Rural Trauma SIG
The Rural Trauma SIG is open to all members. For more information, or to get involved, contact one of the group chairs below.
- 2008 Trauma Program Manager's Workshop
- The "Golden Hour" Life/Death Clock Diagram
Liberman, M., et al (2003). Multi-center Canadian Study of Pre-hospital Trauma Care. Annals of Surgery, 237(2), 153-160.
The objective of this Canadian study was to evaluate whether or not the type of on-scene trauma care affects outcome in trauma patients. The on-going controversy regarding pre-hospital care of trauma patients between advanced life support (ALS) and basic life support (BLS) providers continues to be debated. This prospective study compared three types of pre-hospital trauma care systems: Montreal, where physicians provide ALS (MD-ALS); Toronto, where paramedics provide ALS (PMD-ALS); and Quebec City, where emergency medical technicians provide BLS only (EMT-BLS). All patients were treated at highly specialized tertiary (level I) trauma hospitals. Death as a result of injury was the main outcome parameter. Results showed that in urban trauma centers with highly specialized care, there is no benefit in having on-site ALS for the pre-hospital management of trauma patients in this study. This is a must reading that questions the utility of many of the tenets of pre-hospital trauma care.
Goldstein, L., et al, (2003). Adopting the pre-hospital index for inter-facility helicopter transport: a proposal. Injury, 34(1):3-11.
Inter-facility helicopter transport is expensive and without a proven benefit in outcome for trauma patients. This study sought to determine the fastest method of rural to urban inter-facility transport. A triage tool was developed to identify patients most in need of rapid transport. The tool was then applied to a retrospective cohort of adults with ISS 12. The results showed that air ambulance was faster than ground transport, with helicopter overall superior to fixed-wing (less than 225 km range). Mortality for PTI<4 was 1.4% versus 22% for PTI 4. This Canadian study was useful but no all that helpful as the distance of 225 km is about 140 miles and probably does not reflect the bulk of aero-medical transport in the United States.