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Trauma System Program

Percent of hypotensive, GCS <9, or ISS 16+ who are transferred from Level 4 trauma centers where the EDLOS is more than 2 hours

Current Value

71.6%

Q3 2022

Definition

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Story Behind the Curve

Patients who are either hypotensive (very low blood pressure), with a low Glasgow Coma Scale score of less than 9 (indicative of altered brain function), or with an Injury Severity Score (ISS) of 16 or greater are considered severely injured2. Many times, the care that is required of these patients exceed the capability and capacity of most Level IV trauma centers. For this reason, it is very important that these patients are quickly stabilized and transferred from the emergency department to a trauma center that can provide definitive treatment. This metric tells us how many severely injured patients spend more than two hours in the emergency department of a Level IV trauma center before being transferred to another trauma center that can take care of the patient.

Source: 2Porter, A., Wyrick, D., Bowman, S. M., Recicar, J., & Maxson, R. T. (2014). The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients. Journal of Trauma and Acute Care Surgery, 76(4), 907-912.

Partners

  • Statewide Trauma Centers
  • Emergency Medical Service (EMS) or Ambulance Agencies
  • Arkansas Trauma Communications Center (ATCC)
  • Trauma Advisory Council (TAC)
  • Trauma Regional Advisory Council (TRAC)

What Works

Ongoing training in the form of the Rural Trauma Team Development Course (RTTDC) provided to the hospitals. The RTTDC helps nurses and doctors in Level IV trauma centers to quickly identify and transfer patients whose injuries may exceed the capability and capacity of their  hospital3. Through the course, nurses and doctors are trained on how to start the process of transferring the patient to another hospital while stabilizing their injuries.

Hospitals then contact the Arkansas Trauma Communications Center (ATCC) to coordinate the transfer and activate the urgent trauma transfer protocol which alert the local ambulance service that there is an urgent need to transfer a patient to another trauma center. Using the ATCC to transfer patients will shorten the time that is spent in the emergency department4. The ambulance service will then work with the hospital to ensure that the patient is quickly and safely transferred to a hospital that can care for the patient.

Source: 3Dennis, B. M., Vella, M. A., Gunter, O. L., Smith, M. D., Wilson, C. S., Patel, M. B., ... & Guillamondegui, O. D. (2016). Rural Trauma Team Development Course decreases time to transfer for trauma patients. Journal of Trauma and Acute Care Surgery, 81(4), 632-637.

4Porter, A., Wyrick, D., Bowman, S. M., Recicar, J., & Maxson, R. T. (2014). The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients. Journal of Trauma and Acute Care Surgery, 76(4), 907-912    

Action Plan

The Arkansas Department of Health will continue to promote and provide trauma-specific education to providers. In addition, there are efforts to promote the use of the urgent trauma protocol when appropriate.

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