Mass Casualty following Unprecedented Tornadic Events in the Southeast: Natural Disaster Outcomes at a Level I Trauma Center

2012 ◽  
Vol 78 (7) ◽  
pp. 770-773 ◽  
Author(s):  
Elizabeth H. Hartmann ◽  
Nathan Creel ◽  
Jacob Lepard ◽  
Robert A. Maxwell
Keyword(s):  
Soft Tissue ◽  
Length Of Stay ◽  
Emergency Preparedness ◽  
Trauma Center ◽  
Average Length ◽  
Mass Casualty ◽  
Incident Command ◽  
Trauma Service ◽  
Large Patient ◽  
Level I

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries.

scholarly journals Early Psychiatric Consultation Is Associated With Decreased Cost and Length of Stay in the Patient Population at a Level I Trauma Center

Cureus ◽  
2021 ◽  
Author(s):  
Marin A Chavez ◽  
Jason P Caplan ◽  
Curtis A McKnight ◽  
Andrew B Schlinkert ◽  
Kristina M Chapple ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Population ◽  
Trauma Center ◽  
Psychiatric Consultation ◽  
Level I

scholarly journals (P2-82) Developing and Implementing an Emergency Preparedness and Trauma Research Program in a New Level One Trauma Center

2011 ◽  
Vol 26 (S1) ◽  
pp. s163-s163
Author(s):  
T.E. Rives ◽  
C. Hecht ◽  
A. Wallace ◽  
R. Gandhi
Keyword(s):  
Emergency Preparedness ◽  
Trauma Center ◽  
Emergency Services ◽  
Mass Casualty ◽  
Senior Executives ◽  
Research Administration ◽  
Trauma Research ◽  
Uninsured Patient ◽  
Research Relationship ◽  
Trauma Surgeons

Our level one trauma center with a service area covering a population of approximately four-million people treats approximately 80,000 patients per year. In 2010, we anticipate more than 23,000 patients admitted, and to experience more than 850,000 patient encounters within the network. Trauma research is an important component to any level one trauma center, as well as a requirement of the American College of Surgeons/Committee on Trauma (ACS/COT). Our trauma center has recently gained level one designation and began an emergency preparedness research and trauma research (EPR/TR) program in earnest. We are fortunate to have support from executive administrators. Stewardship is a necessary element of our planning, in part because we are a county hospital serving a large uninsured patient population. The following are a few of the necessary steps we took to build an (EPR/TR) department from the beginning, to the point of submitting abstracts, manuscripts, funding grants, and presentations to regional, national, and international conferences, journals, and agencies. Structure the Emergency Preparedness Office to be a component of Trauma Services, allowing a unique opportunity for real-time disaster and mass casualty research. Secure a commitment from senior executives. Secure an experienced researcher, capable of research administration. Ensure the (EPR/TR) director, trauma medical director, trauma services director, and emergency preparedness coordinator can be a cohesive team with complimentary skills. Encourage trauma surgeons to perform research with assistance from the (EPR/TR) Office. Seek federal and foundation funding. Seek alliances with appropriate consortiums and associations. Develop a research relationship with pre-hospital emergency services. The above steps represent only some of the components used to build our (EPR/TR) department. We anticipate the planned expansion of the above steps will take our EPR/TR to the next level and increase extramural funding.

scholarly journals Influence of a Stay-At-Home Order on Trauma Volume and Injury Patterns at a Level I Trauma Center in Ohio

2021 ◽  
pp. 000313482110474
Author(s):  
Gregory S. Huang ◽  
Elisha A. Chance ◽  
C. Michael Dunham
Keyword(s):  
Trauma Center ◽  
Drug Testing ◽  
Injury Severity ◽  
Census Data ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Trauma Service ◽  
Level I ◽  
At Home

Background Changes in injury patterns during the COVID pandemic have been reported in other states. The objective was to explore changes to trauma service volume and admission characteristics at a trauma center in northeast Ohio during a stay-at-home order (SAHO) and compare the 2020 data to historic trauma census data. Methods Retrospective chart review of adult trauma patients admitted to a level I trauma center in northeast Ohio. Trauma admissions from January 21 to July 21, 2020 (COVID period) were compared to date-matched cohorts of trauma admissions from 2018 to 2019 (historic period). The COVID period was further categorized as pre-SAHO, active-SAHO, and post-SAHO. Results The SAHO was associated with a reduction in trauma center admissions that increased after the SAHO ( P = .0033). Only outdoor recreational vehicle (ORV) injuries ( P = .0221) and self-inflicted hanging ( P = .0028) mechanisms were increased during the COVID period and had substantial effect sizes. Glasgow Coma Scores were lower during the COVID period ( P = .0286) with a negligible effect size. Violence-related injuries, injury severity, mortality, and admission characteristics including alcohol and drug testing and positivity were similar in the COVID and historic periods. Discussion The SAHO resulted in a temporary decrease in trauma center admissions. Although ORV and hanging mechanisms were increased, other mechanisms such as alcohol and toxicology proportions, injury severity, length of stay, and mortality were unchanged.

mma-1. A Length-of-Stay Analysis of a Level I Urban Trauma Center

2003 ◽  
Vol 96 (Supplement) ◽  
pp. S57
Author(s):  
Robert G. Kayser ◽  
Bartholomew J. Tortella
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Level I

333 Undertriage in Trauma: Differences in Outcome Among Trauma Patients With Delayed Trauma Service Activation at a Level I Trauma Center

