The Impact of Distance on Triage to Trauma Centre Care in an Urban Trauma System

Prehospital Emergency Care, Vol. 16, No. 4, Pages 456-462

Urban trauma systems are characterised by high population density, availability of trauma centres, and acceptable road transport times (within 30 minutes). In such systems, patients meeting field trauma triage (FTT) criteria should be transported directly to a trauma centre, bypassing closer non–trauma centres. The authors evaluated emergency medical services (EMS) triage practices to identify opportunities for improving care delivery. Specifically, the effect of the additional distance to a trauma centre, compared with a closer non–trauma centre, was evaluated on the noncompliance with trauma destination criteria by EMS personnel in an urban environment.

Inclusion criteria identified 898 patients; 53% were transported directly to a trauma centre. Falls, female gender, and age greater than 65 years were associated with transport to non–trauma centres. Differential distances greater than 1 mile were associated with a decreased likelihood of triage to a trauma centre.

According to the authors, the differential distance between the closest non–trauma centre and the closest trauma centre is associated with lower compliance with triage protocols, even in an urban setting where trauma centres can be accessed within approximately 30 minutes. The authors suggest that the gap between ideal and actual application of field trauma triage guidelines can be reduced through a process of education and feedback.

http://informahealthcare.com/doi/abs/10.3109/10903127.2012.695431