scholarly journals Prehospital Trauma Care Registry Problems in South Brazil

2014 ◽  
Vol 3 (3) ◽  
pp. 97-100
Author(s):  
Adonis Nasr ◽  
Phillipe Abreu-Reis ◽  
Iwan Collaço ◽  
Flavio Saavedra Tomasich
Keyword(s):  
Trauma Care ◽  
Trauma Center ◽  
Prehospital Care ◽  
Gunshot Wounds ◽  
Trauma Patients ◽  
Continuous Variables ◽  
Electronic Data Collection ◽  
Prehospital Trauma Care ◽  
Care Assessment ◽  
South Brazil

ABSTRACT Background Trauma registry remains a great problem to most countries that are implementing trauma systems. Nondigital data assessment and storage may lead to information deterioration along the process. In order to verify the missing registry in prehospital trauma rescuers’ form, we ran this study. Study design A prospective observational noncontrolled study with 288 random trauma cases brought to a Level 1 Trauma Center in Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the student's t-test for continuous variables. Results Two hundred and eighty-eight trauma cases were observed. Twelve patients were excluded. Of the 276 patients who met the including criteria, 75% were men with a mean age of 27-year-old. In only 8.34% of times patients were brought by doctors, while in 91.66% by paramedics. 63.4% of patients were traffic injuries victims, followed by 12.31% falls, 6.52% falls from the high, 5.79% gunshot wounds, 5.34% assaults, 3.62% stab wounds, 2.89% others. Impressively, 16 patients (5.89%) had no records of respiratory rate from the prehospital care assessment, 20 (7.24%) had no data of systolic blood pressure and 13(4.71%)had no pulse registry. Furthermore, 31.25% of the RR not registered were abnormal in the hospital admission evaluation, as well as 15% of the SBPs, and 23% of HR. None of the cases had information regarding time from the scene to the hospital. Conclusion Electronic data collection shall make checklists consistently filled out. It is not well understood the importance of registering data for most of healthcare providers working in the field, especially when they do not follow the in-hospital care of trauma patients. How to cite this article Abreu-Reis P, Tomasich FS, Nasr A, Collaco I. Prehospital Trauma Care Registry Problems in South Brazil. Panam J Trauma Crit Care Emerg Surg 2014;3(3):97-100.

scholarly journals Misdiagnosed Injuries in the Prehospital Trauma Care: Better Training needs to be Implemented

2014 ◽  
Vol 3 (3) ◽  
pp. 93-96
Author(s):  
Adonis Nasr ◽  
Phillipe Abreu-Reis ◽  
Iwan Collaço ◽  
Flavio Saavedra Tomasich
Keyword(s):  
Health Care Providers ◽  
Trauma Care ◽  
Trauma Center ◽  
Life Support ◽  
Prehospital Care ◽  
Training Needs ◽  
System Capacity ◽  
Controlled Study ◽  
Care Providers ◽  
Prehospital Trauma Care

ABSTRACT Background It is not always that prehospital trauma life support (PHTLS) principles are applied to daily practice. Lack of training to health care providers and a high amount of patients overwhelming the system capacity may let malpractice behavior to happen. It is the aim of this study to assess injuries misdiagnosed by prehospital trauma care in a capital city in southern Brazil. Study design A prospective observational non-controlled study with 174 random trauma cases that were brought to a level 1 trauma center in the city of Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the students’ t-test for continuous variables. Results Of the 174 patients who met the including criteria, 75% were men with a mean age of 27-year-old. Of the 11 injuries to the neck identified in the Hospital evaluation, eight were missed by the prehospital care (OR 0.26 CI 95% 0.07-0.94). Also, only 7/20 injuries to the back were identified by the PHTLS team (OR 0.32 CI 95% 0.13-0.78). Similarly, only 6/26 injuries to the chest (OR 0.20 CI 95% 0.08-0.50), 4/15 to the abdomen (OR 0.24 CI 95% 0.08-0.76), 4/16 to the pelvis (OR 0.23 CI 95% 0.07-0.70), 13/33 to the upper body (OR 0.34 CI 95% 0.17- 0.68),7/39 to the lower body (OR 0.14 CI 95% 0.06-0.33) and 17/55 (OR 0.23 CI 95% 0.12-0.42) were correctly identified in the prehospital scenario. Conclusion Although it is known PHTLS principles, which save lives when applied in practice, further training and remarks to its importance is needed to fully implement efficient trauma systems. Electronic data collection shall make checklists consistently filled out, so that patient care will be improved. How to cite this article Abreu-Reis P, Nasr A, Tomasich FS, Collaco I. Misdiagnosed Injuries in the Prehospital Trauma Care: Better Training needs to be Implemented. Panam J Trauma Crit Care Emerg Surg 2014;3(3):93-96.

