[Interface between preclinical and clinical trauma care: Analysis of the processes in a trauma network]

Unfallchirurg. 2015 Aug;118(8):657-65. doi: 10.1007/s00113-015-0024-9.
[Article in German]

Abstract

Introduction: In the initial treatment of severely injured patients a good cooperation of the emergency medical service (EMS) with the hospital team is mandatory. The aim of this investigation was to evaluate the quality of cooperation between hospitals working within a trauma network and the rescue service and to develop a tool allowing assessment of the preclinical and clinical interface.

Methods: Specific surveys concerning preclinical management and transfer to the target hospital were developed within a modified Delphi process. Injured trauma patients were included if the EMS involved was participating in the network and they were transferred to one of the participating hospitals.

Results: Over an 11-month period a total of 360 patients were included in the study. The notification of transferring injured patients to the target hospital was carried out in a regular manner. Transport accompanied by an emergency physician occurred in 97% of the cases and no emergency physician was available although needed in only 1% of cases. Correct choice of target hospital was documented in 98.2%. The average waiting time for transferring the patient to the hospital team was 0.15 min. In 95.7% of cases a hospital physician was available to directly receive the patient in the emergency room. On a scale ranging from 1 (poor) to 10 (very good) clinical personnel as well as rescue teams rated the cooperation between both with a median of 10 points (IQR 8;10). From the clinicians point of view airway and circulation problems and external bleeding were correctly treated in the preclinical setting (airway 93.9%, circulation 97.3% and external bleeding 95.3%); however, for extremity injuries only in 78.5% of the cases.

Conclusion: This survey presents an adequate tool to identify weak spots within the primary management and to point out elements for improvement.

MeSH terms

  • Aged
  • Attitude of Health Personnel*
  • Critical Care / statistics & numerical data
  • Efficiency, Organizational / statistics & numerical data
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Patient Transfer / statistics & numerical data*
  • Prevalence
  • Process Assessment, Health Care
  • Traumatology / statistics & numerical data*
  • Waiting Lists
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / epidemiology*
  • Wounds and Injuries / therapy*