québec’s trauma registry (2009-2013). Rural hospitals were located in rural small towns (Statistics Canada definition), provided 24/7 physician coverage and admission capabilities. Study population was trauma patients who accessed eligible hospitals. Transferred patients were excluded. Descriptive statistics were used to compare rural with urban trauma case frequency, severity and mortality and descriptive data collected on emergency department (ED) characteristics. Using logistic regression analysis we compared rural to urban in-hospital mortality (pre-admission and during ED stay), adjusting for age, sex, severity (ISS), injury type and mode of transport. Results: Rural hospitals (N=26) received on average 490 000 ED visits per year and urban trauma centres (N=32), 1 550 000. Most rural hospitals had 24/7 coverage and diagnostic equipment e.g. CT scanners (74 %), intensive care units (78 %) and general surgical services (78 %), but little access to other consultants. About 40% of rural hospitals were more than 300 km from a Level-1 or Level-2 trauma centre. Of the 72 699 trauma cases, 4703 (6.5%) were treated in rural and 67 996 (93.5%) in urban hospitals. Rural versus urban case severity was similar: ISS rural: 8.6 (7.1), ISS urban: 7.2 (7.2). Trauma mortality was higher in rural than urban pre-hospital settings: 7.5% vs 2.6%. Reliable pre-hospital times were available for only a third of eligible cases. Rural mortality was significantly higher than urban mortality during ED stays (OR (95% IC): 2.14 (1.61-2.85)) but not after admission (OR (95% IC): 0.87 (0.74-1.02)). Conclusion: Rural hospitals treat equally severe trauma cases as do urban trauma centres but with fewer resources. The higher pre-hospital and in-ED mortality is of grave concern. Longer rural transport times may be a factor. Lack of reliable pre-hospital times precluded further analysis.

