FROM ROADSIDE TO BEDSIDE - THE REGIONALIZATION AT TRAUMA CARE IN A REMOTE RURAL COUNTY

Objective: To determine the current role of rural hospitals and prehos pital agencies in the care of motor vehicle crash victims in a remote, rural county prior to the statewide regionalization of trauma care. S pecifically, we determined the proportion of crashes that required a r esponse by emergency medical services (EMSs), the timeliness of the re sponse, the proportion of patients treated in local hospitals, and the factors that predicted referral to trauma centers. Design: Population -based retrospective cohort study linking emergency medical services, emergency department, and hospital discharge data to police motor vehi cle crash reports and coroner data. Setting: Okanogan County, Washingt on. Subjects: All motor vehicle occupants, pedestrians or pedal-cyclis ts who were involved in a motor vehicle collision with a response by e mergency medical system personnel or the county coroner. Intervention: None. Main Outcome Measures: EMS response times, emergency department and hospital discharge disposition, Injury Severity Scores, hospital length of stay, procedures, deaths. Results: Twelve percent of 669 cra shes reported to the police led to the dispatch of EMS. Crashes with E MS involvement were more likely to include occupants without restraint s, who were ejected from the vehicle or who had alcohol as a contribut ing circumstance. The median interval between crash and EMS dispatch w as 5 minutes (95th percentile: 40 minutes), the median scene time was 15 minutes (95th percentile: 35 minutes), and the median interval betw een dispatch and emergency department arrival was 48 minutes (95th per centile: 95 minutes). Among the 210 patients treated by EMSs, 67 (32%) were admitted to local hospitals, and 19 (9%) were referred to a dist ant trauma center. Of these, 17 were referred directly from the emerge ncy department, one from the scene, and one after local admission. Com pared with patients who were admitted locally, referred patients had a significantly higher mean Injury Severity Score (14.4 vs. 5.1), hospi tal length of stay (9.1 vs. 1.8 days), and rate of operative procedure s (37% vs. 9%). Of the 13 crash-related deaths during the year, nine w ere declared dead at the scene before EMS arrival, three were asystoli c at the time of EMS arrival at the scene, and one died at a referral hospital. Conclusions: The linkage of data from police, prehospital ag encies, and hospitals can reveal important information about the seque nce of health care for trauma patients. The rural hospitals in this co unty currently play a major role in the stabilization and treatment of motor vehicle crash victims.