建立创伤救治能力：利用地理空间分析来考虑设立创伤中心的军事治疗设施。
Building trauma capability: using geospatial analysis to consider military treatment facilities for trauma center development.
作者信息
Lee Blair C, McEvoy Christian S, Ross-Li Dan, Norris Emily A, Tadlock Matthew D, Shackelford Stacy A, Jensen Shane D
机构信息
Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
Independent researcher, Norfolk, Virginia, USA.
出版信息
Trauma Surg Acute Care Open. 2022 May 9;7(1):e000832. doi: 10.1136/tsaco-2021-000832. eCollection 2022.
BACKGROUND
The Military Health System must develop and sustain experienced surgical trauma teams while facing decreased surgical volumes both during and between deployments. Military trauma resources may enhance local trauma systems by accepting civilian patients for care at military treatment facilities (MTFs). Some MTFs may be able to augment their regional trauma systems by developing trauma center (TC) capabilities. The aim of this study was to evaluate the geographical proximity of MTFs to the continental US (CONUS) population and relative to existing civilian adult TCs, and then to determine which MTFs might benefit most from TC development.
METHODS
Publicly available data were used to develop a list of CONUS adult civilian level 1 and level 2 TCs and also to generate a list of CONUS MTFs. Census data were used to estimate adult population densities across zip codes. Distances were calculated between zip codes and civilian TCs and MTFs. The affected population sizes and reductions in distance were tabulated for every zip code that was found to be closer to an MTF than an existing TC.
RESULTS
562 civilian adult level 1 and level 2 TCs and 33 military medical centers and hospitals were identified. Compared with their closest civilian TCs, MTFs showed mean reductions in distance ranging from 0 to 30 miles, affecting populations ranging from 12 000 to over 900 000 adults. Seven MTFs were identified that would offer clinically significant reductions in distance to relatively large population centers.
DISCUSSION
Some MTFs may offer decreased transit times and improved care to large adult populations within their regional trauma systems by developing level 1 or level 2 TC capabilities. The results of this study provide recommendations to focus further study on seven MTFs to identify those that merit further development and integration with their local trauma systems.
LEVEL OF EVIDENCE
IV.
背景
军事卫生系统必须培养并维持经验丰富的外科创伤团队，同时在部署期间及部署间隔面临外科手术量下降的情况。军事创伤资源可通过在军事治疗机构（MTF）接收 civilian 患者进行治疗来增强当地创伤系统。一些 MTF 或许能够通过发展创伤中心（TC）能力来扩充其区域创伤系统。本研究的目的是评估 MTF 与美国本土（CONUS）人口以及相对于现有 civilian 成人 TC 的地理接近程度，然后确定哪些 MTF 可能从 TC 发展中获益最大。
方法
利用公开可用数据编制 CONUS 成人 civilian 一级和二级 TC 的列表，并生成 CONUS MTF 的列表。人口普查数据用于估算各邮政编码区域的成人人均密度。计算邮政编码区域与 civilian TC 和 MTF 之间的距离。对于每个被发现距离 MTF 比现有 TC 更近的邮政编码区域，列出受影响的人口规模以及距离的减少量。
结果
确定了 562 个 civilian 成人一级和二级 TC 以及 33 个军事医疗中心和医院。与距离最近的 civilian TC 相比，MTF 的平均距离减少范围为 0 至 30 英里，受影响人口范围为 12000 至超过 900000 名成年人。确定了七个 MTF，它们到相对较大人口中心的距离在临床上会显著缩短。
讨论
一些 MTF 通过发展一级或二级 TC 能力，可能会为其区域创伤系统内的大量成年人口缩短转运时间并改善护理。本研究结果提供了建议，以便将进一步研究重点放在七个 MTF 上，以确定那些值得进一步发展并与当地创伤系统整合的 MTFs。
证据级别
IV
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