scholarly journals Trauma 2021Perceptions of a trauma team regarding in situ simulationEpidemiology of submersion injuries in Canadian children and adolescents: 1990–2018A survey of medical and administrative directors on REBOA use in Canadian trauma centresCut to the chase: comparing cutting tools in the exposure of simulated trauma patientsPediatric major trauma. Anaesthesia education: airway, breathing, coffee and cases 2020–2021Geriatric trauma care at a level 1 trauma centre: Are we following best practice?Was the introduction of a provincially standardized consensus statement for postintubation analgesia and sedation associated with increased use of associated pharmacological therapies in New Brunswick?Are there important variations in the care of adult trauma patients with isolated, nonoperative subdural hematomas between those admitted to a neurosurgical centre and those admitted to a non-neurosurgical centre for their entire inpatient stay?Flattening the curve on the negative psychosocial impact of trauma on the family of acute care trauma survivors: a quantitative studyDoes ACLS belong in ATLS? Seeking evidence during resuscitative thoracotomyAutologous omental harvest for microvascular free flap reconstruction of a severe traumatic scalp degloving injury: a case reportDerivation and validation of actionable quality indicators targeting reductions in complications for injury admissionsASA dosing practices in the management of blunt cerebrovascular injury: a retrospective reviewA retrospective analysis of bicycle lane collisions in Vancouver, British Columbia, from 2012 to 2017Evaluating the Screening, Brief Intervention and Referral to Treatment (SBIRT) process at Vancouver General HospitalAlcohol use and trauma in Alberta after COVID-19 lockdown: overrepresentation and undertreatment are opportunities for improvementMental health and addiction diagnoses are linked to increased violent injuries and gaps in provision of resources during the COVID-19 pandemicPain management strategies after orthopedic trauma in a level 1 trauma centre: a descriptive study with a view of optimizing practicesStudy to Actively Warm Trauma Patients (STAY WARM): a feasibility pilot evaluationPrehospital trauma care in civilian and military settings including cold environments: a systematic review and knowledge gap analysisAntibiotic administration in open fractures: adherence to guidelines at a Canadian trauma centreAre we meeting massive transfusion protocol activation and blood product delivery times in trauma patients? A retrospective review from 2014 to 2018Unplanned returns to the operating room: a quality improvement initiative at a level 1 trauma centreStopping the bleed: the history and rebirth of Canadian freeze-dried plasmaThe state of the evidence for emergency medical services (EMS) care of prehospital severe traumatic brain injury: an analysis of appraised research from the Prehospital Evidence-based Practice programA mixed methods study of a paramedic falls referral program in Nova ScotiaFirst presentations of psychiatric illness at a level 1 trauma centreAlcohol and substance abuse screening in pediatric trauma patients: examining rates of screening and implementing a screen for the pediatric populationMeasuring behavioural quality and quantity of team leaders during simulated interprofessional trauma careImproving rural trauma outcomes: a structured trauma-training program for rural family physicians with enhanced surgical skills — a pilot projectTrauma treatment: evidence-based response to psychological needs after a natural disasterHow prepared are Canadian trauma centres for mass casualty incidents?The catalytic effect of multisource feedback for trauma teams: a pilot studyRetrievable inferior vena cava filter for primary prophylaxis of pulmonary embolism in at-risk trauma patients: a feasibility trialValue of data collected by the medical examiner service on the quality of alcohol and toxicology testing in fatal motor vehicle collisionsPrehospital narrow pulse pressure predicts need for resuscitative thoracotomy and emergent surgical intervention after traumaImpact of a geriatric consultation service on outcomes in older trauma patients: a retrospective pre–post studyExploring physical literacy as a condition of fall mechanism in older adultsIs the use of business intelligence software helpful in planning injury prevention campaigns?Exposure to endotracheal intubation among trauma patients in level 5 trauma centres in New Brunswick — a retrospective reviewAre early specialist consultations helpful predictors of those who require care in level 1 or 2 designated trauma centres?Neurologic outcomes after traumatic cardiac arrest: a systematic reviewClosed-loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysisEmbolization in nonsplenic trauma: outcomes at a Canadian trauma hospitalThe matrix: grouping ICD-10-CA injury codes by body region and nature of injury for reporting purposesEvaluation of low-value clinical practices in acute trauma care: a multicentre retrospective studyTrauma 101: a virtual case-based trauma conference as an adjunct to medical educationPhysiologic considerations, indications and techniques for ECLS in trauma: experience of a level 1 trauma centreEngaging patients in the selection of trauma quality indicatorsStrategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping reviewAugmented reality surgical telementoring for leg fasciotomyIdentification of high-risk trauma patients requiring major interventions for traumatic hemorrhage: a prospective study of clinical gestaltEvaluating best practices in trauma care of older adultsBetween paradigms: comparing patient and parent experiences of injured adolescents treated at pediatric or adult trauma centresEarly outcomes after implementation of chest trauma management protocol in Vancouver General HospitalUtility of diagnostic peritoneal lavage versus focused abdominal sonography for trauma in penetrating abdominal injuryTime to definitive surgery and survival in pediatric patients younger than 18 years with gunshot woundsThe effect of chronic obstructive lung disease on post-traumatic acute respiratory distress syndrome: predictors of morbidity and mortalityThe association between injury type and clinical outcomes in patients with traumatic renal injury after nephrectomyWhen low complication rates are a bad sign: the negative impact of introducing an electronic medical record on TQIP data completenessClinical handover from paramedic services to the trauma team: a video review analysis of the IMIST-AMBO protocol implementationGeriatric Recovery and Enhancement Alliance in Trauma (GREAT) multidisciplinary quality improvement initiative: improving process and outcome measures for geriatric trauma patientsIncreasing the safety of inadvertent iliac artery device deployment with the COBRA-OS, a novel low-profile REBOA deviceIs it better to watch before or listen while doing? A randomized trial of video-modelling versus telementoring for out-of-scope tube thoracostomy insertion performed by search and rescue medicsIndications for prehospital civilian tourniquet application by first responders: an expert consensus opinion of military physicians by the Delphi method