2011 ◽  
Vol 58 (4) ◽  
pp. S289-S290
Author(s):  
C. Rogen ◽  
T. Shiuh ◽  
P. Veneri ◽  
B. Campbell ◽  
C.J. Hoon ◽  
...  
Keyword(s):  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Service ◽  
Level I

The Affordable Care Act and its association with length of stay and payer status for trauma patients at a level I trauma center

2017 ◽  
Vol 213 (5) ◽  
pp. 870-873 ◽  
Author(s):  
Vicente Jose Undurraga Perl ◽  
Chris Dodgion ◽  
Kyle Hart ◽  
Bruce Ham ◽  
Martin Schreiber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Affordable Care Act ◽  
Trauma Center ◽  
Trauma Patients ◽  
The Affordable Care Act ◽  
Level I

Staff Commitment to Trauma Care Improves Mortality and Length of Stay at a Level I Trauma Center

2009 ◽  
Vol 66 (5) ◽  
pp. 1315-1320 ◽  
Author(s):  
Charles Mains ◽  
Kristin Scarborough ◽  
Raphael Bar-Or ◽  
Allison Hawkes ◽  
Jeffery Huber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Care ◽  
Trauma Center ◽  
Level I ◽  
Staff Commitment

scholarly journals Improving the Transition of Intravenous to Enteral Antibiotics in Pediatric Patients with Pneumonia or Skin and Soft Tissue Infections

2019 ◽  
Vol 15 (01) ◽  
pp. 9-15 ◽  
Author(s):  
Sonya C Tang Girdwood ◽  
Maria N Sellas ◽  
Joshua D Courter ◽  
Brianna Liberio ◽  
Michael J Tchou ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Length Of Stay ◽  
Average Length ◽  
Hospital Medicine ◽  
Community Acquired Pneumonia ◽  
Soft Tissue Infections ◽  
Patient Encounter ◽  
Statistical Process ◽  
Transition Criteria ◽  
The Impact

BACKGROUND: Despite national recommendations for early transition to enteral antimicrobials, practice variability has existed at our hospital. OBJECTIVE: The aim of this study was to increase the proportion of enterally administered antibiotic doses for Pediatric Hospital Medicine patients aged >60 days admitted for uncomplicated community-acquired pneumonia or skin and soft tissue infections from 44% to 75% in eight months. METHODS: This quality improvement study was conducted at a large, urban, academic children’s hospital. The study population included Hospital Medicine patients aged >60 days with diagnoses of pneumonia or skin and soft tissue infections. Interventions included education on intravenous and enteral antibiotic charge differentials, documentation of transition plan, structured discussions of transition criteria, and real-time identification of failures with feedback. Our process measure was the total number of enteral antibiotic doses divided by all antibiotic doses in patients receiving enteral medications on the same day. An annotated statistical process control chart tracked the impact of interventions on the administration route of antibiotic doses over time. Additional outcome measures included antimicrobial costs per patient encounter using average wholesale prices and length of stay. RESULTS: The percentage of enterally administered antibiotic doses increased from 44% to 80% within eight months. Antimicrobial costs per patient encounter and the associated standard deviation of costs for our target diagnoses decreased by 70% and 84%, respectively. Average length of stay did not change. CONCLUSIONS: Standardized communication about criteria for transition from intravenous to enteral antibiotics can lead to earlier transitions for patients with pneumonia or skin and soft tissue infections, subsequently reducing costs and prescribing variability.

Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience

2017 ◽  
Vol 83 (4) ◽  
pp. 394-398 ◽  
Author(s):  
Andrew Nunn ◽  
Peter Fischer ◽  
Ronald Sing ◽  
Megan Templin ◽  
Michael Avery ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Massive Transfusion ◽  
Unit Length ◽  
Hospital Length Of Stay ◽  
Modest Improvement ◽  
Massive Transfusion Protocol ◽  
Fresh Frozen ◽  
Level I ◽  
Transfusion Protocol

We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004–2012) that received massive transfusions (≥10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.

scholarly journals Length of stay patterns for patients of an acute care hospital: implications for nutrition and food services

2007 ◽  
Vol 31 (2) ◽  
pp. 282 ◽  
Author(s):  
Angela P Vivanti ◽  
Merrilyn D Banks
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Average Length ◽  
Acute Care Hospital ◽  
Tertiary Hospital ◽  
Service Planning ◽  
Care Hospital ◽  
Large Patient ◽  
Increased Risk ◽  
Time Periods

Objective: Shortened hospital average length of stay (ALOS) has been used to justify rationalisation of some services, but, by definition, some patients stay for longer than the average. The objective of this study was to explore lengths of stay and proportions of hospital occupied bed-days (OBDs) of those admitted for longer time periods to inform service planning. Methods: The proportion and ALOS of overnight separations at an Australian tertiary hospital were assessed for admissions of up to 4 days and 4 days or more. This was repeated for 7, 14 and 28 days. The proportion of OBD?s for each time period was determined. Results: While the proportion of total hospital patients staying for 4, 7, 14 and 28 days or more is relatively small (21.9%, 13.5%, 6.2%, 2.6%, respectively), they represent a large proportion of OBD?s (74.9%, 67.2%, 50.8%, 34.2%) with an ALOS of 14.0, 20.3, 33.7, and 54.4 days, respectively. The majority of long-stay patients were in acute care. Conclusion: Substantial proportions of OBD?s are due to patients admitted for time periods far greater than reflected by ALOS. Hospitals need to rethink how to optimally accommodate the nutrition and food requirements of the large patient numbers admitted for longer time periods, many of whom are at increased risk of malnutrition.

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