scholarly journals From roadside to hospital: A pilot study to investigate the factors influencing the time taken to deliver trauma patients to a regional hospital

2015 ◽  
Vol 6 (3) ◽  
Author(s):  
Malcolm Boyle ◽  
Peter O’Meara
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Emergency Services ◽  
Prehospital Care ◽  
Trauma System ◽  
Regional Hospital ◽  
Adverse Outcomes ◽  
Trauma Patients ◽  
Transport Time ◽  
The Right

IntroductionOne of the trauma system objectives for the ambulance service is to get the right patient to the right hospital in a timely manner. The Review of Trauma and Emergency Services in Victoria, Australia, identified prolonged prehospital scene times of greater than 20 minutes for non trapped patients as a deficiency that may have adverse outcomes for severely injured trauma patients. The objective of this pilot study was to identify the factors that impact on the timely transfer of trauma patients from the scene of an incident to a regional hospital emergency department and justification for the delays, as the basis for a further detailed study.MethodsA retrospective pilot cohort study of trauma patients transported by ambulance to the emergency department of the Latrobe Regional Hospital over a six-month period who had an emergency department triage category of 1, 2 or 3 was undertaken. Data relating to the prehospital care of trauma patients with scene times > 20 minutes and transport times > 30 minutes were extracted from Rural Ambulance Victoria patient care records and hospital patient records. Ethics approval was granted.ResultsThere were 70 trauma patients transported to the hospital during the collection period. Of these 49 patients were available for analysis, 21 cases were excluded due to incomplete time or ED triage details. There were 12 cases where scene times were > 20 minutes. Only one paramedic crew spent an unjustifiably long time at the scene and only one patient had a transport time to hospital > 30 minutes.ConclusionThis pilot study confirms that there are prolonged prehospital scene times involving paramedics, however, the study suggests that most of the extended times are explained by factors outside the control of the attending paramedics. There was only one case where the scene time was not justified. One patient had a transport time > 30 minutes which was due to the patient being taken to a higher level of care. Experiences from this pilot study have led to changes in subsequent prehospital trauma studies.

SP9.1.7 Emergency Laparotomy for Trauma in the United Kingdom and Ireland: a Prospective Multicentre Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Paul Vulliamy ◽  
Max Marsden ◽  
Richard Carden ◽  
Karim Brohi ◽  
Ross Davenport ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Prehospital Care ◽  
Trauma System ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Transfusion Rate ◽  
Young Males ◽  
Prospective Multicentre Study ◽  
The Uk ◽  
Emergency Abdominal Surgery

Abstract Aims Trauma patients requiring abdominal surgery have significant morbidity and mortality, but are not included in existing national audits of emergency laparotomy. The aim of this study was to examine processes of care and outcomes among trauma patients undergoing emergency abdominal surgery in the UK and Ireland. Methods A prospective trainee-led multicentre audit was conducted over six months from January 2019 across the national trauma system. Patients undergoing laparotomy or laparoscopy within 24 hours of injury were included. Subgroup analysis was conducted in those requiring major haemorrhage protocol (MHP) activation. Results The study included 363 patients from 34 hospitals (22 major trauma centres). The majority were young males with no co-morbidities who required surgery for control of bleeding (51%) or exploration of penetrating injuries (46%). Over 85% received consultant-led care in the emergency department (318/363) and operating theatre (321/363). The MHP subgroup made up 45% of the cohort but accounted for 97% of deaths and 79% of ICU days, with a mortality rate of 19% and a massive transfusion rate of 32%. Compared to non-MHP patients they had shorter times to theatre (122 vs 218 minutes, p < 0.001), higher rates of advanced prehospital care (60% vs 33%, p < 0.001) and higher rates of consultant-led care (95% vs 85%, p < 0.001). Conclusion The majority of trauma patients requiring emergency abdominal surgery receive consultant-delivered perioperative care which is appropriately tailored to patient risk profile. Despite this, mortality and resource utilization among high-risk patients remains substantial, justifying ongoing performance improvement initiatives and research into novel therapeutics.

