ABSTRACT
To determine the effect of implementation of a regional trauma system on utilization of medical care we studied ambulance transports, emergency department (ED) visits, and hospital days for trauma and nontrauma patients before and after system implementation. Serious injury affects approximately one of every 1,000 persons each year and accounts for approximately one of every 250 ED visits, one of every 100 hospital days, and one of every 20 ambulance transports. Following system implementation the trauma hospitals experienced insignificant changes in annual percentage of market share of ED visits and hospital days and in annual rate of growth of ED visits and hospital days. We conclude that implementation of a medically directed regional trauma system has resulted in a predictable redistribution of a small number of seriously injured patients, and has not been associated with significant changes in utilization of EDs or hospitals.
Subject(s)
Emergencies , Emergency Medical Services/statistics & numerical data , Trauma Centers/statistics & numerical data , California , Emergency Medical Services/trends , Hospitalization , Humans , Trauma Centers/trends , Triage , Wounds and Injuries/epidemiology , Wounds and Injuries/mortalityABSTRACT
Medical accountability is an essential component of a system for trauma care. The microcomputerized regional trauma registry provides a simple method of providing accountability by integrating medical and system information to evaluate quality of care, adequacy of system criteria, and system compliance. The regional trauma registry is developed by identifying all patients who are suspected or known to have sustained a serious injury, whether or not they received trauma system care, and documenting their course from initial contact through final disposition. The microcomputer provides an inexpensive and readily available method for storing and evaluating the database. Information derived from the regional trauma registry is useful for profiling the nature and extent of trauma and for monitoring and modifying the system to improve patient access and medical care.
Subject(s)
Computers , Medical Audit/methods , Microcomputers , Registries , Wounds and Injuries , California , Humans , Oregon , SoftwareABSTRACT
The case of a scuba diver who suffered a cardiac arrest is presented. The history of a short, lucid interval after surfacing followed by cardiac arrest, the finding of hemoptysis, and the characteristic response to recompression therapy are consistent with the diagnosis of gas embolism. The clinical presentation and pathophysiology of gas embolism are discussed, and an approach to emergency stabilization and definitive management of gas embolism is reviewed, with emphasis on cardiac arrest.