2021 ◽  
Vol 64 (5 Suppl 1) ◽  
pp. S37-S64
Author(s):  
Olga Bednarek ◽  
Mike O’Leary ◽  
Sean Hurley ◽  
Caleb Cummings ◽  
Ruth Bird ◽  
...  
Keyword(s):  
New Brunswick ◽  
Trauma Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Trauma Patients ◽  
Trauma Outcomes ◽  
Trauma Centres ◽  
Level 1

scholarly journals Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie A. Sewalt ◽  
Benjamin Y. Gravesteijn ◽  
Daan Nieboer ◽  
Ewout W. Steyerberg ◽  
Dennis Den Hartog ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Absolute Benefit ◽  
Predicted Probability ◽  
Prehospital Triage ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

scholarly journals Maturation process and international accreditation of trauma system in a rapidly developing country

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243658
Author(s):  
Ayman El-Menyar ◽  
Ahammad Mekkodathil ◽  
Mohammad Asim ◽  
Rafael Consunji ◽  
Gustav Strandvik ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Trauma System ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Maturation Process ◽  
Level 1 ◽  
Group 2 ◽  
Group 1

Background As trauma systems mature, they are expected to improve patient care, reduce in-hospital complications and optimize outcomes. Qatar has a single trauma center, at the Hamad General Hospital, which serves as the hub for the trauma system that was verified as a level 1 trauma system by the Accreditation Canada International Distinction program in 2014. We hypothesized that this international accreditation was a major step, in the maturation process of the Qatar trauma system, that has positively impacted patient care, reduced complications and improved outcomes of trauma patients in such a rapidly developing country. Methods A retrospective analysis of data was conducted for all trauma patients who were admitted between 2010 and 2018. Data were obtained from the level 1 trauma center registry at Hamad Medical Corporation. Patients were divided into Group 1- pre-accreditation (admitted from January 2010 to October 2014) and Group 2- post-accreditation (admitted from November 2014 to December 2018). Patients’ characteristics and in-hospital outcomes were analyzed and compared. Data included patients’ demographics; injury types, mechanism and injury severity scores, interventions, hospital stay, complications and mortality (pre-hospital and in-hospital). Time series analysis for mortality was performed using expert modeler. Results Data from a total of 15,864 patients was collected and analyzed. Group 2 patients had more severe injuries in comparison to Group 1 (p<0.05). However, Group 2, had a lower complication rate (ventilator associated pneumonia (VAP)) and a shorter mean hospital length of stay (p<0.05). The overall mortality was 8%. In Group 2; the pre-hospital mortality was higher (52% vs. 41%, p = 0.001), while in-hospital mortality was lower (48% vs. 59%) compared to Group 1 (p = 0.001). Conclusions The international recognition and accreditation of the trauma center in 2014 was the key factor in the maturation of the trauma system that improved the in-hospital outcomes. Accreditation also brought other benefits including a reduction in VAP and hospital length of stay. However, further studies are required to explore the maturation process of all individual components of the trauma system including the prehospital setting.

Trauma Care During the COVID-19 Pandemic: A Canadian Survey

2021 ◽  
Vol 44 (4) ◽  
pp. E17-22
Author(s):  
Mostafa Alhabboubi ◽  
François De Champlain ◽  
Khalifa AlQaydi ◽  
Basem Algamdi ◽  
Joe Nemeth ◽  
...  
Keyword(s):  
Health Care ◽  
Response Rate ◽  
Health Care Systems ◽  
Trauma Patients ◽  
Trauma Centres ◽  
Online Platforms ◽  
Trauma Service ◽  
Care Systems ◽  
Level 1 ◽  
Injured Patients

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has placed major limitations on trauma health care systems. This survey aims to identify how Canadian trauma centres altered their processes to care for injured patients and protect their staff during the pandemic. Methods: A survey was distributed to trauma directors at level 1 Canadian adult trauma centres in July 2020. Questions included changes made to the trauma service in preparation for the pandemic, modification to clinical practice and expected lasting modifications after the pandemic. Results: The response rate was 68.4%. All trauma centres modified their treatment and investigation protocols for the pandemic. Most respondents adopted online platforms for meetings and educational activities and used simulation to prepare for COVID-19-infected trauma patients. The approach to who would intubate trauma patients, which trauma patients should be tested for COVID-19 and who should use N95 ventilators, varied among the sites surveyed. Conclusion: All centres modified some of their treatment and investigation protocols for the pandemic but not all modifications were adopted universally. Knowing these steps and comparing them with other global centres will help organize disaster plans for the current and future pandemics.

