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Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary
TRAUMA SYSTEM DATA AND METRICS
Charles Mains, trauma medical director for Centura Health Trauma System and medical director at Saint Anthony Central Hospital in Denver, Colorado, began with a brief review of the consequences of shock, reminding participants that multiorgan failure and death may occur several weeks after the initial traumatic insult. Optimal patient outcomes depend on an integrated system of care from prehospital to rehabilitation, he said.
In an effort to develop a fully integrated statewide trauma system, Centura has 19 facilities, 14 of which are designated trauma centers, and all of which are not-for-profit. Combined, they log 300,000 emergency room (ER) visits and 8,000 trauma admissions per year. Centura also provides medical direction to 130 prehospital agencies and averages 4,000 medical flight missions per year, which are dispatched through a centralized flight operations center. When flights are grounded, there are four critical care ground units that can travel to the scene. There are four different modes of communication between the trauma centers and the affiliated facilities. Centura also maintains a centralized trauma registry that currently has data from about 32,000 patients over the past 4 years. Mains said that this makes the Centura system ideally suited to study the metrics of trauma care across a broad region.
Mains explained that the fully integrated system of care incorporates quality processes, best practices, and national benchmarks, as well as an extensive outreach and education program. The system has destination guidelines, patient tracking through a unified medical record system, and coordination with the state trauma system. There is radiology interconnectivity via the Internet so that in-house trauma radiologists can read films in any of the rural facilities and decide which hospital in the system is most appropriate for patients’ triage. Using the one-call system, patients are directed to the facility with the resources that best meet their medical needs (which is not always the top-ranked care facility).
For trauma system metrics, the Centura system is benchmarking against national trauma data. They assess individual facility and system risk-adjusted mortality versus injury severity score (ISS) versus probability of survival. They also study preventable death, inappropriate double transport, and transport time to definitive care. Flattening of the second and third peaks in the trimiodal death curve (i.e., deaths occurring hours to weeks after the initial trauma) is a sign of the maturity of a trauma system, Mains said. If both the EMS and the initial hospital are effective at resuscitation, there will be fewer respiratory distress and multiorgan failure deaths in the intensive care units (ICU). Great field capabilities are wasted if the hospital is not prepared to perform critical care at the level needed. Centura’s quality initiatives focus on efforts that can make a significant im-