Stabilization of Rural Multiple-Trauma Patients at Level III Emergency Departments Before Transfer to a Level I Regional Trauma Center☆,☆☆,★
Section snippets
INTRODUCTION
Several studies have demonstrated an increased risk of dying from trauma when a patient is injured in a rural area with a low population density and is treated at a small rural hospital.1, 2, 3 The failure to recognize injury severity, the failure to institute appropriate standard resuscitative treatment procedures, and the lack of timely surgical involvement have been implicated as factors contributing to death.4, 5, 6 Level I trauma centers must receive trauma patients from rural areas in a
MATERIALS AND METHODS
Wayne County, in upstate New York, is a large, predominantly rural county east of Rochester with a population of 85,000 and covering 607 square miles. Two hospitals serve the county: Newark-Wayne Community Hospital (80 acute-care beds) and Myers Community Hospital (50 acute-care beds). Each hospital's ED approximates Level III criteria as established by the American College of Surgeons Committee on Trauma guidelines. This was determined after author review of the services available at each
RESULTS
Fifty patients met the study entry criteria; 41 (82%) were male. The mean age was 34 years (range, 9 months to 97 years). Eleven patients (22%) were younger than 18 years. Forty-five patients (90%) were victims of blunt trauma. Of these, the cause of trauma was motor vehicle accident for 36 (72%), a fall for 7 (14%), and other blunt injury for 2 (4%). Motor vehicle accident victims included five (10%) bicyclists struck by cars, six (12%) pedestrians struck by cars, and two (4%) involved in
DISCUSSION
In the 1980s, regionalized trauma care predominantly took place in areas with a high population density and short transportation distances and benefited from adequate funding. The problems inherent to rural areas with low population density have been documented.1, 2, 3, 4, 5, 6
Baker and O'Neil1 demonstrated an inverse correlation between population density and mortality from motor vehicle crashes. The higher death rates in rural areas with a low population density were attributed to higher
CONCLUSION
Triage and stabilization of severely injured rural trauma victims at rural Level III EDs before Level I transfer can provide outcomes comparable to national standards. Unexpected death before transfer remains a problem in rural Level III EDs. The establishment and staffing of rural Level III EDs by emergency physicians may have a profound impact in the care of the rural trauma victim, because emergency physicians have expertise in trauma care and resuscitation.
Acknowledgements
The authors thank Jean Welch, RN (Trauma Coordinator, Strong Memorial Hospital), and Sam Bean, RN (Nurse Manager, ED at Myers Community Hospital), for their help in data collection.
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Cited by (44)
Outcomes of rural trauma patients who undergo damage control laparotomy
2019, American Journal of SurgeryCitation Excerpt :While not specifically addressing DCL, Veenema and Rodewald discussed the importance of stabilizing rural patients at level III emergency departments before transfer to level 1 trauma center.12 Using TRISS methodology, they were able to show that with stabilization at a level III facility, the number of actual deaths was less than the predicted number of deaths.12 DCL should be included as a tool for stabilization.
The impact of transfer on pediatric trauma outcomes
2016, Journal of Pediatric SurgeryTrauma
2008, Emergency Medicine Clinics of North AmericaImproving outcomes in a regional trauma system: impact of a level III trauma center
2006, American Journal of SurgeryCitation Excerpt :This supports the hypothesis that regional trauma center care after initial evaluation and resuscitation elsewhere can be effective even when timing of transfer is suboptimal. Veenema and Rodewald [3] reported that triage and stabilization of severely injured rural trauma victims at a level III emergency department before transfer to a level I trauma center resulted in outcomes similar to MTOS data. Rogers et al [4] similarly demonstrated that trauma care in rural areas involving initial stabilization at outlying hospitals did not adversely affect mortality.
Strategic Decision-Making in Trauma Systems
2024, Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)
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From the Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
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Address for reprints: Kenneth R Veenema, MD, FACEP, Department of Emergency Medicine, 601 Elmwood Avenue, Box 655, Rochester, New York 14642, 716-275-4503
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Reprint no. 47/1/61848