Emergency Code Systems and Disaster Preparedness in Level-1 Trauma Centers in the US

2003 ◽  
Vol 10 (5) ◽  
pp. 529-b-530
Author(s):  
R. E Antosia
Keyword(s):  
Disaster Preparedness ◽  
Trauma Centers ◽  
The Us ◽  
Level 1

Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers

2013 ◽  
Vol 3 (1) ◽  
pp. 88-92
Author(s):  
Daniel S Mangiapani ◽  
Bret C Peterson ◽  
Ryan Kellogg ◽  
Fraser J Leversedge
Keyword(s):  
Real Time ◽  
Improve Patient Care ◽  
Hand Surgery ◽  
Emergency Call ◽  
Trauma Centers ◽  
Level Ii ◽  
The Us ◽  
Level 1 ◽  
Level I ◽  
Microvascular Replantation

ABSTRACT Purpose The inconsistency of subspecialty emergency call services is a growing concern as declining reimbursements, increased legal risk, and challenging social and professional issues present a deterrent to call panel participation. This study assessed call availability of hand and microvascular replantation surgery at all level I and II trauma centers in the US. Materials and methods Between May and December 2010, all level I (n = 137) and level II (n = 153) trauma centers across the US were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our IRBapproved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital. Results: Level 1 centers: 117 of 137 (85%) participated, of which 64 (54.7%) had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services 15 to 31 days per month and 3 hospitals supported 1 to 15 days per month. Ten hospitals indicated an inconsistent coverage which was difficult to estimate and 34 hospitals reported no coverage. Level 2 centers 132 of 153 (86.3%) participated, of which 38 (29%) had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services 15 to 31 days per month and 3 hospitals for 1 to 15 days per month. 84 hospitals reported no specific coverage protocol. Conclusion Consistent on-call availability for emergency hand and microvascular replantation services remains a challenge across the US: • 54.7% of level I trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage; • 29% of level II trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage. Over 50% had no specific coverage protocol; • Many hospitals indicated the presence of subspecialty hand surgery coverage, however microvascular replantation resources were not available consistently; • While not confirmed, the current study findings suggest that a more clearly defined and coordinated system of hand surgery and microvascular replantation emergency call coverage will likely improve the efficiency of a limited resource and, ultimately, improve patient care. Peterson BC, Mangiapani DS, Kellogg R, Leversedge FJ. Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers. The Duke Orthop J 2013;3(1):88-92.

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 Effect of the COVID-19 pandemic on the ability of level 1 trauma centers to meet American College of Surgeons research requirements

2021 ◽  
Vol 6 (1) ◽  
pp. e000692
Author(s):  
Robert M Madayag ◽  
Erica Sercy ◽  
Gina M Berg ◽  
Kaysie L Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
American College Of Surgeons ◽  
The Usa ◽  
Virus Exposure ◽  
Level 1 ◽  
Verification Process ◽  
Question Survey

IntroductionThe COVID-19 pandemic has had major effects on hospitals’ ability to perform scientific research while providing patient care and minimizing virus exposure and spread. Many non-COVID-19 research has been halted, and funding has been diverted to COVID-19 research and away from other areas.MethodsA 28-question survey was administered to all level 1 trauma centers in the USA that included questions about how the pandemic affected the trauma centers’ ability to fulfill the volume and research requirements of level 1 verification by the American College of Surgeons (ACS).ResultsThe survey had a 29% response rate (40/137 successful invitations). Over half of respondents (52%) reported reduced trauma admissions during the pandemic, and 7% reported that their admissions dropped below the volume required for level 1 verification. Many centers diverted resources from research during the pandemic (44%), halted ongoing consenting studies (33%), and had difficulty fulfilling research requirements because of competing clinical priorities (40%).DiscussionResults of this study show a need for flexibility in the ACS verification process during the COVID-19 pandemic, potentially including reduction of the required admissions and/or research publication volumes.Level of evidenceLevel IV, cross-sectional study.

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

2020 ◽  
Vol 86 (5) ◽  
pp. 467-475
Author(s):  
Sara Seegert ◽  
Roberta E. Redfern ◽  
Bethany Chapman ◽  
Daniel Benson
Keyword(s):  
Injury Severity ◽  
Trauma Centers ◽  
Activation Level ◽  
American College Of Surgeons ◽  
Before And After ◽  
Trauma Response ◽  
Level 1 ◽  
Transferred Patients ◽  
Trauma Activation ◽  
Level 1 Trauma Center

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care?

