pact on the care of trauma patients, such as resuscitation guidelines, severe head injury guidelines, and geriatric protocols.

Coordinated care, adequate transportation, and planning of facility scope of practice all contribute to improving the outcome of trauma patients in rural areas, Mains concluded. A list of discussed metrics can be found in Box 6-2.

BOX 6-2

Suggested Metrics

Planning and Concept Metrics

  • Rural and frontier-specific patient care and outcomes data (most current data are based on urban and suburban transport times and facility capabilities that do not necessarily translate to a rural setting)

  • Frequency of incidents

  • Time to fill ICS roles

  • Extent of integration (public/private, local/regional) in broad response planning

  • Multidisciplinary participation in mass casualty exercises

  • Access to trauma care (onsite, after transport, telemedicine)

  • Triage and treatment protocols

  • Alternative treatment facilities for triage and stabilizing those awaiting transport

  • Ability to treat special needs populations (e.g., pediatric)

  • Quantity, status, and safety of transportation assets

  • Effective use of strike teams

Metrics Collected by Geographic Location

  • Ground and helicopter EMS services

  • Hospital locations and trauma center designations

  • Available resources (equipment and personnel)

EMS Personnel-Specific Metrics

  • Education, training, exercise frequency, field skill expansion, medical supervision onsite/through telemedicine, after-action debriefing, quality improvement, safety and security issues

Transportation-MCI-Specific Metrics

  • Location-specific coding of transportation crashes (including road descriptions)

  • Traffic volume by segment of roadway

  • Traffic volume by type of vehicle

  • Weather

Patient-Centered Metrics

  • Risk-adjusted mortality, injury severity score, probability of survival by treatment center/region

  • Number of preventable deaths

  • Number of inappropriate double transports

  • Transport time to definitive care

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