Preventable deaths in a self-designated trauma system.

Organized paramedic care was established in 1974 in Hillsborough County, Florida, with subsequent development of a hospital self-designation system for trauma in 1980. To evaluate the level of trauma care in the county, a review of trauma deaths in 1984 was performed. A total of 452 trauma deaths was identified. Of these, 191 deaths occurred at the scene. The remaining 261 patients were transported to one of six hospitals within the county. One hundred ninety-nine subsequent deaths were attributed to central nervous system (CNS) injury, while 62 deaths were secondary to non-CNS injuries. By the method of group review, 14 (22.6%) preventable non-CNS trauma deaths were identified. Six women died and eight men died; the mean age of the deceased was 44. Ten deaths (71.4%) were secondary to blunt trauma. Mean ISS score was 21.1. Eleven deaths (79%) were due to delay to the OR, 2 deaths (14%) were due to inadequate resuscitation, and 1 death (7%) was due to lack of surgical intervention. This study demonstrates that a self-designation system without regulatory control results in a high percentage of preventable trauma deaths. We conclude that established trauma systems are needed in all areas, including those that have had organized prehospital and hospital levels of care.