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Delays in Interfacility Transport of Trauma Patients in a Rural Environment

Paul Kispert, John Sutton, Kenneth Burchard, Horace Henriques, John Higgins, James Whedon, Peter Steinberg
Dartmouth-Hitchcock Medical Center, Lebanon, NH

Objective: Determine the frequency and duration of interfacility transport delays in a rural environment
Design: Retrospective analysis of trauma and transport registry data
Setting: Level I trauma center receiving patients from multiple hospitals in a rural setting
Patients: Patients entered into the trauma registry transported by the DHMC on-site air or ground transport teams between 1/1/04 and 12/31/04
Interventions: None
Main Outcome Measures: Time from arrival at the referring hospital to first telephone contact with DHMC to request transfer.
Results: 287 patients were transported. Time of arrival at the initial hospital and time of initial telephone contact to request transfer to DHMC was available for 238 patients. The following data reflects the time in minutes : percentages from arrival at the initial hospital to telephone request for transfer to DHMC; Request prior to arrival: 19.3% (n=46), 0-59: 32.5% (n=77), 60-119: 23.1% (n=55), 120-179: 17.6% (n=42) and >179: 7.5% (n=18). No statistical correlation was found between frequency of CT scanning or ISS and delayed request for transfer.
Conclusions: Long delays prior to the recognition of the need to transfer the patient are common. In our region, 25% of patients spent two hours or more being evaluated prior to any contact being made to transfer the patient. We would propose that the time interval from arrival at the first hospital to contact with a trauma center be considered a measure of function in a trauma system. In an effective trauma system, these delays to contact should decrease over time.

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