Hurricane Impact on Emergency Services and Use of Telehealth to Support Prehospital Care

2019 ◽  
Vol 14 (1) ◽  
pp. 39-43
Author(s):  
David M. French ◽  
Greg A. Hall ◽  
Todd McGeorge ◽  
Michael Haschker ◽  
Joseph G. Brazeal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Management ◽  
Emergency Services ◽  
Health Care Systems ◽  
Prehospital Care ◽  
Storm Duration ◽  
Care Systems ◽  
Hurricane Impact ◽  
State And Local ◽  
The Impact

ABSTRACTThe impact of hurricanes on emergency services is well-known. Recent history demonstrates the need for prehospital and emergency department coordination to serve communities during evacuation, storm duration, and cleanup. The use of telehealth applications may enhance this coordination while lessening the impact on health-care systems. These applications can address triage, stabilization, and diversion and may be provided in collaboration with state and local emergency management operations through various shelters, as well as during other emergency medical responses.

Prehospital Care and In-hospital Mortality of Trauma Patients in Iran

2014 ◽  
Vol 29 (5) ◽  
pp. 473-477 ◽  
Author(s):  
Mohammad Paravar ◽  
Mehrdad Hosseinpour ◽  
Mahdi Mohammadzadeh ◽  
Azade Sadat Mirzadeh
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Publication Type ◽  
Transport Time ◽  
Severe Injuries

AbstractIntroductionThe aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

scholarly journals Lack of Prioritization Causes Extended Time to Assessment of Severely Injured Trauma Patients in a Resource-Scarce Emergency Department

2019 ◽  
Vol 34 (s1) ◽  
pp. s144-s145
Author(s):  
Maria Lampi ◽  
John Tabu ◽  
Johan Junker ◽  
Andreas Wladis
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Prehospital Care ◽  
Medical Intervention ◽  
Trauma Patients ◽  
Triage System ◽  
Post Test ◽  
Care Systems ◽  
Sub Saharan ◽  
A Prospective Study

Introduction:The time between injury and medical intervention is crucial in trauma care. Triage is essential to ensure prioritization and timely assessment of injured patients.Aim:To investigate how the lack of triage system impacts timely intervention in a sub-Saharan hospital emergency department, and to investigate potential benefits of triage towards efficient management of trauma patients.Methods:A prospective study including adult trauma patients admitted to the emergency department at Moi Teaching and Referral Hospital in Eldoret, Kenya, was conducted. Mode of arrival, vital parameters, time before physician’s assessment, and mortality were registered. Retrospectively, Injury Severity Score (ISS) was calculated, and patients were categorized according to the Rapid Emergency Triage and Treatment System (RETTS).Results:A total of 571 patients were analyzed, revealing a mean ISS of 12.2 (SD 7.7) and a mean length of stay of 11.6 (SD 18.3) days. 70% of the patients arrived by taxi, private car, or police car; only 17.6% were transported by ambulance. RETTS categorization was compared with ISS using a Kruskal-Wallis test with Dunn’s multiple comparisons post-test. A higher average ISS was found in the red category compared to other categories (H(df) = 24.47(4), p < 0.001). A Spearman correlation test between ISS and time to assessment revealed an r value of −0.041 (p = 0.43).Discussion:The results clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. Since there was no difference in time to assessment regardless of ISS, the need for a triage system is apparent. Currently, the implementation and evaluation of a validated triage tool at the emergency department are underway. Moreover, the finding that less than 18% of trauma patients are transported to the emergency department by ambulance illustrates the need to develop prehospital care systems.

