Patients with major trauma who do n

Patients with major trauma who do not use emergency ambulances

B P McNicholl, J Lee


When planning a trauma service it is important to estimate the number of injured patients who will attend a hospital other than the designated trauma centre. Up to a third of patients in one study went to the wrong hospital.' This happens because paramediCs make triage errors and take patients to the wrong hospitaF and (we hypothesise) because some patients make their own way to hospital. Because a trauma service may be established in Northern Ireland we tried to estimate the numbers of injured patients likely to take themselves to the wrong hospital.


Methods and results
For one year a surveillance system monitored 12 randomly chosen hospitals out of the 19 in Northern Ireland that receive cases of major trauma. Patients were detected by monitoring all the accident and emergency and intensive care units, tertiary referral centres, and necropsies. Patients with an injury
severity score of > 15 who reached hospital alive were included. Data were collected by twice weekly monitoring of each hospital and the ambulance service (where all emergency calls are tape recorded). We
collected data on how each patient had arrived at
hospital.

Seventeen patients had a delay between injury and transport to hospital. This was due to delays in the appearance of physical signs and delays in acting on them by relatives or general practitioners. Ten of these patients were injured in falls at ground level and were not found for some time or treated as drunk.


Comment
Studies from the United States have shown that between 7% and 21% of all trauma victims may be taken to the wrong hospital by the paramedics staffing emergency ambulances.'' If even trained paramedics make wrong decisions then patients themselves might be likely to. Moreover, patients cannot be expected to know which hospitals are trauma centres and which are not. Our study showed that even in a place with a free emergency ambulance service, 16% of badly injured patients make their own way to hospital.
These findings suggest that within a planned trauma service, with designated trauma centres, any hospital with an accident and emergency department, whether a trauma unit or not, should be prepared to receive criticially injured patients unexpectedly. Based on our data and those from the United States the proportion may be anywhere between 7% and 37% (though not all the patients who make their own way to hospital will go to the wrong one). The likely size of this group, the relative fate of these "outcasts," and whether a higher morbidity among this group offsets the benefits of trauma centres need to be prospectively researched. In both predicting and evaluating the effectiveness of a trauma service these patients need to be included in the calculations_


Unknown* Car
Other ambulancet
Carried
Police
Bust

Total

14 Of 239 patients in the study 39 (34 men, 5 women)
14 did not arrive at hospital by ambulance (see table).
6 Thirty one patients went to their nearest hospital.
2 Their median injury severity score was 24, and five
I died. Seven injuries were penetrating. Half of the
39 patients (20) required immediate surgery (defined as surgery for life threatening injury to vessels or organs

We thank the Department of Health for funding and Mr W
H Rutherford and Mr B Fisher for their advice. We are grateful to the Northern Ireland ambulance service and the participating hospitals for their cooperation.


I Mackenzie EJ, Steinwachs DM, Ramzy AI. Evaluating performance of statewide regionalized systems of ttauma care.J Trauma 1990;30:681-8.

*These patients did not have mode
of transport recorded in their hospital records, but we know they did not use emergency ambulances. tTwo of these were requested by family doctors.
:j:An injured bus driver.


1442

scoring abbreviated injury score of 3 or more), nine
neurosurgical procedures, and eight laparotomies.
Among the 200 patients who did use emergency ambulances 44 (22%) required immediate surgery
Cx'=OO•OO; P

ผลลัพธ์ (อังกฤษ) 1:

