911 Emergency Medical Services and Re-Triage to Level I Trauma Centers

被引:8
作者
Kuncir, Eric [1 ]
Spencer, Dean [2 ]
Feldman, Kelly [4 ]
Barrios, Cristobal, Jr. [1 ]
Miller, Kenneth [3 ]
Lush, Stephanie [1 ]
Dolich, Matthew [1 ]
Lekawa, Michael [1 ]
机构
[1] Univ Calif Irvine, Dept Surg, Div Trauma & Crit Care Surg, Orange, CA 92668 USA
[2] Univ Calif Irvine, Sch Med, Irvine, CA 92717 USA
[3] Santa Clara Cty Emergency Med Serv, Santa Jose, CA USA
[4] Univ Miami, Sch Med, Miami, FL USA
关键词
INJURED PATIENTS; SYSTEM; OUTCOMES; BENEFIT; TRANSPORT; MORTALITY; SURVIVAL; IMPACT;
D O I
10.1016/j.jamcollsurg.2017.09.013
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Interfacility transfer of undertriaged patients to higher-level trauma centers has been found to result in a delay of appropriate care and an increase in mortality. To address this, for the last 10 years our region has used 911 emergency medical services (EMS) paramedics for rapid retriage of undertriaged patients to our institution's Level I trauma center. We sought to determine whether using 911 EMS for re-triage to our institution was associated with worse outcomes-with mortality as the primary end point-compared with direct EMS transport from point of injury. STUDY DESIGN: We retrospectively reviewed all trauma activations to our institution during a 16-month period; 3,394 active traumas were analyzed. RESULTS: Two hundred and seventy patients (8%) arrived via 911 EMS re-triage and 3,124 (92%) arrived via direct EMS transport. Total EMS transport time was significantly longer (122.5 minutes vs 33.7 minutes; p < 0.001) between the 2 groups, but there was no significant difference in mortality rates (4.1% vs 3.6%; p = 0.67). CONCLUSIONS: These data show that although using 911 EMS for re-triage is associated with an increase in total transport time, it does not result in an increase in mortality compared with direct EMS transport. We conclude that the use of 911 EMS can be considered a safe method to re-triage patients to higher-level trauma centers. (C) 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:64 / 69
页数:6
相关论文
共 15 条
[1]   Level I Versus Level II Trauma Centers: An Outcomes-Based Assessment [J].
Cudnik, Michael T. ;
Newgard, Craig D. ;
Sayre, Michael R. ;
Steinherg, Steven M. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2009, 66 (05) :1321-1326
[2]   INTERFACILITY TRANSPORTS UTILIZING THE 9-1-1 EMERGENCY MEDICAL SERVICES SYSTEM [J].
Eckstein, Marc ;
Schlesinger, Shira A. ;
Sanko, Stephen .
PREHOSPITAL EMERGENCY CARE, 2015, 19 (04) :490-495
[3]   Survival Benefit of Transfer to Tertiary Trauma Centers for Major Trauma Patients Initially Presenting to Nontertiary Trauma Centers [J].
Garwe, Tabitha ;
Cowan, Linda D. ;
Neas, Barbara ;
Cathey, Timothy ;
Danford, Brandon C. ;
Greenawalt, Patrice .
ACADEMIC EMERGENCY MEDICINE, 2010, 17 (11) :1223-1232
[4]   The mortality benefit of direct trauma center transport in a regional trauma system: A population-based analysis [J].
Haas, Barbara ;
Stukel, Therese A. ;
Gomez, David ;
Zagorski, Brandon ;
De Mestral, Charles ;
Sharma, Sunjay V. ;
Rubenfeld, Gordon D. ;
Nathens, Avery B. .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2012, 72 (06) :1510-1515
[5]   Transfer times to definitive care facilities are too long - A consequence of an immature trauma system [J].
Harrington, DT ;
Connolly, M ;
Biffl, WL ;
Majercik, SD ;
Cioffi, WG .
ANNALS OF SURGERY, 2005, 241 (06) :961-966
[6]   Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury [J].
Hartl, Roger ;
Gerber, Linda M. ;
Iacono, Laura ;
Ni, Quanhong ;
Lyons, Kerry ;
Ghajar, Jamshid .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2006, 60 (06) :1250-1256
[7]   Impact of Interhospital Transfer on Outcomes for Trauma Patients: A Systematic Review [J].
Hill, Andrea D. ;
Fowler, Robert A. ;
Nathens, Avery B. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2011, 71 (06) :1885-1900
[8]   The effect of interfacility transfer on outcome in an urban trauma system [J].
Nathens, AB ;
Maier, RV ;
Brundage, SI ;
Jurkovich, GJ ;
Grossman, DC .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 55 (03) :444-449
[9]   The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments [J].
Newgard, Craig D. ;
McConnell, K. John ;
Hedges, Jerris R. ;
Mullins, Richard J. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 63 (05) :965-971
[10]   Increase survival among severe trauma patients - The impact of a national trauma system [J].
Peleg, K ;
Aharonson-Daniel, L ;
Stein, M ;
Kluger, Y ;
Michaelson, M ;
Rivkind, A ;
Boyko, V .
ARCHIVES OF SURGERY, 2004, 139 (11) :1231-1236