Poland’s syndrome mimicking traumatic chest injury

2021 ◽  
Vol 14 (5) ◽  
pp. e241408
Author(s):  
May Honey Ohn ◽  
Khin Maung Ohn
Keyword(s):  
Emergency Department ◽  
Anterior Chest Wall ◽  
Congenital Disorder ◽  
Chest Injury ◽  
Trauma Patients ◽  
Poland’S Syndrome ◽  
Hand Deformities ◽  
Poland's Syndrome ◽  
Pectoralis Muscles ◽  
The Right

Poland’s syndrome (PS) is a rare developmental anomaly that can manifest mild (pectoralis muscles involvement) to severe deformities (rib hypoplasia and hand deformities). We report a case of 69-year-old man who presented to the emergency department with a traumatic chest injury after a fall. It was initially thought to have a significant chest injury as the trauma survey revealed a palpable defect and tenderness in the right anterior chest wall. There was also a symbrachydactyly deformity in the right hand. CT of the chest showed lack of right pectoralis muscles, which were consistent with PS. This case highlights the importance of gathering detail history in adult trauma patients such as congenital disorder especially in the presence of bony deformity. With possibilities of several traumatic conditions in trauma patients eliminated, one can expand the non-traumatic differential, keeping in mind the possibility of a congenital disorder that can mimic traumatic chest injury.

Primary Care or A&E? a Study of Patients Redirected from an Accident & Emergency Department

2000 ◽  
Vol 45 (5) ◽  
pp. 144-147 ◽  
Author(s):  
E.A. McGugan ◽  
W. Morrison
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Pilot Study ◽  
Care Setting ◽  
Primary Care Setting ◽  
Young Men ◽  
Working Hours ◽  
Adverse Outcomes ◽  
Limited Resources

A departmental policy was introduced whereby patients with a complaint of over three days duration are assessed at triage by senior doctors as to whether they should be seen in A&E or redirected to primary care. This pilot study aimed to establish numbers, demographics, reasons for attending and outcome. A total of 179 patients were studied. Most were young men attending during working hours on week days. Most had symptoms for more than one week and had not seen their GP. Of 137 patients advised to see their GP — 67 did so. No adverse outcomes were reported. Twenty-three patients were seen in A&E: six had fractures, one required admission. Limited resources and increasing demands means that A&E must define its service. This system selects out those patients with prolonged symptoms who are likely to be able to be managed in the primary care setting.

Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls

2018 ◽  
Vol 33 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Mark Levitan ◽  
Madelyn P. Law ◽  
Richard Ferron ◽  
Karen Lutz-Graul
Keyword(s):  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Emergency Services ◽  
Life Support ◽  
Systems Approach ◽  
Prehospital Care ◽  
Trauma Patients ◽  
Publication Type ◽  
Complex Adaptive ◽  
Facilitators And Barriers

AbstractIntroductionAccording to Ontario, Canada’s Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves. It is also the first study to explore this issue from a complex, adaptive systems approach which recognizes that OSTs may be impacted by local, contextual features.ProblemResearch addressed the following problem: what are the facilitators and barriers to achieving 10-minute OSTs?MethodsThis project used a descriptive, qualitative design to examine facilitators and barriers to achieving 10-minute OSTs on trauma calls, from the perspective of paramedics. Paramedics from a regional Emergency Services organization were interviewed extensively over the course of one year, using qualitative interviewing techniques developed by experts in that field. All interviews were recorded, transcribed, and entered into NVivo for Mac (QSR International; Victoria, Australia) software that supports qualitative research, for ease of data analysis. Researcher triangulation was used to ensure credibility of the data.ResultsThirteen percent of the calls had OSTs that were less than 10 minutes. The following six categories were outlined by the paramedics as impacting the duration of OSTs: (1) scene characteristics; (2) the presence and effectiveness of allied services; (3) communication with dispatch; (4) the paramedics’ ability to effectively manage the scene; (5) current policies; and (6) the quantity and design of equipment.ConclusionThese findings demonstrate the complexity of the prehospital environment and bring into question the feasibility of the 10-minute OST standard.LevitanM,LawMP,FerronR,Lutz-GraulK.Paramedics’ perspectives on factors impacting on-scene times for trauma calls.Prehosp Disaster Med.2018;33(3):250–255.