Patients with major trauma who do not use emergency ambulancesB P McNicholl, J LeeWhen planning a trauma service it is important to estimate the number of injured patients who will attend a hospital other than the designated trauma centre. Up to a third of patients in one study went to the wrong hospital.' This happens because paramediCs make triage errors and take patients to the wrong hospitaF and (we hypothesise) because some patients make their own way to hospital. Because a trauma service may be established in Northern Ireland we tried to estimate the numbers of injured patients likely to take themselves to the wrong hospital.Methods and resultsFor one year a surveillance system monitored 12 randomly chosen hospitals out of the 19 in Northern Ireland that receive cases of major trauma. Patients were detected by monitoring all the accident and emergency and intensive care units, tertiary referral centres, and necropsies. Patients with an injuryseverity score of > 15 who reached hospital alive were included. Data were collected by twice weekly monitoring of each hospital and the ambulance service (where all emergency calls are tape recorded). Wecollected data on how each patient had arrived athospital. Seventeen patients had a delay between injury and transport to hospital. This was due to delays in the appearance of physical signs and delays in acting on them by relatives or general practitioners. Ten of these patients were injured in falls at ground level and were not found for some time or treated as drunk.CommentStudies from the United States have shown that between 7% and 21% of all trauma victims may be taken to the wrong hospital by the paramedics staffing emergency ambulances.'' If even trained paramedics make wrong decisions then patients themselves might be likely to. Moreover, patients cannot be expected to know which hospitals are trauma centres and which are not. Our study showed that even in a place with a free emergency ambulance service, 16% of badly injured patients make their own way to hospital.These findings suggest that within a planned trauma service, with designated trauma centres, any hospital with an accident and emergency department, whether a trauma unit or not, should be prepared to receive criticially injured patients unexpectedly. Based on our data and those from the United States the proportion may be anywhere between 7% and 37% (though not all the patients who make their own way to hospital will go to the wrong one). The likely size of this group, the relative fate of these "outcasts," and whether a higher morbidity among this group offsets the benefits of trauma centres need to be prospectively researched. In both predicting and evaluating the effectiveness of a trauma service these patients need to be included in the calculations_ Unknown* CarOther ambulancetCarriedPolice BustTotal 14 Of 239 patients in the study 39 (34 men, 5 women)14 did not arrive at hospital by ambulance (see table).6 Thirty one patients went to their nearest hospital.2 Their median injury severity score was 24, and fiveI died. Seven injuries were penetrating. Half of the39 patients (20) required immediate surgery (defined as surgery for life threatening injury to vessels or organs We thank the Department of Health for funding and Mr WH Rutherford and Mr B Fisher for their advice. We are grateful to the Northern Ireland ambulance service and the participating hospitals for their cooperation.I Mackenzie EJ, Steinwachs DM, Ramzy AI. Evaluating performance of statewide regionalized systems of ttauma care.J Trauma 1990;30:681-8. *These patients did not have modeof transport recorded in their hospital records, but we know they did not use emergency ambulances. tTwo of these were requested by family doctors.:j:An injured bus driver.1442 scoring abbreviated injury score of 3 or more), nineneurosurgical procedures, and eight laparotomies.Among the 200 patients who did use emergency ambulances 44 (22%) required immediate surgeryCx'=OO•OO; P 2 Knudson P, Frecceri CA, Del..ateur SA. Improving the field rriage of major trauma victims. J Trauma 1988;28:602-6.3 West JG, Murdock MA, Baldwin LA, Whalen E. A method for evaluating field rriage criteria. J Trauma 1986;26:655-9.

ผลลัพธ์ (อังกฤษ) 2:

Who trauma patients with Major Emergency Ambulances do not use BP McNicholl, J Lee When planning a trauma it is important to Estimate the Number Service of Hospital Injured patients Who Will attend a designated trauma Other than the Centre. Up to a third of patients in one study went to the wrong hospital. '. This happens because paramediCs make triage errors and take patients to the wrong hospitaF and (we hypothesise) because some patients make their own way to hospital. Because a trauma Service May be established in Northern Ireland we tried to Estimate the Numbers of Injured patients likely to take themselves to the Wrong Hospital. Methods and results For one year a surveillance System monitored 12 randomly Chosen hospitals out of the 19 in Northern Ireland that. receive cases of major trauma. Patients were detected by monitoring all the accident and emergency and intensive care units, tertiary referral centres, and necropsies. Patients with an injury Severity Score of> 15 Who reached Alive Hospital were included. Data were collected by twice weekly monitoring of each hospital and the ambulance service (where all emergency calls are tape recorded). We Collected Data on Patient How each had arrived at Hospital. Seventeen patients had a Delay between injury and Transport to Hospital. This was due to delays in the appearance of physical signs and delays in acting on them by relatives or general practitioners. Ten of these patients were Injured in Falls at Ground level and were not Found for Some time or treated as Drunk. Comment Studies from the United States have shown that between 7% and 21% of all trauma victims May be taken to the Wrong Hospital by. the paramedics staffing emergency ambulances. '' If even trained paramedics make wrong decisions then patients themselves might be likely to. Moreover, patients can not be expected to know which hospitals are trauma centres and which are not. Our Study Showed that even in a Place with a free Emergency Ambulance Service, 16% of badly Injured patients Make their own Way to Hospital. These findings suggest that Within a planned trauma Service, with designated trauma Centres, any Hospital with an accident and Emergency. department, whether a trauma unit or not, should be prepared to receive criticially injured patients unexpectedly. Based on our data and those from the United States the proportion may be anywhere between 7% and 37% (though not all the patients who make their own way to hospital will go to the wrong one). The likely size of this group, the relative fate of these "outcasts," and whether a higher morbidity among this group offsets the benefits of trauma centres need to be prospectively researched. In both predicting and evaluating the effectiveness of a trauma Service these patients Need to be included in the Calculations_ Unknown * Car Other Ambulancet carried Police Bust Total 14 Of 239 patients in the Study 39 (34 Men, 5 Women) 14 did not Arrive at Hospital. by Ambulance (See Table). 6 Thirty one patients went to their nearest Hospital. 2 Their Severity Score was 24 Median injury, and Five I died. Seven injuries were penetrating. Half of the 39 patients (20) required immediate Surgery (defined as Surgery for Life threatening injury to vessels or organs We Thank the Department of Health for funding and Mr W H Rutherford and Mr B Fisher for their Advice. We are grateful to the Northern. Ireland Ambulance Service and the participating hospitals for their Cooperation. I Mackenzie EJ, Steinwachs DM, Ramzy AI. Evaluating Performance of statewide regionalized Systems of Trauma Ttauma Care.J 1990th; 30: from 681 to 8. * These patients did not have mode of Transport. Recorded in their Hospital records, but we know they did not use Emergency Ambulances. TTwo of these were requested by Family Doctors. : J: An Injured Bus Driver. 1 442 scoring abbreviated injury Score of 3 or more), Nine neurosurgical procedures, and Eight. Laparotomies. Among the 200 patients Emergency Ambulances Who did use 44 (22%) required immediate Surgery Cx '= OO • OO; P




















































