Changes in rural trauma prehospital times following the Rural Trauma Team Development Course training

Malekpour, Mahdi; Neuhaus, Nina; Martin, David S.; Widom, Kenneth; Rapp, Megan; Leonard, Diane; Baro, Susan; Dove, James T.; Hunsinger, Marie; Blansfield, Joseph; Shabahang, Mohsen; Torres, Denise; Wild, Jeffrey

doi:10.1016/j.amjsurg.2016.06.015

Cited by 24 publications

(24 citation statements)

References 12 publications

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“…The Rural Trauma Team Development Course (RTTDC) is based on the concept that in most situations, rural facilities can form a trauma team consisting of at least 3 core members, 43 and there is evidence that participation in RTTDC can significantly improve prehospital times. 44,45 In Nova Scotia, the provincial trauma program (Trauma Nova Scotia) began offering RTTDC in 2012. Further research is warranted to determine whether implementation of RTTDC training in Nova Scotia has had an effect on outcomes in rural trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia

Tansley

Schuurman

Bowes

et al. 2019

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Background: Trauma is a leading contributor to the burden of disease in Canada, accounting for more than 15 000 deaths annually. Although caring for injured patients at designated trauma centres (TCs) is consistently associated with survival benefits, it is unclear how travel time to definitive care influences outcomes. Using a population-based sample of trauma patients, we studied the association between predicted travel time (PTT) to TCs and mortality for patients assigned to ground transport. Methods: Victims of penetrating trauma or motor vehicle collisions (MVCs) in Nova Scotia between 2005 and 2014 were identified from a provincial trauma registry. We conducted cost distance analyses to quantify PTT for each injury location to the nearest TC. Adjusted associations between TC access and injury-related mortality were then estimated using logistic regression. Results: Greater than 30 minutes of PTT to a TC was associated with a 66% increased risk of death for MVC victims (p = 0.045). This association was lost when scene deaths were excluded from the analysis. Sustaining a penetrating trauma greater than 30 minutes from a TC was associated with a 3.4-fold increase in risk of death. Following the exclusion of scene deaths, this association remained and approached significance (odds ratio 3.48, 95% confidence interval 0.98-14.5, p = 0.053). Conclusion: Predicted travel times greater than 30 minutes were associated with worse outcomes for victims of MVCs and penetrating injuries. Improving communication across the trauma system and reducing prehospital times may help optimize outcomes for rural trauma patients. Contexte : Les traumatismes contribuent pour une bonne part au fardeau de la maladie au Canada; on leur attribue plus de 15 000 décès annuellement. Même si les soins prodigués aux patients victimes de traumatismes dans les centres de traumatologie désignés (CTD) sont toujours associés à des gains au plan de la survie, on ignore quelle est l'influence du temps de transfert vers le CTD sur l'issue. À partir d'un échantillon de patients polytraumatisés basé dans la population, nous avons analysé le lien entre le temps de transfert prévu (TTP) vers le CTD et la mortalité des patients transportés par voie terrestre. Méthodes : On a identifié les victimes de traumatismes pénétrants ou d'accidents de la route en Nouvelle-Écosse entre 2005 et 2014 à partir d'un registre provincial de traumatologie. Nous avons analysé la distance de coût pour quantifier le TTP à partir de chaque scène vers le CTD le plus proche. Les liens ajustés entre l'accès au CTD et la mortalité liée au traumatisme ont ensuite été estimés par régression logistique. Résultats : Un délai de TTP de plus de 30 minutes pour arriver au CTD a été associé à un accroissement de 66 % du risque de décès chez les patients polytraumatisés (p = 0,045). Ce lien s'annulait si on excluait de l'analyse les décès survenus sur la scène de l'accident. Subir un traumatisme ouvert à plus de 30 minutes de distance d'un CTD a été associé à une augmentation par un facteu...

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Section: Discussionmentioning

confidence: 99%

Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia

Tansley

Schuurman

Bowes

et al. 2019

cjs

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“…[8,9,16] The rural trauma team development course has been reported to decrease the time for patient transfer; the risk of death, however, was not reduced as expected. [10,17,18] To the best of our knowledge, our study rstly demonstrated that regular feedback on the inter-hospital transfer might contribute to the reduction of mortality risk.…”

Section: Resultsmentioning

confidence: 64%

“…This explain why the mortality risk was decreased in our study but not in other study. [10,17] The context of feedback was not only lecture or presentation on the outcomes of the transferred patients, but also communication and interaction of emergency department physicians and trauma surgeons on the transfer detail. The feedback is supposed to be innovative and problem-solving instead of faultnding and anxiety-provoking.…”

Section: Resultsmentioning

confidence: 99%

“…[3,[5][6][7] Nonetheless, delayed transfer and prolonged process of transfer with inadequate initial resuscitation of major trauma patient are still a problem. [8][9][10] Without feedback from the receiving hospital and specialists in trauma care, there can be no room for improvement. Hospitals in Taiwan are not equally facilitated with specialized trauma surgeons and capabilities.…”

Section: Introductionmentioning

confidence: 99%

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Regular Feedback on the Inter-hospital Transfer Improved the Quality and Survival in Patients with Multiple Trauma: A Retrospective Cohort Study

