Factors associated with mode of transport to acute care hospitals in rural communities.

This study identifies factors associated with mode of transport to rural hospitals. We evaluated 11,541 trauma patient visits that came by ground ambulance or private vehicle to the Emergency Department of one of six northwest Iowa rural hospitals. We performed univariate analyses and logistic regression analyses to identify factors associated with mode of transport for each severity level (fatal, major and minor). For major/fatal injuries, we found that those aged 65 years and over were 3.6 (95% CI = 2.7-4.9) times more likely to use ambulances than those under 15. Motor vehicle traffic injuries and hip fractures were also associated with ambulance usage, while arm fractures and farm-related injuries were not. We conclude that for major/fatal injuries, older persons, those injured from high velocity causes, and those with hip fractures are more likely to use an ambulance. Emergency Medical Services may improve the community's ambulance utilization by providing public education (e.g., proper use of 911 and injury severity recognition), and by collaborating with dispatch, the local community and health care providers. Further study of the community's and individuals' decision-making factors determining mode of transportation is needed.

Characteristics of twice-transferred, rural trauma patients.

OBJECTIVE: Undertriage has seldom been evaluated in the trauma population. In rural states patients often go to the nearest hospital first, where they are evaluated and, if necessary, transferred to another hospital. If they are undertriaged when transferred to the second hospital, they will require a second transfer to a higher-level trauma center. METHODS: The authors retrospectively reviewed the charts of all trauma patients at a level I trauma center from 1996 to 1999 who were seen at two acute care facilities because of a single acute traumatic event before reaching the trauma center. Ninety-three patient charts were analyzed. RESULTS: Forty-six percent of the patients were victims of a motor vehicle crash. Patients were mostly transferred to the level I trauma center for non-spine orthopedic injuries (28%), followed by spine injuries (14%) and head injuries (13%). These patients were stable, as manifested by an average trauma score of 11.6. However, there was a significant positive interaction between injury severity score and time to definitive care. CONCLUSIONS: The authors infer from the data analysis that more serious or complex injuries took longer to evaluate. Since these patients were physiologically stable, reducing the number of twice-transferred trauma patients will involve refining transfer protocols concerning the need for specialty care.