BACKGROUND Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers). METHODS Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers. RESULTS After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries. CONCLUSIONS Our findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.

https://www.nejm.org/doi/pdf/10.1056/NEJMsa052049

A National Evaluation of the Effect of Trauma-Center Care on Mortality

Introduction
Excessive alcohol consumption is a leading cause of premature mortality in the United States The objectives of this study were to update national estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) in the United States, calculate age-adjusted rates of AAD and YPLL in states, assess the contribution of AAD and YPLL to total deaths and YPLL among working-age adults, and estimate the number of deaths and YPLL among those younger than 21 years

/pdf/contribution-of-excessive-alcohol-consumption-to-deaths-and-dh1udian7h.pdf

Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States.

OBJECTIVE:: To determine the impact of the increasing aging population on trauma mortality relative to mortality from cancer and heart disease in the United States. BACKGROUND:: The population in the United States continues to increase as medical advancements allow people to live longer. The resulting changes in the leading causes of death have not yet been recognized. METHODS:: Data were obtained (2000-2010) from the Web-based Injury Statistics Query and Reporting System database of the Centers for Disease Control and Prevention. We defined trauma deaths as unintentional injuries, suicides, and homicides. RESULTS:: From 2000 to 2010, the US population increased by 9.7% and the number of trauma deaths increased by 22.8%. Trauma deaths and death rates deceased in individuals younger than 25 years but increased for those 25 years and older. During this period, death rates for cancer and heart disease decreased. The largest increases in trauma deaths were in individuals in their fifth and sixth decades of life. Since 2000, the largest proportional increase (118%) in crude trauma deaths occurred in 54-year-olds. Overall, in 2010, trauma was the leading cause of death in individuals 46 years and younger. Trauma remains the leading cause of years of life lost.Trauma is now the leading cause of death for individuals 46 years and younger. The largest increase in the number of trauma deaths and the highest crude number of trauma deaths occurred in baby boomers. Policy makers allocating resources should be made aware of the larger impact of trauma on our aging and burgeoning US population. Language: en

Increasing trauma deaths in the United States.

Maintaining good hospital records during military conflicts can provide medical personnel and researchers with feedback to rapidly adjust treatment strategies and improve outcomes. But to convert the resulting raw data into meaningful conclusions requires clear terminology and well thought out equations, utilizing consistent numerators and denominators. Our objective was to arrive at terminology and equations that would produce the best insight into the effectiveness of care at different stages of treatment, either pre or post medical treatment facility care. We first clarified three essential terms: 1) the case fatality rate (CFR) as percentage of fatalities among all wounded; 2) killed in action (KIA) as percentage of immediate deaths among all seriously injured (not returning to duty); and 3) died of wounds (DOW) as percentage of deaths following admission to a medical treatment facility among all seriously injured (not returning to duty). These equations were then applied consistently across data from the WWII, Vietnam and the current Global War on Terrorism. Using this clear set of definitions we used the equations to ask two basic questions: What is the overall lethality of the battlefield? How effective is combat casualty care? To answer these questions with current data, the three services have collaboratively created a joint theater trauma registry (JTTR), cataloging all the serious injuries, procedures, and outcomes for the current war. These definitions and equations, consistently applied to the JTTR, will allow meaningful comparisons and help direct future research and appropriate application of personnel.

Understanding combat casualty care statistics

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the national public health burden associated with trauma and injury. In the United States (U.S.), injury is the leading cause of death for persons aged 1–44 years. In 2008, approximately 30 million injuries resulted in an emergency department (ED) evaluation; 5.4 million (18%) of these patients were transported by Emergency Medical Services (EMS).1 EMS providers determine the severity of injury and begin initial management at the scene. The decisions to transport injured patients to the appropriate hospital are made through a process known as “field triage.” Since 1986, the American College of Surgeons Committee on Trauma (ACS-COT) has provided guidance for the field triage process though its “Field Triage Decision Scheme.” In 2005, the CDC, with financial support from the National Highway Traffic Safety Administration (NHTSA), collaborated with ASC-COT to convene the initial meeting of the National Expert Panel on Field Triage (the Panel) to revise the decision scheme. This revised version was published in 2006 by ASC-COT, and in 2009 the CDC published a detailed description of the scientific rational for revising the field triage criteria entitled, “Guidelines for Field Triage of Injured Patients.”2–3 In 2011, the CDC reconvened the Panel to review the 2006 Guidelines and recommend any needed changes. We present the methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level.

