minutes; P < .001) (Table 2).Discussion | Through this quality improvement process, we found that the rapid retriage protocol identified critically injured patients at higher risk for poor outcomes who could benefit from the use of rapid retriage. For critically injured ED trauma transfer patients who died, especially those with blunt trauma rather than penetrating trauma, increased time at a nontrauma hospital prior to transfer could have contributed to the higher mortality rate. In California's exclusive trauma system, data for patients cared for in nontrauma hospitals are not systematically available, even for patients transferred to a trauma center. In this study, we identified important clinical data elements that are not routinely obtained from referring nontrauma hospitals. A regional trauma center committee is using this information to create a consensus-based trauma transfer performance improvement page within each site's current trauma registry. This would enable the recording of data necessary to understand the emergency transfer process to improve the care for this vulnerable critically injured population.

Three patients attempted suicide by burning in one ward of a psychiatric hospital in a period of less than 1 month. No such attempts had occurred there in the previous 9 years. The three patients were schizophrenics with depressive features who occupied the same room in the ward. It seems reasonable to suggest that at least the choice of method and the timing of these suicide attempts were influenced by imitation. Hospital staff should be especially aware of the influence of imitation in suicide in order to avert such undesired epidemics.

Prehospital TXA protocol based on the CRASH-2 trial is safe and feasible. The first dose of TXA administered under this protocol marks the first ground EMS administration in the USA. Conceivably, this will pose as a model to other trauma centers that receive patients from outlying areas without immediate access to care. Large multi-institutional analyses need to be performed to evaluate survival benefits of prehospital TXA administration protocol.

No abstract