Evaluation of Performance in Trauma Care: experts’ viewpoints

2020 ◽  
Author(s):  
Yalda Mousazadeh ◽  
Ali Janati ◽  
Homayoun Sadeghi-bazarghani ◽  
Mahboub Pouraghaei
Keyword(s):  
Information System ◽  
Focus Group ◽  
Trauma Care ◽  
Group Discussion ◽  
Monitoring And Evaluation ◽  
Trauma Patients ◽  
Care Providers ◽  
Care Assessment ◽  
The World ◽  
Care Improvement

Abstract Background: Trauma is one of the leading causes of mortality across the world. Trauma patients had critical status and need timely, adequate and organized care. The different consequences of trauma care among service centers around the world and even within a country reveal the need for care assessment. This study was designed and executed to collect experts’ opinion on the evaluation of trauma care in Iran. Methods: This qualitative study with conventional content analysis approach, two focus group discussions with 12 participants and 16 face-to-face in-depth interviews were conducted to collect the required data. Participants were selected through purposive sampling method. The experts’ viewpoints were classified in accordance with the main and sub themes. Results: Four basic themes extracted from the interviews and focus group discussion including, trauma care importance (sub-themes: the involved Individuals’ being young and productive and the effectiveness of trauma care); trauma care indicators (sub-themes: pre-hospital indicators, in-hospital indicators and post-hospital indicators); stages of trauma care evaluation (sub-themes: evaluation prerequisites, finalization of indicators prior to evaluation, determining evaluation time scope, determining evaluation dimensions, monitoring and evaluation and use of evaluation results); trauma care promotion (sub-themes: balancing workload in trauma centers, enhancement of information system, considering extra-organizational dimensions in trauma care and empowerment of trauma care providers). Conclusion: Performance evaluation through acceptable indicators is basis of health care improvement. In addition to the evaluation, reforming macro policies, development of infrastructures, enhancement of information system and training care providers should be taken into account too. Keywords: Performance indicators, Evaluation, Hospital, Trauma care

Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients

2018 ◽  
Vol 57 (05/06) ◽  
pp. 231-242 ◽  
Author(s):  
Birgit Reime ◽  
Thomas Wurmb ◽  
Uwe Kippnich ◽  
Layal Shammas ◽  
Asarnusch Rashid ◽  
...  
Keyword(s):  
Trauma Care ◽  
A Priori ◽  
Treatment Quality ◽  
Cochrane Library ◽  
Trauma Patients ◽  
Comprehensive Overview ◽  
Prehospital Trauma Care ◽  
Final Sample ◽  
Electronic Database Search ◽  
Video And Audio