/pdf/guidelines-for-field-triage-of-injured-patients-in-24km3ywqhb.pdf

Guidelines for Field Triage of Injured Patients: In conjunction with the Morbidity and Mortality Weekly Report published by the Center for Disease Control and Prevention.

ContextPrevious studies have reported that the number and distribution of trauma
centers are uneven across states, suggesting large differences in access to
trauma center care.ObjectiveTo estimate the proportion of US residents having access to trauma centers
within 45 and 60 minutes.Design and SettingCross-sectional study using data from 2 national databases as part of
the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH)
project. Trauma centers, base helipads, and block group population were counted
for all 50 states and the District of Columbia as of January 2005.Main Outcome MeasuresPercentages of national, regional, and state populations having access
to all 703 level I, II, and III trauma centers in the United States by either
ground ambulance or helicopter within 45 and 60 minutes.ResultsAn estimated 69.2% and 84.1% of all US residents had access to a level
I or II trauma center within 45 and 60 minutes, respectively. The 46.7 million
Americans who had no access within an hour lived mostly in rural areas, whereas
the 42.8 million Americans who had access to 20 or more level I or II trauma
centers within an hour lived mostly in urban areas. Within 45 and 60 minutes,
respectively, 26.7% and 27.7% of US residents had access to level I or II
trauma centers by helicopter only and 1.9% and 3.1% of US residents had access
to level I or II centers only from trauma centers or base helipads outside
their home states.ConclusionSelecting trauma centers based on geographic need, appropriately locating
medical helicopter bases, and establishing formal agreements for sharing trauma
care resources across states should be considered to improve access to trauma
care in the United States.

https://www.lifeflightmaine.org/Documents/EMS-and-Hospitals/Research/Access-to-Care/Access-to-Trauma-Centers-06_2005.aspx

Access to trauma centers in the United States.

Humanitarian relief is a key operation after a disaster for people who are isolated in disaster-affected areas and cannot get basic supplies for daily living. Because the demand can be large and unexpected, an efficient humanitarian relief logistics planning becomes extremely important. In a recent paper, Lin et al. (2009) proposed a logistics model for disaster relief operations. In this paper the authors demonstrate how to apply their model to a case study. The scenario that the authors have selected is that of an earthquake disaster in Southern California simulated using the HAZUS-MH software. A series of sensitivity analyses is conducted in the paper to provide insights on the influence of various parameter settings to the performance of a disaster relief operation – specifically the authors study the impact of the depot location, the number of vehicles, and the number of clusters chosen. For the simulated earthquake disaster, the analysis shows that geographic location for the depot is important, increasing the number of vehicles does improve the performance, and that reduction in the number of clusters does not guarantee an improvement in the logistics of humanitarian relief.

/pdf/application-of-a-humanitarian-relief-logistics-model-to-an-25ek45yff4.pdf

Application of a Humanitarian Relief Logistics Model to an Earthquake Disaster

Highway crashes exact an enormous human and financial cost. The problem is proportionately more acute in rural states. Points of intervention include immediate response to crashes and community supports to individuals injured in crashes. Two studies were conducted. The first examined the context of routing advanced automatic crash notification (AACN) messages into the emergency response system and demonstrating the feasibility of doing so. The second examined the referral process from medical treatment to community return. The effort to integrate AACN data into the existing emergency response system culminated in the demonstration of the receipt of simulated AACN information by the Missoula Public Safety Answering Point (PSAP) and the subsequent real-time sharing of this information with Emergency Medical Services (EMS) and hospital-based stakeholders. The project also included the development of a computerized database infrastructure, which was designed to capture OnStar AACN crash data starting in July 2012. The effort to develop and expand models for providing community supports to individuals injured in car crashes culminated in the development of new strategies for marketing the Resource Referral System – now the Brain Injury Help Line – and an assessment of the effectiveness of various strategies for recruiting hospital emergency department participation. Since the beginning of the project, overall referrals to the Help Line increased from 148 to 222. Finally, these data were used to estimate the budget needed to expand the service to meet the potential need. That estimate suggests either the Brain Injury Association of Montana (BIAMT) Hot Line is underfunded or it is overstretched.