Use of 911 for Rapid Re-Triage of Critical Trauma Patients

2020 ◽  
Vol 35 (5) ◽  
pp. 488-494
Author(s):  
Jake Toy ◽  
Clayton Kazan ◽  
Marianne Gausche-Hill ◽  
Nichole Bosson
Keyword(s):  
Community Hospital ◽  
Trauma System ◽  
High Volume ◽  
Trauma Patients ◽  
Hospital Data ◽  
Transport Time ◽  
Educational Module ◽  
Common Criteria ◽  
Total Transport ◽  
New Community

AbstractObjectives:The objective of this study was to evaluate the effectiveness of a 911 trauma re-triage protocol implemented at a new community hospital in a region with a high volume of trauma and frequent transports by private vehicle.Methods:This retrospective cohort study included all trauma patients ≥15 years old transferred via 911 trauma re-triage from a new community hospital over a 10-month period from August 2015 through April 2016. Criteria for 911 trauma re-triage were developed with input from local Emergency Medical Services (EMS) and trauma experts. An educational module, along with the criteria and implementation steps, was distributed to the emergency department (ED) personnel at the community hospital. Data were abstracted from the regional trauma registry, and the EMS patient care records were reviewed. Primary outcomes were: (1) median total transport time; and (2) proportion of patients who met the 911 re-triage criteria.Results:During the study period, 32 patients with traumatic injuries were transferred via 911 re-triage to the closest trauma center (TC). The median age of patients was 31 years (IQR 24-45 years) with 78% male and 66% suffering from a penetrating mechanism. The median prehospital provider scene time was 10 minutes (IQR 8-12 minutes) and transport time was seven minutes (IQR 6-9 minutes). Median total transport time was 17 minutes (IQR 15-20 minutes). Seventeen patients (53%) met 911 re-triage criteria as determined by study investigators. The most common criteria met was “penetrating injury to the head, neck, or torso” in 14 cases.Conclusion:This study demonstrated that 911 re-triage was a feasible strategy to expeditiously transfer critical trauma patients to a TC within a mature trauma system in an urban-suburban setting with a median total transport time of 17 minutes.

How Much Time Do Unhospitalized Patients Applying For Emergency Services Stay in Emergency Department

2013 ◽  
Vol 1 (1) ◽  
pp. 16
Author(s):  
Mansur Kursad Erkuran ◽  
Arif Duran ◽  
Tarık Ocak ◽  
Mervan Bekdaş
Keyword(s):  
Emergency Department ◽  
Emergency Services

scholarly journals Optimizing Emergency Medical Service Structures Using a Rule-Based Discrete Event Simulation—A Practitioner’s Point of View

2021 ◽  
Vol 18 (5) ◽  
pp. 2649
Author(s):  
Christoph Strauss ◽  
Günter Bildstein ◽  
Jana Efe ◽  
Theo Flacher ◽  
Karen Hofmann ◽  
...  
Keyword(s):  
Discrete Event Simulation ◽  
Emergency Services ◽  
Prehospital Care ◽  
Discrete Event ◽  
Point Of View ◽  
Public Healthcare ◽  
Healthcare Organizations ◽  
Rule Based ◽  
Event Simulation ◽  
Emergency Medical

Many studies in research deal with optimizing emergency medical services (EMS) on both the operational and the strategic level. It is the purpose of this method-oriented article to explain the major features of “rule-based discrete event simulation” (rule-based DES), which we developed independently in Germany and Switzerland. Our rule-based DES addresses questions concerning the location and relocation of ambulances, dispatching and routing policies, and EMS interplay with other players in prehospital care. We highlight three typical use cases from a practitioner’s perspective and go into different countries’ peculiarities. We show how research results are applied to EMS and healthcare organizations to simulate and optimize specific regions in Germany and Switzerland with their strong federal structures. The rule-based DES serves as basis for decision support to improve regional emergency services’ efficiency without increasing cost. Finally, all simulation-based methods suggest normative solutions and optimize EMS’ performance within given healthcare system structures. We argue that interactions between EMS, emergency departments, and public healthcare agencies are crucial to further improving effectiveness, efficiency, and quality.

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