Comparison of Outcomes for Pediatric Trauma at Different Types of Trauma Centers: The Unresolved Mystery

2018 ◽  
Vol 84 (6) ◽  
pp. 1054-1057
Author(s):  
Adel Elkbuli ◽  
Jennifer R. Lopez ◽  
Paul Perales Villarroel ◽  
Darwin Ang ◽  
Huazhi Liu ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Health Care Administration ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Pediatric Hospital ◽  
Pediatric Hospitals ◽  
Crude Mortality Rate ◽  
Level 1 ◽  
Expected Mortality ◽  
Level 2

In Florida, injured children can receive emergent care at one of three types of state-approved trauma centers (TCs). A Level 1 combined adult/pediatric TC (L1, A + P), a Level 2 TC with an associated pediatric hospital (L2 + PH) or a pediatric TC at a pediatric hospital (PTH). This study aims to compare the mortality outcomes between Florida L1, A + Ps, to L2 + PHs, and PTHs. A retrospective review of dataset from the Agency for Health Care Administration compared outcomes from 2013 to 2016 at all three types of TCs. Outcomes were stratified by using the observed over expected mortality (O/E). Significance defined as P < 0.05. A total of 13,428 pediatric trauma patients were treated at all three TCs (L1, A + P, L 2 + PHs, or PTH). L1, A + Ps treated 6975 pediatric patients with 104 deaths [crude mortality rate (CMR) 1.49%, O/E = 0.96], L2 + PHs treated 4066 patients with 69 deaths (CMR 1.70%, O/E = 1.21), PTHs treated 2387 patients with 34 deaths (CMR 1.42%, O/E = 1.25). When O/E's at L1, A + Ps and L2 + PHs were compared, results were statistically significant (P = <0.03),but not at L1, A + P versus PTHs. This is the first study to reveal that Level 1 adult/pediatric TCs have lower mortality rates compared with Level 2 TCs with an associated pediatric hospital. Level 1,A + P TCs had similar outcomes to pediatric TCs at standalone pediatric hospitals.

scholarly journals A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany

2010 ◽  
Vol 80 (3) ◽  
pp. 145-150 ◽  
Author(s):  
Johanna M. M. Nijboer ◽  
Martin E. Wullschleger ◽  
Susan E. Nielsen ◽  
Anitia M. McNamee ◽  
Rolf Lefering ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Centres ◽  
Level 1

scholarly journals Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028512 ◽  
Author(s):  
Richard Fleet ◽  
François Lauzier ◽  
Fatoumata Korinka Tounkara ◽  
Stéphane Turcotte ◽  
Julien Poitras ◽  
...  
Keyword(s):  
Cohort Study ◽  
Outcome Measures ◽  
Trauma Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Trauma Registry ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Trauma Patients ◽  
Trauma Centres

ObjectivesAs Canada’s second largest province, the geography of Quebec poses unique challenges for trauma management. Our primary objective was to compare mortality rates between trauma patients treated at rural emergency departments (EDs) and urban trauma centres in Quebec. As a secondary objective, we compared the availability of trauma care resources and services between these two settings.DesignRetrospective cohort study.Setting26 rural EDs and 33 level 1 and 2 urban trauma centres in Quebec, Canada.Participants79 957 trauma cases collected from Quebec’s trauma registry.Primary and secondary outcome measuresOur primary outcome measure was mortality (prehospital, ED, in-hospital). Secondary outcome measures were the availability of trauma-related services and staff specialties at rural and urban facilities. Multivariable generalised linear mixed models were used to determine the relationship between the primary facility and mortality.ResultsOverall, 7215 (9.0%) trauma patients were treated in a rural ED and 72 742 (91.0%) received treatment at an urban centre. Mortality rates were higher in rural EDs compared with urban trauma centres (13.3% vs 7.9%, p<0.001). After controlling for available potential confounders, the odds of prehospital or ED mortality were over three times greater for patients treated in a rural ED (OR 3.44, 95% CI 1.88 to 6.28). Trauma care setting (rural vs urban) was not associated with in-hospital mortality. Nearly all of the specialised services evaluated were more present at urban trauma centres.ConclusionsTrauma patients treated in rural EDs had a higher mortality rate and were more likely to die prehospital or in the ED compared with patients treated at an urban trauma centre. Our results were limited by a lack of accurate prehospital times in the trauma registry.

