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The Impact of Variation in Trauma Care Times: Urban versus Rural

Published online by Cambridge University Press:  28 June 2012

Thomas J. Esposito ,
Ronald V. Maier ,
Frederick P. Rivara ,
Susan Pilcher ,
Janet Griffith ,
Susan Lazear  and
Scott Hogan
Thomas J. Esposito*
Affiliation:
Loyola University Shock Trauma Institute, Maywood, Illinois
Ronald V. Maier
Affiliation:
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
Frederick P. Rivara
Affiliation:
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
Susan Pilcher
Affiliation:
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
Janet Griffith
Affiliation:
Washington State Department of Health, Office of Emergency Medical Services and Trauma Systems, Olympia, Washington
Susan Lazear
Affiliation:
Washington State Department of Health, Office of Emergency Medical Services and Trauma Systems, Olympia, Washington
Scott Hogan
Affiliation:
Washington State Department of Health, Office of Emergency Medical Services and Trauma Systems, Olympia, Washington
*
Loyola University Shock Trauma Institute, 2160 South First Avenue, Maywood, IL 60153USA
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Abstract

Study Objectives:

To document the existence and nature of variation in times to trauma care between urban and rural locations; to assess the impact of identified variations on outcome.

Design:

Retrospective case review

Setting:

Washington state, 1986

Participants:

Motor-vehicle-collision fatalities

Methods:

Previously unreported definitions of urban and rural location and possibly preventable death were used to conduct a comparative analysis of urban and rural fatalities. Trauma care times in the prehospital and the emergency department (ED) phases of care were abstracted. Their relationships to corresponding crude death rates and possibly preventable death rates also were examined.

Results:

Prehospital times averaged two times longer in rural locations than in urban areas. First-physician contact in the ED averaged six times longer in rural locations than in urban settings. Concomitantly, the crude death rate in rural settings was three times that of the urban areas. The overall possibly preventable death rate was double the urban rates in rural incidents. When stratified by phase of care, rate of possibly preventable death showed no urban/rural variation for the prehospital phase, but was three times greater for the ED phase in rural areas than in urban ones.

Conclusions:

Trauma care times and adverse outcome appear to be associated. Allocation of resources to decrease length of and geographic variation in time to definitive care, particularly in the ED phase, seems appropriate.

Keywords

emergency departmentpreventable deathresponse timerural incidentsscene timetrauma care timesurban incidents
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 3: CJ Shanaberger Memorial Issue , September 1995 , pp. 161 - 166
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

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