Toy Jake, Kazan Clayton, Gausche-Hill Marianne, Bosson Nichole
Harbor UCLA Medical Center, Department of Emergency Medicine, Torrance, CaliforniaUSA; The Lundquist Institute, Torrance, CaliforniaUSA.
Los Angeles County EMS Agency, Santa Fe Springs, CaliforniaUSA.
Prehosp Disaster Med. 2020 Oct;35(5):488-494. doi: 10.1017/S1049023X20000898. Epub 2020 Jul 14.
The objective of this study was to evaluate the effectiveness of a 911 trauma re-triage protocol implemented at a new community hospital in a region with a high volume of trauma and frequent transports by private vehicle.
This retrospective cohort study included all trauma patients ≥15 years old transferred via 911 trauma re-triage from a new community hospital over a 10-month period from August 2015 through April 2016. Criteria for 911 trauma re-triage were developed with input from local Emergency Medical Services (EMS) and trauma experts. An educational module, along with the criteria and implementation steps, was distributed to the emergency department (ED) personnel at the community hospital. Data were abstracted from the regional trauma registry, and the EMS patient care records were reviewed. Primary outcomes were: (1) median total transport time; and (2) proportion of patients who met the 911 re-triage criteria.
During the study period, 32 patients with traumatic injuries were transferred via 911 re-triage to the closest trauma center (TC). The median age of patients was 31 years (IQR 24-45 years) with 78% male and 66% suffering from a penetrating mechanism. The median prehospital provider scene time was 10 minutes (IQR 8-12 minutes) and transport time was seven minutes (IQR 6-9 minutes). Median total transport time was 17 minutes (IQR 15-20 minutes). Seventeen patients (53%) met 911 re-triage criteria as determined by study investigators. The most common criteria met was "penetrating injury to the head, neck, or torso" in 14 cases.
This study demonstrated that 911 re-triage was a feasible strategy to expeditiously transfer critical trauma patients to a TC within a mature trauma system in an urban-suburban setting with a median total transport time of 17 minutes.
本研究的目的是评估在一个创伤量大且私家车转运频繁的地区的一家新社区医院实施的911创伤再分诊方案的有效性。
这项回顾性队列研究纳入了2015年8月至2016年4月这10个月期间通过911创伤再分诊从一家新社区医院转诊的所有15岁及以上的创伤患者。911创伤再分诊标准是在当地紧急医疗服务（EMS）和创伤专家的参与下制定的。一个教育模块，连同标准和实施步骤，分发给了社区医院的急诊科（ED）人员。数据从区域创伤登记处提取，并审查了EMS患者护理记录。主要结果是：（1）总转运时间中位数；（2）符合911再分诊标准的患者比例。
在研究期间，32例创伤患者通过911再分诊被转运至最近的创伤中心（TC）。患者的中位年龄为31岁（四分位间距24 - 45岁），78%为男性，66%为穿透性损伤机制。院前急救人员在现场的时间中位数为10分钟（四分位间距8 - 12分钟），转运时间为7分钟（四分位间距6 - 9分钟）。总转运时间中位数为17分钟（四分位间距15 - 20分钟）。17例患者（53%）符合研究调查人员确定的911再分诊标准。最常见的符合标准的情况是14例“头、颈或躯干穿透伤”。
本研究表明，在城乡结合部的成熟创伤系统中，911再分诊是一种可行的策略，可将关键创伤患者迅速转运至创伤中心，总转运时间中位数为17分钟。