scholarly journals Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032062 ◽  
Author(s):  
Ling-wei Kuo ◽  
Chih-Yuan Fu ◽  
Chien-An Liao ◽  
Chien-Hung Liao ◽  
Chi-Hsun Hsieh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Hospital Mortality ◽  
National Health Insurance ◽  
Low Income ◽  
Trauma Care ◽  
Trauma Patients ◽  
Research Database ◽  
Single Payer ◽  
Torso Trauma

​ObjectivesTo assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan.​DesignA nationwide, retrospective cohort study.​SettingAn observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI.​ParticipantsPatients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis.​Primary and secondary outcome measuresThe primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables.​ResultsIn univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001).​ConclusionEven with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.

A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters

2016 ◽  
Vol 31 (4) ◽  
pp. 413-421 ◽  
Author(s):  
Brendan G. Carr ◽  
Lauren Walsh ◽  
Justin C. Williams ◽  
John P. Pryor ◽  
Charles C. Branas
Keyword(s):  
Hospital Mortality ◽  
Simulation Model ◽  
Trauma Care ◽  
Trauma Center ◽  
Mortality Rates ◽  
Mass Casualty ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Disaster Scenario ◽  
Us Cities

AbstractBackgroundThough the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters.ObjectiveA proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events.MethodsTo demonstrate the model’s potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties.ResultsAcross all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks involved, on average, more trauma centers and had lower mortality rates compared with the remaining 16 cities.ConclusionsThe disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed.CarrBG, WalshL, WilliamsJC, PryorJP, BranasCC. A geographic simulation model for the treatment of trauma patients in disasters. Prehosp Disaster Med.2016;31(4):413–421.

scholarly journals P095: Who, what, where: a critical assessment of helicopter emergency medical services transport and transfer times on patient outcomes at two level 1 trauma centres

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S110-S110
Author(s):  
B. Nolan ◽  
A. Ackery ◽  
H. Tien ◽  
B. Sawadsky ◽  
S. Rizoli ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Emergency Medical Services ◽  
Trauma Centre ◽  
Medical Services ◽  
Trauma Patients ◽  
Helicopter Emergency Medical Services ◽  
Trauma Centres ◽  
Emergency Medical ◽  
Level 1 ◽  
Mode Of Transport

Introduction: Helicopter emergency medical services (HEMS) have become an engrained component of trauma systems to expedite transportation to a trauma centre. Ornge is a provincially run, paramedic-staffed HEMS that is responsible for all air ambulance service within Ontario, Canada. They provide transportation for trauma patients through one of three ways: scene call, modified scene call or interfacility transfer. In this study we report the characteristics of patients transported by each of these methods to two level 1 trauma centres and assess for any impact on morbidity or mortality. Methods: A local trauma registry was used to identify all patients transported to our two trauma centres by HEMS over a 36-month period. Data surrounding patient demographic, arrival characteristics, transport times and in-hospital course were abstracted from the registry. Statistical analysis will be used to compare methods of transport and characterize any association between mode of transport and mortality. Results: From January 1st, 2012 to December 31st, 2014 HEMS transferred a total of 911 patients to our trauma centers with an overall mortality rate of 11%. Of these patients 139 were scene calls with a mortality rate of 8%, 333 were modified scene calls with a mortality rate of 14% and 439 were interfacility transfers with a mortality rate of 10%. Conclusion: Identifying any association between the type of HEMS transport and morbidity and mortality, we may be able to predict those that need more urgent transfer to a trauma centre and find ways to decrease our overall pre-trauma center time.

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