Wang

Yang

Hung

et al. 2020

Preprint

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Background: Under-triage of major trauma patients has been unavoidable, especially in the trauma system of rural area. Timely stabilization and transfer of critical trauma patients remains a great challenge for hospitals limited in resources for major trauma management. No definitive measure has been proved to improve the outcome of transferred major trauma patients. Current study hypothesized that regular feedback on inter-hospital transfer of patients with major trauma can improve care quality and outcome.Method: This retrospective cohort study retrieved the transferred trauma patients with injury severity score(ISS) ≥ 16 between Jan 2010 and Dec 2018 from the trauma registry databank of a tertiary medical center. Regular monthly feedback on inter-hospital transfer was initiated since 2014. The patients were divided into the without-feedback group and the with-feedback group. The demographic data, management before transfer, and outcome after transfer were collected and analyzed. Results: A total of 178 patients were included; 69 patients in the without-feedback and 109 in the with-feedback group. The with-feedback group had higher ISS (25 vs 27, p = 0.049), and more patients needing massive transfusion (14.49% vs 29.36%, p = 0.036). After adjusted for confounding factors, the with-feedback group was associated with higher rate of blood transfusion before transfer (adjusted odds ratio [aOR] 2.75, 95% CI [1.01-7.52], p = 0.049), shorter time span before blood transfusion (-31.80 ± 15.14, p = 0.038), and decreased mortality risk (aOR 0.33, 95% CI [0.13-0.83], p = 0.019).Conclusion: This retrospective cohort study revealed that regular feedback on inter-hospital transfer improved the quality of blood transfusion and was associated with decreased mortality risk.

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“…2,3 Patients from rural areas may sustain injuries from agricultural trauma (such as machinery runovers, and entanglement and impingement by heavy equipment), motor vehicle collisions and animal encounters. 3,5,6 However, management of these cases poses particular challenges for several reasons: long transport times owing to the diverse terrain and seasonal weather changes, variation in the expertise of the people providing prehospital care, [7][8][9] the dearth of rural health care facilities, 6 limited access to diagnostic equipment and medical specialists, and rural health care providers' infrequent exposure to severe trauma and their consequent inexperience in treating such cases. [10][11][12] These barriers lead to increased morbidity and mortality among rural trauma patients, who are twice as likely to die from their injuries as their urban counterparts.…”

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confidence: 99%

Evaluation of trauma resources in rural northern Alberta identifies opportunities for improvement

Jiang¹,

MacLean

Yoon³

et al. 2020

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Background: The care of rural trauma patients in northern Alberta can be extremely challenging because of the vast geographic area, the limited access to health care facilities and the lack of adequate resources to manage severe injuries. Identifying gaps in equipment and personnel in rural centres can provide opportunities for improving the care of injured patients in these environments. We conducted a survey based on Canadian Accreditation Council quality indicators to evaluate trauma infrastructure and human resources in rural centres across northern Alberta. Methods: A standardized survey was developed to assess the availability of trauma-specific equipment and personnel across the prehospital and emergency department (ED) settings. The survey was distributed to 50 peripheral hospitals biannually from January 2017 to September 2018. Two-tailed paired t tests were used to evaluate changes in survey responses; a p value of less than 0.05 was considered statistically significant. Results: The survey response rate was 100%. By the end of the study period, there were significant improvements in the number of providers (p = 0.04), nurses (p = 0.01) and dedicated trauma resuscitation bays (p = 0.04) in the ED for managing injured patients. There were also significant increases in the availability of equipment, including advanced airway management tools (p = 0.02), rapid infusion devices (p = 0.02) and warmers (p = 0.04). Access to x-ray equipment (p = 0.03) and computed tomography (CT) scanners (p = 0.04) as well as equipment to support telehealth and teleconferencing (p = 0.04) increased during the study period. Access to, and supply of, blood products also increased significantly (p = 0.02) during the study period. Conclusion: Our study demonstrates that the trauma resources of rural health care centres may be evaluated in a standardized fashion centres, and the results point to opportunities to remedy gaps in equipment and personnel. Our methods may be applied to any trauma network that serves geographically large areas with a sparse distribution of health care facilities, to provide critical information for the optimization of resources in rural trauma. Contexte : Les soins aux patients victimes de traumatismes en région rurale dans le nord de l'Alberta peuvent être très difficiles en raison de la superficie de la région, de l'accès limité aux établissements de santé et du manque de ressources pour soigner adéquatement les blessures graves. En repérant les lacunes en équipement et en personnel dans les établissements en région rurale, on peut créer des occasions d'améliorer les soins aux patients blessés dans ces milieux. Nous avons mené un sondage fondé sur les indicateurs de qualité du Conseil d'accréditation canadien pour évaluer les infrastructures et les ressources humaines en traumatologie dans les établissements des régions rurales du nord de l'Alberta. Méthodes : Un sondage standardisé a été créé pour évaluer la disponibilité des équipements et des ressources humaines en traumatologie en contexte préhosp...

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Changes in rural trauma prehospital times following the Rural Trauma Team Development Course training

Cited by 24 publications

References 12 publications

Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia

Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia

Regular Feedback on the Inter-hospital Transfer Improved the Quality and Survival in Patients with Multiple Trauma: A Retrospective Cohort Study

Evaluation of trauma resources in rural northern Alberta identifies opportunities for improvement

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