Background Trauma is a global burden. Emergency medical services (EMS) provide care for individuals who have serious injuries or suffered a major trauma. Objective This paper provides a comprehensive overview of telemedicine applications in prehospital trauma care. Methods We conducted a systematic review according to PRISMA guidelines. We identified articles by electronic database search (PubMed, EMBASE, the Cochrane Library, CINAHL, SpringerLink, LIVIVO, DARE, IEEE Xplore, Google Scholar and ScienceDirect) using keywords related to prehospital settings, ambulance, telemedicine and trauma. Search terms and inclusion criteria were specified a priori by the PICOS template and revised throughout a configurative approach iteratively, to outline the complexity and variety of different telemedical concepts. Results A final sample of 15 records was systematically selected. Most interventions were piloted and/or evaluated in Germany for trauma victims in prehospital settings. Six studies were simulated scenarios. Telemedical assistance (TMA) via real-time telemetry systems (RTS), enabling video and audio conferencing between EMS by tele-emergency physicians (TEP) were associated with a higher treatment quality and a shorter time-to-treatment in invasive procedures. By initiating in-hospital preparations based on telemedical prehospital notification (TPN), loss of information during the clinical handover was reduced and in-hospital protocols were activated with high accuracy. Remotely guided ultrasound (Tele-Ultrasound) by TEP showed an overall high diagnostic accuracy in simulations. Technical solutions were reliable, seemed practical and auspicious. Conclusion The review indicates that TMA and TPN are accompanying telemedical concepts in out-of-hospital trauma care. Well-designed populated studies are needed to fully assess the effect of telemedicine in acute trauma care. Therefore, evidence regarding the effectiveness of telemedicine in prehospital setting for trauma patients is still limited.

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.

Prehospital Trauma Care

2016 ◽  
Vol 1 (4) ◽  
pp. 158-163 ◽  
Author(s):  
SM Sharma
Keyword(s):  
Trauma Care ◽  
Life Support ◽  
Prehospital Care ◽  
Developed Countries ◽  
Care Needs ◽  
Air Ambulances ◽  
Prehospital Trauma Care ◽  
Trained Staff ◽  
The Developed Countries ◽  
Accident Site

ABSTRACT The global human population is spread all over the world, but cities, towns, and large villages have dense concentrations of human inhabitation. The inhabitants of cities and towns do have easy and satisfactory access for the management of traumatized patients. However, trauma victims in remote and distant regions, generally, do not have ambulance services or treatment centers nearby to deal effectively with injuries. Even on highways, at accident sites, the injured may succumb to the injuries due to delay in rescue and nonavailability of vital basic life support compounded by delay in transportation of the patient to appropriate hospital or dedicated trauma center. Other factors which add to mortality are nonavailability of trained and experienced personnel at the accident site, inadequate and improper resuscitation during transportation, and referral to a hospital ill-equipped to treat traumatized patients. Trauma is the leading cause of death for patients in their first four decades of life. Prehospital trauma care to save life has not received the necessary attention in developing world due to diverse reasons, including lack of trained staff, inadequate funding, lack of awareness, ignorance, lack of will, and unpredictability of occurrence of accidents. Trauma management remains neglected in third world countries; however, the developed countries have made continuous efforts to save lives of traumatized patients by systematized prehospital care at the site of accident, rescue, and extrication of victims, rendering lifesaving resuscitation on the spot and quick and safe evacuation of the patients to trauma centers by surface and air ambulances depending upon the terrain and distance of the site of occurrence from hospital with continuous monitoring of the patient onboard. Prehospital trauma care needs focused attention to evolve a system and institutions which would impart care to the wounded inclusive of rescue, resuscitation, stabilization of vital parameters, and safe transportation to a dedicated hospital to save life and prevent morbidity. How to cite this article Sharma SM. Prehospital Trauma Care. Int J Adv Integ Med Sci 2016;1(4):158-163.

scholarly journals Availability of Essential Medical Equipment for Prehospital Trauma Care on Public Ambulances in Ukraine

2019 ◽  
Vol 34 (s1) ◽  
pp. s104-s104
Author(s):  
Stanislav Gaievskyi ◽  
Colin Meghoo
Keyword(s):  
Trauma Care ◽  
Medical Equipment ◽  
Prehospital Care ◽  
Traumatic Injury ◽  
Eastern European Country ◽  
World Health ◽  
Ministry Of Health ◽  
Equipment And Supplies ◽  
Prehospital Trauma Care ◽  
Advanced Airway

