The mortality benefit of direct trauma center transport in a regional trauma system

“…Although we focused on hospitals, our results are consistent with a recent report on access to trauma centres that showed that 22.5% of Canadians reside more than 1 hour by road from a Level I or II trauma centre-mostly citizens living in rural and remote regions. 9 Although clinical outcomes have been shown to be superior in these trauma centres, 31,32 it is likely that a significant subset of trauma cases is initially managed in rural hospitals. Although British Columbia has more air medevac potential than Quebec, many factors affect timely air medevac other than the number of aircraft (weather, geography, trained and available staff, budget constraints, and maintenance issues).…”

Section: Access To Trauma Centres and Air Medevacmentioning

confidence: 99%

Comparison of access to services in rural emergency departments in Quebec and British Columbia

Fleet

Audette

Marcoux

et al. 2014

CJEM

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Introduction: Although emergency departments (EDs) in Canada's rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged. Objective: The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec. Methods: Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services. Results: British Columbia has more rural EDs (n 5 34) than Quebec (n 5 26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec. Conclusions: The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.

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“…There is overwhelming evidence demonstrating that modern, regionalized trauma systems have improved injuryrelated mortality by using this paradigm. [48][49][50][51][52][53][54][55][56][57][58][59] Furthermore, there are data suggesting that patients treated at level-1 centers also have improved functional outcomes after an injury, 60-62 with higher patient volumes associated with better outcomes. 63 It is generally thought that the marked improvements in morbidity and mortality with regionalized trauma systems are secondary to more patients with the most severe injuries being treated at level-1 trauma centers and because of a reduction in the time from injury to definitive treatment through rapid triage and transport.…”

Section: Limiting the Number Of Stroke Centersmentioning

confidence: 99%