2011 ◽  
Vol 201 (4) ◽  
pp. 445-449 ◽  
Author(s):  
Tolulope A. Oyetunji ◽  
Adil H. Haider ◽  
Stephanie R. Downing ◽  
Oluwaseyi B. Bolorunduro ◽  
David T. Efron ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Trauma Centers ◽  
Adult Level ◽  
Specialized Care ◽  
Level 1

Hand and Microvascular – Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers

2011 ◽  
Vol 36 (8) ◽  
pp. 2
Author(s):  
Bret C. Peterson ◽  
Daniel Mangiapani ◽  
Ryan Kellogg ◽  
Fraser J. Leversedge
Keyword(s):  
Real Time ◽  
Trauma Centers ◽  
Level 1 ◽  
Microvascular Replantation

Differences in trauma mortality between ACS-verified and state-designated trauma centers in the US

Injury ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 186-191 ◽  
Author(s):  
Finn D. Schubert ◽  
Laura J. Gabbe ◽  
Marc A. Bjurlin ◽  
Audrey Renson
Keyword(s):  
Trauma Centers ◽  
The Us ◽  
Trauma Mortality

Diverticulitis Outcomes are Equivalent between Level 1 Trauma Centers and Community Hospitals in New Jersey

2015 ◽  
Vol 81 (6) ◽  
pp. 600-604 ◽  
Author(s):  
Stephen C. Gale ◽  
Dena Arumugam ◽  
Viktor Y. Dombrovskiy
Keyword(s):  
New Jersey ◽  
Acute Diverticulitis ◽  
Acute Care Surgery ◽  
Trend Test ◽  
Trauma Centers ◽  
Medical Database ◽  
Emergency General Surgery ◽  
Level 1 ◽  
Armitage Trend Test ◽  
Care Surgery

Traditionally, general surgeons provide emergency general surgery (EGS) coverage by assigned call. The acute care surgery (ACS) model is new and remains confined mostly to academic centers. Some argue that in busy trauma centers, on-call trauma surgeons may be unable to also care for EGS patients. In New Jersey, all three Level 1 Trauma Centers (L1TC) have provided ACS services for many years. Analyzing NJ state inpatient data, we sought to determine whether outcomes in one common surgical illness, diverticulitis, have been different between L1TC and nontrauma centers (NTC) over a 10-year period. The NJ Medical Database was queried for patients aged 18 to 90 hospitalized from 2001 to 2010 for acute diverticulitis. Demographics, comorbidities, operative rates, and mortality were compiled and analyzed comparing L1TC to NTC. For additional comparison between L1TC and NTC, 1:1 propensity score matching with replacement was accomplished. χ2, t test, and Cochran-Armitage trend test were used. From 2001 to 2010, 88794 patients were treated in NJ for diverticulitis. 2621 patients (2.95%) were treated at L1TCs. Operative rates were similar between hospital types. Patients treated at L1TCs were more often younger (63.1 ± 0.3 vs 64.7 ± 0.1; P < 0.001), nonwhite (43.1% vs 23.1%; P < 0.0001), and uninsured (11.0% vs 5.5%; P < 0.0001). After propensity matching, neither operative mortality (9.7% vs 7.9% P = 0.45), nor nonoperative mortality (1.2% vs 1.3% P = 0.60) were different between groups. Mortality and operative rates for patients with acute diverticulitis are equivalent between LT1C and NTC in NJ. Trauma centers in NJ more commonly provide care to minority and uninsured patients.

Optimizing Health Care Coalitions: Conceptual Frameworks and a Research Agenda

2015 ◽  
Vol 9 (6) ◽  
pp. 717-723 ◽  
Author(s):  
Nathaniel Hupert ◽  
Karen Biala ◽  
Tara Holland ◽  
Avi Baehr ◽  
Aisha Hasan ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Response ◽  
Disaster Preparedness ◽  
Research Agenda ◽  
Positive Impact ◽  
High Reliability ◽  
The United States ◽  
Health Care Facilities ◽  
The Us ◽  
Hospital Preparedness

AbstractThe US health care system has maintained an objective of preparedness for natural or manmade catastrophic events as part of its larger charge to deliver health services for the American population. In 2002, support for hospital-based preparedness activities was bolstered by the creation of the National Bioterrorism Hospital Preparedness Program, now called the Hospital Preparedness Program, in the US Department of Health and Human Services. Since 2012, this program has promoted linking health care facilities into health care coalitions that build key preparedness and emergency response capabilities. Recognizing that well-functioning health care coalitions can have a positive impact on the health outcomes of the populations they serve, this article informs efforts to optimize health care coalition activity. We first review the landscape of health care coalitions in the United States. Then, using principles from supply chain management and high-reliability organization theory, we present 2 frameworks extending beyond the Office of the Assistant Secretary for Preparedness and Response’s current guidance in a way that may help health care coalition leaders gain conceptual insight into how different enterprises achieve similar ends relevant to emergency response. We conclude with a proposed research agenda to advance understanding of how coalitions can contribute to the day-to-day functioning of health care systems and disaster preparedness. (Disaster Med Public Health Preparedness.2015;9:717–723)

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