Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-30T23:25:17.760Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  14 July 2020

Jake Toy Open the ORCID record for Jake Toy [Opens in a new window] ,
Clayton Kazan ,
Marianne Gausche-Hill  and
Nichole Bosson
Jake Toy*
Affiliation:
Harbor UCLA Medical Center, Department of Emergency Medicine, Torrance, CaliforniaUSA; The Lundquist Institute, Torrance, CaliforniaUSA
Clayton Kazan
Affiliation:
Los Angeles County EMS Agency, Santa Fe Springs, CaliforniaUSA
Marianne Gausche-Hill
Affiliation:
Harbor UCLA Medical Center, Department of Emergency Medicine, Torrance, CaliforniaUSA; The Lundquist Institute, Torrance, CaliforniaUSA Los Angeles County EMS Agency, Santa Fe Springs, CaliforniaUSA
Nichole Bosson
Affiliation:
Harbor UCLA Medical Center, Department of Emergency Medicine, Torrance, CaliforniaUSA; The Lundquist Institute, Torrance, CaliforniaUSA Los Angeles County EMS Agency, Santa Fe Springs, CaliforniaUSA David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaUSA
*
Correspondence: Jake Toy, DO, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W Carson St, Box 21, Building D9, Torrance, California90509, USA, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

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.

Keywords

inter-facility transferpatient transferre-triagetraumatriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 5 , October 2020 , pp. 488 - 494
Copyright
© World Association for Disaster and Emergency Medicine 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Ten Leading Causes of Death and Injury; 2019. https://www.cdc.gov/injury/wisqars/LeadingCauses.html. Accessed September 17, 2019.Google Scholar
Emergency Medical Services Agency, Los Angeles County. 2018 Los Angeles County EMS System Report. http://file.lacounty.gov/SDSInter/dhs/1052574_EMSAnnualDataReport2018-12-01.pdf. Accessed September 17, 2019.Google Scholar
Haas, B, Gomez, D, Zagorski, B, et al. Survival of the fittest: the hidden cost of under-triage of major trauma. J Am Coll Surg. 2010;211(6):804–811.CrossRefGoogle Scholar
Haas, B, Stukel, TA, Gomez, D, et al. The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis. J Trauma Acute Care Surg. 2012;72(6):1510–1515; discussion 1515-1517.CrossRefGoogle Scholar
MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–378.CrossRefGoogle ScholarPubMed
Mullins, RJ, Veum-Stone, J, Hedges, JR, et al. Influence of a statewide trauma system on location of hospitalization and outcome of injured patients. J Trauma. 1996;40(4):536–545; discussion 545-536.CrossRefGoogle ScholarPubMed
Harrington, DT, Connolly, M, Biffl, WL, et al. Transfer times to definitive care facilities are too long: a consequence of an immature trauma system. Ann Surg. 2005;241(6):961–966; discussion 966-968.Google ScholarPubMed
Kuncir, E, Spencer, D, Feldman, K, et al. 911 Emergency Medical Services and re-triage to Level I trauma centers. J Am Coll Surg. 2018;226(1):64–69.CrossRefGoogle ScholarPubMed
Della Valle, JM, Newton, C, Kline, RA, et al. Rapid re-triage of critically injured trauma patients. JAMA Surg. 2017;152(10):981–983.CrossRefGoogle Scholar
Crandall, ML, Esposito, TJ, Reed, RL, et al. Analysis of compliance and outcomes in a trauma system with a 2-hour transfer rule. Arch Surg. 2010;145(12):1171–1175.CrossRefGoogle Scholar
Eckstein, M, Schlesinger, SA, Sanko, S. Interfacility transports utilizing the 9-1-1 Emergency Medical Services System. Prehosp Emerg Care. 2015;19(4):490–495.Google ScholarPubMed
Emergency Medical Services Agency, Department of Health Services, County of Los Angeles. Prehospital Care Manual, Trauma Triage, Reference No. 506; 2019. http://file.lacounty.gov/SDSInter/dhs/206237_ReferenceNo.506TraumaTriage.pdf. Accessed September 17, 2019.Google Scholar
Emergency Medical Services Agency, Department of Health Services, County of Los Angeles. Trauma Center Data Dictionary, Reference No. 646; 2020. http://file.lacounty.gov/SDSInter/dhs/1031433_TraumaDataDictionary2018.pdf. Accessed April 2, 2020.Google Scholar
Porter, A, Wyrick, D, Bowman, SM, et al. The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients. J Trauma Acute Care Surg. 2014;76(4):907–911; discussion 911-912.Google ScholarPubMed
Sampalis, JS, Denis, R, Lavoie, A, et al. Trauma care regionalization: a process-outcome evaluation. J Trauma. 1999;46(4):565–579; discussion 579-581.Google ScholarPubMed
Holst, JA, Perman, SM, Capp, R, et al. Under-triage of trauma-related deaths in US emergency departments. West J Emerg Med. 2016;17(3):315–323.CrossRefGoogle Scholar
Carr, BG, Caplan, JM, Pryor, JP, et al. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006;10(2):198–206.CrossRefGoogle ScholarPubMed
Cribari, C, Rontondo, M, Smith, R, et al. Resources for the Optimal Care of the Injured Patient. Vol 28. Chicago, Illinois USA: American College of Surgeons; 2014.Google Scholar