2 Knudson P, Frecceri CA, Del..ateur SA. Improving the field rriage of major trauma victims. J Trauma 1,988th; 28: 602-6.
3 West JG, Murdock MA, Baldwin LA, E. Whalen A method for evaluating field Rriage criteria. J Trauma 1986; 26: 655-9.

ผลลัพธ์ (อังกฤษ) 3:

Patients with major trauma who do not use emergency ambulances

B, P McNicholl J Lee


When planning a trauma service it. Is important to estimate the number of injured patients who will attend a hospital other than the designated trauma, centre. Up to a third of patients in one study went to the wrong hospital.'This happens because paramediCs make triage errors and take patients to the wrong hospitaF and (we hypothesise because.) Some patients make their own way to hospital. Because a trauma service may be established in Northern Ireland we tried to. Estimate the numbers of injured patients likely to take themselves to the wrong hospital.


Methods and results
.For one year a surveillance system monitored 12 randomly chosen hospitals out of the 19 in Northern Ireland that receive. Cases of major trauma. Patients were detected by monitoring all the accident and emergency and intensive, care units tertiary. Referral, centres and necropsies. Patients with an injury
severity score of > 15 who reached hospital alive were included.Data were collected by twice weekly monitoring of each hospital and the ambulance service (where all emergency calls are. Tape recorded). We
collected data on how each patient had arrived hospital at
.

Seventeen patients had a delay between. Injury and transport to hospital.This was due to delays in the appearance of physical signs and delays in acting on them by relatives or general, practitioners. Ten of these patients were injured in falls at ground level and were not found for some time or treated as drunk.


Comment
.Studies from the United States have shown that between 7% and 21% of all trauma victims may be taken to the wrong hospital. By the paramedics staffing emergency ambulances. '' If even trained paramedics make wrong decisions then patients themselves. Might be likely to. Moreover patients cannot, be expected to know which hospitals are trauma centres and which are not.Our study showed that even in a place with a free emergency, ambulance service 16% of badly injured patients make their. Own way to hospital.
These findings suggest that within a planned trauma service with designated, trauma centres any hospital,, With an accident and, emergency department whether a trauma unit or not should be, prepared to receive criticially injured. Patients unexpectedly.Based on our data and those from the United States the proportion may be anywhere between 7% and 37% (though not all the. Patients who make their own way to hospital will go to the wrong one). The likely size of, this group the relative fate. Of these "outcasts," and whether a higher morbidity among this group offsets the benefits of trauma centres need to be prospectively. Researched.In both predicting and evaluating the effectiveness of a trauma service these patients need to be included in the calculations _
.



* Car Unknown Other ambulancet Carried Police





14 Bust Total Of 239 patients in the study 39 (34, Men 5 women)
14 did. Not arrive at hospital by ambulance (see table).
6 Thirty one patients went to their nearest hospital.
2 Their median injury. Severity score, was 24And five
I died. Seven injuries were penetrating. Half of the
39 patients (20) required immediate surgery (defined as surgery. For life threatening injury to vessels or organs

We thank the Department of Health for funding and Mr W
H Rutherford and. Mr B Fisher for their advice. We are grateful to the Northern Ireland ambulance service and the participating hospitals. For their cooperation.


.I Mackenzie, DM EJ Steinwachs, AI Ramzy. Evaluating performance of statewide regionalized systems of ttauma care.J Trauma. 1990; 30: 681-8.

* These patients did not have mode
of transport recorded in their, hospital records but we know they did. Not use emergency ambulances. TTwo of these were requested by family doctors.
: J: An injured bus driver.


1442

.Scoring abbreviated injury score of 3 or more), nine
neurosurgical procedures and eight, laparotomies.
Among the 200 patients. Who did use emergency ambulances 44 (22%) required immediate surgery
Cx '= OO - OO; P < O - OOl).

2 Knudson P Frecceri CA Del..Ateur,,, SA. Improving the field rriage of major trauma victims. J Trauma 1988; 28: 602-6.
3, West JG Murdock MA Baldwin LA Whalen,,, E.A method for evaluating field rriage criteria. J Trauma 1986; 26: 655-9.

.