Automatic Crash Notification Project: Assessing Montana’s Motor Vehicle Crash and Related Injury Data Infrastructure

Much work has been done recently to examine the trends, contributing factors and characteristics of the increasing number of fatal motorcycle crashes occurring in the United States. This paper explores two new resources, geocoded Fatality Analysis Reporting System (FARS) data and roadway orthoimagery, to examine the geo-spatial characteristics of U.S. fatal motorcycle crashes. Using 2001, 2002, 2003, and 2004 FARS crash data (that were previously geocoded by the National Highway Traffic Safety Administration’s (NHTSA's) National Center for Statistics and Analysis), the authors have characterized the locations in the United States that have had fatal motorcycle crashes. Locations where crashes occurred were identified by using spatial and attribute queries of the NHTSA FARS database after the database was imported into a Geographic Information System. During the period from 2001 through 2004, FARS identifies 14,653 fatal motorcycle crashes. Approximately 91 percent of these crashes (13,329) were successfully geocoded and entered into the analyses. A majority (about 70%) of motorcycle fatalities occur on undivided roadways. A valuable new approach to the analysis of fatal motorcycle crashes will be described. This approach involves use of high resolution orthoimagery which is now available for some, although not all, roadways. In addition, care must be taken to insure that available imagery displays roadway features at the time of the crash. This paper provides the first geospatial analysis of fatal U.S. motorcycle crashes using national geocoded FARS data coupled with available roadway orthoimagery. Precise crash location, roadway imagery and FARS crash attributes provide unique opportunities to investigate crash trends, causation factors and potential crash mitigation techniques.

Use of geocoded FARS data to analyze fatal motorcycle crashes

In the not too distant future, sensor-rich vehicles operating on smart roadways will automatically exchange safety information with other vehicles and with the roadway infrastructure. Active sensing and ranging systems such as radar, laser scanners and ultrasonic sensors, will be fused with passive systems such as computer vision, to provide redundant sensing and prevent crashes. Some level of vehicle automation will be established up to and including autonomous (driverless) cars, and infrastructure-based radar, a key technology in active traffic management, will help stabilize vehicle flows. If all of this proceeds as expected, the changes will be revolutionary with significant reductions in crashes expected. However, some crashes will still occur - as will man-made and natural disaster events - and there will always be non-crash-related injuries and illnesses which require emergency transport. For these reasons, the authors anticipate the continued need for emergency responders of all types (i.e., medical/police/fire/power/ communications). The purpose of this paper is to examine the in-vehicle and infrastructure-based technologies which are emerging in the next five to eight years and assess the utility of these technologies for responders, particularly Emergency Medical Services (EMS). They also consider whether protocols might need to be changed when EMS are responding along a route where platoons or autonomous vehicles are operating. Finally, they examine how the types of future emergencies on the roadways may change and suggest event scenarios (use cases) which may help guide planning for the revolutionary changes ahead.

Utility of Advanced Driver Assistance Systems and Connected Vehicle Technologies for Emergency Medical Services: Emergency Event Use Cases in an Automated and Connected Transportation System

Alan Blatt

Papers

Access to trauma centers in the United States.

Application of a Humanitarian Relief Logistics Model to an Earthquake Disaster

Automatic Crash Notification Project: Assessing Montana’s Motor Vehicle Crash and Related Injury Data Infrastructure

Use of geocoded FARS data to analyze fatal motorcycle crashes

Utility of Advanced Driver Assistance Systems and Connected Vehicle Technologies for Emergency Medical Services: Emergency Event Use Cases in an Automated and Connected Transportation System