Introduction:The public ambulance system in Ukraine is the primary deliverer of prehospital care for trauma patients in this Eastern European country, but no national assessment has previously been made to ensure the presence of essential medical equipment on these ambulances.Aim:Working with the Ukraine Ministry of Health, our aim was to assess the availability of public ambulances of medical equipment essential for managing traumatic injury using an internationally recognized standard for prehospital care.Methods:We identified 53 Advanced Life Support (ALS) ambulances from randomly selected cities for evaluation. We performed an inventory of available medical equipment and supplies on these ambulances against a matrix of essential equipment for prehospital providers developed by the World Health Organization (WHO).Results:Essential medical equipment in the categories of personal protection, patient monitoring, hemorrhage control, and immobilization were generally available in the ALS public ambulances surveyed. Deficiencies were noted in equipment and supplies for basic and advanced airway monitoring and management.Discussion:Public ALS ambulances across Ukraine are adequately equipped with many essential medical supplies to manage traumatic injury, but have deficiencies in both basic and advanced airway management. Correcting these deficiencies may improve prehospital survival of the traumatically injured patient. The results of this study will enable the Ukraine Ministry of Health to develop requirements of essential medical equipment for all public ALS ambulances in the country, to inform resource allocation decisions, and to guide public health policy regarding prehospital trauma care.

scholarly journals Global Connections: Telemedicine as a Tool to extend Trauma Education

2013 ◽  
Vol 2 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Nicholas Namias ◽  
Antonio C Marttos ◽  
Fernanda M Kuchkarian ◽  
Daniel F Rojas ◽  
Francisco S Collet-Silva ◽  
...  
Keyword(s):  
Critical Care ◽  
Trauma Care ◽  
International Health ◽  
Gunshot Wounds ◽  
The United States ◽  
Virgin Islands ◽  
Trauma Patients ◽  
Surgical Interventions ◽  
Global Connections ◽  
Trauma Education

ABSTRACT Introduction Telemedicine is revolutionizing the delivery of trauma care and education. The International Trauma Tele- Grand Rounds is a series that unites institutions worldwide to discuss complex clinical cases and advanced trauma and critical care topics. Materials and methods Multiple remote institutions connect simultaneously to discuss the management of a trauma patient from the prehospital phase to discharge. Weekly, a case is presented in English by one institution on a rotating basis. Key points include mechanism of injury, resuscitation, laboratory and imaging diagnostics, surgical interventions, postoperative patient care, evaluation of treatment decisions and review of the literature. The highly interactive format allows participants to evaluate differences in trauma care across international health systems. Results During 2010 to 2011, 68 sessions were documented. Cases include blunt (42.6%), penetrating (48.5%), blast (7.4%) and crushing (1.5%) traumas. Gunshot wounds were the most frequent (25%). A holistic range of injuries were represented including injuries to major arteries, veins, lungs, heart, pericardium, esophagus, diaphragm, abdominal wall, stomach, intestines, liver, kidneys, pelvis, and the extremities. A variety of surgical and nonsurgical interventions were explored. To date, there have been 42 participating institutions from the United States, Brazil, Colombia, Bahamas, Canada, Mexico, Venezuela, Argentina, Panama, Puerto Rico, Dominican Republic, British Virgin Islands, Spain, Thailand, Turkey and Iraq; ranging from academic medical centers military hospitals, community hospitals, and rural hospitals. In 2011, the series received accreditation by the Accreditation Council for Continuing Medical Education. Conclusion Telemedicine offers a solution to address the disparities in access to trauma care and education. The diversity of institutional settings allows participants to learn from others on how to best treat trauma patients, despite differences in resources and expertise. In addition to serving as an educational tool, the series provides a mechanism for physicians to network and collaborate on future endeavors. How to cite this article Marttos AC, Kuchkarian FM, Rojas DF, Fraga GP, Collet-Silva FS, de Almeida Costa C, Garcia GD, Ginzburg E, Schulman CI, Namias N. Global Connections: Telemedicine as a Tool to extend Trauma Education. Panam J Trauma Critical Care Emerg Surg 2013;2(1):62-66.

