Directly taking accident victims to a trauma centre increases chances of survival

Minutes matter, says Dr. Avery Nathens

People who are seriously injured in a car accident are more than 30 per cent more likely to survive at least 48 hours if they are taken directly to a trauma centre than those who are taken first to a non-trauma centre, new research has found.

However, fewer than half of people seriously injured in car accidents in Ontario are taken directly from the scene to a trauma centre. In addition, only half of those taken to the nearest hospital are later transferred to a trauma centre after being assessed and stabilized.

These findings by Dr. Avery Nathens, trauma director at St. Michael's Hospital in Toronto, were published in the June issue of the Journal of Trauma and Acute Care Surgery.

Ontario has nine Level 1 or Level 11 adult trauma centres. A trauma centre is a hospital with a trauma team that includes specially trained personnel available 24 hours a day, every day, to provide immediate treatment for the most critically injured patients. Higher levels of trauma centres also have the staff and highly sophisticated medical diagnostic equipment to provide specialized emergency care such as neurosurgery and orthopedics.

Dr. Nathens and his team looked at data from 6,341 car accidents in Ontario from 2002 to 2010. Of those, 45 per cent were transported from the scene to a trauma centre. Of patients who were taken first to a non-trauma centre, only 57 per cent were transferred to a trauma centre.

Patients are taken to non-trauma centres for one of two reasons, Dr. Nathens said. First, the potential severity of their injuries might not be recognized by EMS personnel, so they might be transported to a non-trauma center if it is the closest hospital. . Second, transport to a trauma centre might take too long, so patients are taken to a non-trauma centre unless air transportation is available.

When patients are taken first to a non-trauma centre, Dr. Nathens said it's important that the emergency physician recognizes the potential severity of their injuries and transfers them to a trauma centre as soon as possible.

Taken together, he said the findings point to the need to make sure all health care workers, especially EMS personnel and Emergency Department physicians, are trained to recognize who needs to be treated at a trauma center. In addition, the health care system needs the resources to transport those patients quickly, he said.

"Minutes matter and severely injured patients can't advocate for themselves so we have the responsibility to ensure that the system works optimally," he said.