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Stamey HM, Brou LI, Meyers KR, Yang H, Thackeray-Pflughoft K, Spilman SK. Getting patients to the right level of trauma center after motorcycle crashes in a rural trauma system. Am J Emerg Med 2024; 78:8-11. [PMID: 38181543 DOI: 10.1016/j.ajem.2023.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE After a motorcycle crash (MCC), emergency medical services (EMS) responders must balance trauma center proximity with clinical needs of patients, which is especially challenging in rural states. The study purpose was to determine if MCC patients treated at lower-level trauma centers (LLTC) experienced higher mortality when compared to patients transported directly to the highest level of trauma care available in the state at Level II trauma centers. PROCEDURES A retrospective study was conducted on MCC patients transported by EMS to Montana hospitals and met registry inclusion criteria in 2020-2021. The first study group included patients initially transported to state-designated trauma centers (equivalent to Level III-V) or non-designated hospitals (LLTC), and the second group included patients transported directly to American College of Surgeon verified Level II trauma centers (L2TC). Secondary transfer was defined as initial transport to a LLTC and subsequent transfer to a L2TC. Primary study outcome was mortality at the L2TC. Chi-square tests and Wilcoxon rank sum tests were used for analysis. FINDINGS In the study period, 337 MCC patients were transported by EMS; 186 (55%) patients were transported to a LLTC while 151 patients (45%) were transported to a L2TC. There were no statistically significant differences in mortality (12% vs 8%, p = 0.30) when comparing secondary transfer patients to patients transported directly to a L2TC. CONCLUSIONS Nearly half of patients initially evaluated at a LLTC required transfer to a higher-level of care. Secondary transfer was not associated with increased mortality.
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Affiliation(s)
- Heather M Stamey
- Intermountain Healthcare St. Vincent, Billings, MT, United States of America
| | - Lina I Brou
- Biostatistical Consultant, Denver, CO, United States of America
| | - Katherine R Meyers
- Intermountain Healthcare St. Vincent, Billings, MT, United States of America.
| | - Hannah Yang
- Montana Department of Public Health and Human Services, Helena, MT, United States of America
| | | | - Sarah K Spilman
- Diligent Research & Consulting, Urbandale, IA, United States of America
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Fernald DH, Zittleman L, Gilchrist EC, Brou LI, Brou LI, Niebauer L, Ledonne C, Sutter C, Felzien M, Westfall JM, Green LA. UPSTREAM! Together evaluation results from community efforts to prevent mental, emotional, and behavioral health problems. Eval Program Plann 2021; 89:102000. [PMID: 34555734 DOI: 10.1016/j.evalprogplan.2021.102000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/08/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
Mental, emotional, and behavioral (MEB) health problems are prevalent globally. Despite effective programs that can prevent MEB problems and promote mental health, there has not been widespread adoption. UPSTREAM! Together was a planning project in three Colorado communities. Communities partnered with academic and policy entities to 1) translate evidence about MEB problem prevention into locally-relevant messages and materials and 2) develop long-term plans for broad implementation of interventions to prevent high-priority MEB problems. Community members recognized the need to talk about MEB problems to prevent them. The UPSTREAM! communities localized messages designed to start conversations and sustain attention on preventing MEB problems. The communities understood that prevention takes sustained community attention and advocacy, knowing that important outcomes may be years away. Long-term implementation plans aimed to strengthen families and enhance social connections among youth. Despite community readiness and capacity to implement evidence-based programs, there were few funding opportunities, delaying program implementation and revealing gaps between funding policies and community readiness. This community-engaged experience suggests an achievable approach, acceptable to communities, and worthy of further development and testing. Policies that cultivate and support local expertise may help to increase wider community adoption of evidence-based programs that promote mental health among youth.
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Affiliation(s)
- Douglas H Fernald
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Emma C Gilchrist
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
| | - Lina I Brou
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lina I Brou
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Linda Niebauer
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
| | - Charlotte Ledonne
- San Luis Valley Area Health Education Center, Alamosa, CO, United States
| | - Christin Sutter
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; High Plains Research Network Community Advisory Council, Sterling, CO, United States
| | - Maret Felzien
- High Plains Research Network Community Advisory Council, Sterling, CO, United States
| | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
| | - Larry A Green
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
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