scholarly journals Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefanie Fitschen-Oestern ◽  
Sebastian Lippross ◽  
Rolf Lefering ◽  
Tim Klüter ◽  
Matthias Weuster ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Ct Scan ◽  
Multiple Trauma ◽  
Trauma Care ◽  
Trauma Center ◽  
Injury Severity ◽  
Emergency Operation ◽  
Trauma Patients ◽  
X Ray ◽  
Multiple Trauma Patients

Abstract Background Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Methods Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am–11.59 am (morning), 12.00 pm–5.59 pm (afternoon), 6.00 pm–11.59 pm (evening), 0.00 am–5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. Results Fewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am–5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm–05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am–5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate. Conclusion The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.

Abstract 322: Prehospital Care From Emergency Life-Saving Technicians Promotes the Survival of Trauma Patients

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tsuyoshi Nojima ◽  
Hiromichi Naito ◽  
Tetsuya Yumoto ◽  
Atsunori Nakao
Keyword(s):  
Logistic Regression ◽  
Trauma Care ◽  
Injury Severity ◽  
Prehospital Care ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Multivariable Logistic Regression Model ◽  
Full Field ◽  
Multivariable Logistic Regression ◽  
Life Saving

Introduction: Optimal trauma care strategies remain a matter of debate. Prehospital trauma care protocols for paramedics range from no intervention to full field stabilizations. In Japan, emergency life-saving technicians (ELSTs) are certified specialists trained to provide advanced techniques and knowledge for prehospital emergency care. They can give fluid resuscitation and inform the receiving hospital for definitive surgery. However, the effectiveness of ELSTs over basic emergency medical technicians (BEMTs) regarding trauma transport remains unclear. Hypothesis: We tested whether the presence of an ELST improves the outcomes of trauma patients. Methods: We retrospectively studied 2004- 2017 data from the Japan Trauma Data Bank (JTDB). Inclusion criteria were patients age ≥ 16 with at least one Abbreviated Injury Scale (AIS) score ≥ 3 trauma. Exclusion criteria were patients with burns, AIS score = 6 in any region, and missing data. We compared two trauma patient groups. ELST group: patients transported by EMS including at least one ELST. BEMT group: patients transported only by basic EMS personnel. The primary outcome measure was survival at discharge. A multivariable logistic regression model was used to adjust for patient baseline characteristics. Results: Included were 124,563 patients, with 119,352 patients in the ELST group and 5,211 patients in the BEMT group. Patients’ ages (ELST vs. BEMT [Mean ± SD]: 57 ± 22 vs. 59 ± 22 years, p < 0.01) were lower and transportation time (15 ± 12 vs. 17 ± 14 min, p < 0.01) was shorter in the ELST group. Gender (male: 64 vs. 64 %, p = 0.66), proportion of blunt trauma (96 vs. 96 %, p = 0.10), proportion of blood transfusion (15 vs. 14 %, p = 0.11) and Injury Severity Score (16 ± 11 vs. 16 ± 11, p = 0.28) were similar between groups. Revised Trauma Score (7.0 ± 1.9 vs. 7.1± 1.7, p < 0.01) was lower in the ELST group and proportion of emergency surgery (12 vs. 11 %, p < 0.01) was higher in the ELST group, indicating that ELSTs treat more severe cases. In the multivariable logistic regression, the ELST group had higher odds for survival (adjusted OR: 1.18, 95% CI: 1.01-1.37). Conclusions: ELSTs encountered more severe cases than BEMTs. After adjustment, transport by the ELST group was associated with improved survival of trauma patients.

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.

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