Abstract
There have been recent proposals to enhance organization and funding of emergency care in the U.S. because of perceived deficiencies – especially in services for children. Motor vehicle crashes are among the leading causes of death and disability for both adults and children in the United States and place a heavy burden on emergency and trauma care. This study uses the Fatality Accident Reporting System (FARS) to examine the length of time between vehicle crash and hospital arrival for crashes involving seriously injured children transported to hospital in 2003. Only about 1/3 (1868) of 5436 crashes had data for hospital arrival time. For those cases that could be evaluated, median transport time was 46 minutes (52 minutes for rural crashes, 35 minutes for those in urban areas). There was substantial delay in a minority of crashes. Delays occurred both between crash and emergency services (EMS) notification and between EMS contact and hospital arrival and were more common in rural crashes. Other research has shown that prolonged transport times are associated with worsened trauma outcomes. Since states vary in the extent and sophistication of their trauma services we sought, but failed to find, correlation between number of trauma centers (Level I and II or all-level) per million population and median arrival time calculated for each U.S. state. Integrated trauma care begins at the site of injury and continues through posthospital care. Time between injury and hospital admission is one important indicator of trauma system performance.
Highlights
In June, 2006 the U.S Institute of Medicine released three reports on the state of the country’s emergency treatment
Data was downloaded into Microsoft Excel from the Fatality Accident Reporting System (FARS) computer database on all fatal U.S crashes occurring in 2003 in which at least one victim was under the age of 19, at least one seriously injured victim was transported to a hospital, and for which data on time of crash and time of hospital arrival were available
In 91 crashes there was a delay of 30 minutes or more from emergency services (EMS) notification to arrival, and 90% of these delayed ambulance arrivals occurred in rural areas
Summary
In June, 2006 the U.S Institute of Medicine released three reports on the state of the country’s emergency treatment. One of these reports paints a problematic picture of emergency care for children [1]. While problems are significant in urban areas, they may be more severe in rural areas where specialized services of any sort are often in short supply Many of these deficiencies have been addressed, at least to some extent, by grants provided through the federal Emergency Medical Services for Children program, a program slated for elimination in the current national budget proposed by President Bush.
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