Evaluating regional trauma concept #trauma

While just about everything in the medevac industry seems controversial, it is not surprising that some who argue that there is not much validity in establishing regional trauma centers.  Any attempt to evaluate the impact of a regional trauma center is uniquely complex due to the large number of variables that must be taken into account.  It was the intent of the 1985, Trunkey study to demonstrate that preventable death could be used to evaluate the impact of regional trauma programs in reducing mortality.  Salmi, Williams, Guibert et.al. from Montreal, Quebec and Germany has challenged the validity of United States studies on preventable death rates.  They profess that “preventable death rate” studies have major flaws.

By thorough review of design and research strategies, selection of subjects these researchers have come to the conclusion that “unless results from two or more studies are based on comparable data, the comparisons may reflect systematic information biases.”  They cite the following basic flaws in preventable death studies:  1) Time trends in trauma severity unrelated to care are not taken into account.  2)  Selection bias occurs when there is a restriction of cases by region hospital, type or cause of injury, time of death, or other variables.  3)  Other problems arise if clinical and post mortem data are drawn inconsistently from varying sources.  4) Also, the choice of criteria for consensus about preventability could by itself explain observed differences in preventable death rates.”  They also point out a more serious flaw of not accounting for those patients who would have died, but actually survived because of adequate care.

A trauma system can only be as effective as the services provided to designated communities.  Effectiveness is dependent upon quickly identifying the victims and dispatching EMS services; immediate and accurate diagnosis of severe injury; compliance of ambulance services, emergency rooms, hospital specialists and providing all victims with the highest standard of treatment through all stages of care.  Further consumer awareness, acceptance, and use of services plays an important role.  There is also the possibility that the quality of care may be related to differences in circumstances completely unrelated to care.

Death at the scene may or may not be preventable.  However, delays in response can result in “preventable deaths.”  Failure to provide basic or Advanced Life Supports at the scene or in transit may contribute to DOA (Death on Arrival).

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