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Compliance with Closest Hospital Transport Protocol

Published online by Cambridge University Press:  28 June 2012

Robert L. Norton ,
Edward A. Bartkus ,
Keith W. Neely ,
John A. Schriver  and
Jerris R. Hedges
Robert L. Norton*
Affiliation:
Oregon Health Sciences University, Division of Emergency Medicine, Portland, Ore.
Edward A. Bartkus
Affiliation:
Oregon Health Sciences University, Division of Emergency Medicine, Portland, Ore.
Keith W. Neely
Affiliation:
Oregon Health Sciences University, Division of Emergency Medicine, Portland, Ore.
John A. Schriver
Affiliation:
Yale University, Department of Emergency Services, Yale New Haven Hospital, New Haven, Conn.
Jerris R. Hedges
Affiliation:
Oregon Health Sciences University, Division of Emergency Medicine, Portland, Ore.
*
Oregon Health Sciences University, Division of Emergency Medicine/UHN 52, 181 SW Sam Jackson Park Road, Portland, OR 97201-3098USA
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Abstract

Hypothesis:

Paramedics accurately estimate the closest trauma hospital for ground transport.

Population:

Ground ambulance scene transports of trauma system patients to six participating trauma hospitals in Multnomah County, Oregon from 1 January 1986 to 1 January 1987 were studied. Transports involving multiple patients or pediatric patients were excluded.

Methods:

A retrospective analysis was performed on consecutive patient transports to be taken to the closest trauma hospital as required by protocol. The availability of each hospital to receive trauma patients was monitored continuously by a central communications facility. Paramedics were provided hospital availability data at the time of patient system entry. When several hospitals were available, the paramedics were required by protocol to select the “closest” hospital. Subsequently, the vector distance from the trauma site to each of the available hospitals was measured using a grid map. This method was validated by odometer measurement (r2 = 0.924). Chisquare analysis was used to analyze hospital bypasses to specific hospitals.

Results:

Of the 1193 eligible patients entered into the trauma system, 160 (13%; 95% CI = 11–15%) transports bypassed the closest available hospital for a receiving hospital ≥1 mile more distant. There were 11 (1%; 0–2%) patients transported to a hospital more than five miles more distant. Of the 132 patients with a trauma score (TS) <12, 15 (11%; 6–18%) were taken to a hospital one mile or further beyond the closest hospital. None (0%; 0–2%) were transported more than five miles past the closest hospital. Of the six hospitals, three were bypassed more than one mile significantly more often then they received bypass patients. One hospital received such patients four times more than it was bypassed (p <.001).

Conclusion:

While paramedics generally can identify the closest hospital for trauma patient transport, some systematic hospital bypass errors occur. If a community wants assurance of an equitable patient distribution among participating trauma hospitals and assignment of the closest geographic hospital for injured patients, then map vector distance determination to identify the closest available hospital should supplement paramedic dispatching.

Keywords

dispatcher triageemergency medical dispatchemergency medical servicesemergency medical services communication systemsmedical priority dispatch systemprehospital emergency carepriority dispatching
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 3 , September 1992 , pp. 243 - 249
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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Footnotes

Presented at the 6th Annual NAEMSP Meeting and Scientific Assembly, June 1990, Houston, Tex.

References

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4. Neely, KW, Norton, RL, Bartkus, E, Schriver, JA: Analysis of hospital ability to provide trauma services: A comparison between teaching and community hospitals. Prehospital and Disaster Medicine 1991;6:455–458.CrossRefGoogle ScholarPubMed