Trauma Resources Research Articles

Implementation of the best practice guidelines on geriatric trauma care: a Canadian perspective.

traumatic injuries are increasingly affecting older patients who are prone to more complications and poorer recovery compared to younger patients. Practices of trauma health care providers therefore need to be adapted to meet the needs of geriatric trauma patients. to assess the implementation of the American College of Surgeons best practice guidelines on geriatric trauma management across level I to III Canadian trauma centres. 69 decision-makers working in Canadian trauma centres were approached to complete a web-based practice survey. Percentages and means were calculated to describe the level of best practice guideline implementation. 50 decision-makers completed the survey for a response rate of 72%. Specialised geriatric trauma resources were utilised in 37% of centres. Implementation of mechanisms to evaluate common geriatric issues (e.g. frailty, malnutrition and delirium) varied from 28 to 78% and protocols for the optimisation of geriatric care (e.g. Beers criteria to adjust medication, anticoagulant reversal and early mobilisation) from 8 to 56%. Guideline recommendations were more often implemented in level I and level II trauma centres. The adjustment of trauma team activation criteria to the geriatric population and transition of care protocols were more frequently used by level III centres. despite the growing number of older patients admitted in Canadian trauma centres annually, the implementation of best practice guidelines on geriatric trauma management is still limited. Prospective multicentre studies are required to develop and evaluate interdisciplinary knowledge translation initiatives that will promote the uptake of guidelines by trauma centres.

Pre-hospital shock index correlates with transfusion, resource utilization and mortality; The role of patient first vitals

IntroductionThe aim of our study was to evaluate if pre-hospital shock index (SI) can predict transfusion requirements, resource utilization and mortality in trauma patients. MethodsWe performed a 2-year analysis of all adult trauma patients in the TQIP database. Shock index was calculated by dividing heart-rate over systolic blood pressure. Patients were divided into two groups pre-hospital SI ≤ 1 and prehospital SI > 1. Regression and ROC curve analyses were performed. Results144951 patients were included in the study. Mean age was 45 ± 34 years, 61% were male, 84.7% had blunt injuries and median ISS was 13 [9–17]. Overall 9.1% of the patients had a pre-hospital SI > 1. Patients with pre-hospital SI > 1 had higher likelihood of requiring massive transfusion (25% vs. 0.012%, p < 0.02), interventional-radiology intervention (6.2% vs. 1%,p < 0.001) or operative intervention (14.7% vs. 2%,p < 0.001) compared to SI ≤ 1. Similarly, patients with SI > 1 had higher mortality (12.3% vs. 5.2%, p < 0.001) and were more likely to be discharged to Rehab/SNF (34.6% vs. 21.4%, p < 0.001). ConclusionsPre-hospital SI predicts trauma-center resource utilization and can guide patient triage and trauma resource recruitment.

Complications and resource utilization in trauma patients with diabetes.

Diabetes is associated with poor outcomes in critically ill populations. The goal of this study was to determine if diabetic patients suffer poorer outcomes following trauma. Collaborative trauma patient data from 2012–2018 was analyzed. Patients with no signs-of-life, Injury Severity Score (ISS) <5, age <16 years, and hospitalization <1 day were excluded. Multivariable logistic and linear regression were used to compare patients with and without diabetes for selected outcomes. Risk-adjustment variables included demographics, physiology, comorbidities, and injury scoring. Of 106,141 trauma patients, 14,150 (13%) had diabetes. On admission, diabetes was associated with significantly increased risk of any, serious, infectious, urinary tract, sepsis, pneumonia, and cardiac complications. Diabetes was also associated with increased ventilator days (7.5 vs. 6.6 days, p = 0.003), intensive care unit days (5.8 vs. 5.3 days, p<0.001), and hospital length of stay (5.7 vs. 5.3 days, p<0.001). Subgroup analysis revealed the least injured diabetic category (ISS 5–15) suffered higher odds of hospital mortality and any, serious, infectious and cardiac complications. The association between diabetes, hospital mortality and complication rates in mild traumatic injury is independent of age. Trauma patients with diabetes experience higher rates of complications and resource utilization. The largest cohort of diabetics experience the least severe injuries and suffer the greatest in hospital mortality and complication rates. A better understanding of the physiologic derangements associated with diabetes is necessary to develop novel approaches to reduce excess trauma morbidity, mortality and resource consumption.

Race/Ethnicity and Geographic Access to Urban Trauma Care

Little is known about the distribution of life-saving trauma resources by racial/ethnic composition in US cities, and if racial/ethnic minority populations disproportionately live in US urban trauma deserts. To examine racial/ethnic differences in geographic access to trauma care in the 3 largest US cities, considering the role of residential segregation and neighborhood poverty. A cross-sectional, multiple-methods study evaluated census tract data from the 2015 American Community Survey in Chicago, Illinois; Los Angeles (LA), California; and New York City (NYC), New York (N = 3932). These data were paired to geographic coordinates of all adult level I and II trauma centers within an 8.0-km buffer of each city. Between February and September 2018, small-area analyses were conducted to assess trauma desert status as a function of neighborhood racial/ethnic composition, and geospatial analyses were conducted to examine statistically significant trauma desert hot spots. In small-area analyses, a trauma desert was defined as travel distance greater than 8.0 km to the nearest adult level I or level II trauma center. In geospatial analyses, relative trauma deserts were identified using travel distance as a continuous measure. Census tracts were classified into (1) racial/ethnic composition categories, based on patterns of residential segregation, including white majority, black majority, Hispanic/Latino majority, and other or integrated; and (2) poverty categories, including nonpoor and poor. Chicago, LA, and NYC contained 798, 1006, and 2128 census tracts, respectively. A large proportion comprised a black majority population in Chicago (35.1%) and NYC (21.4%), compared with LA (2.7%). In primary analyses, black majority census tracts were more likely than white majority census tracts to be located in a trauma desert in Chicago (odds ratio [OR], 8.48; 95% CI, 5.71-12.59) and LA (OR, 5.11; 95% CI, 1.50-17.39). In NYC, racial/ethnic disparities were not significant in unadjusted models, but were significant in models adjusting for poverty and race-poverty interaction effects (adjusted OR, 1.87; 95% CI, 1.27-2.74). In comparison, Hispanic/Latino majority census tracts were less likely to be located in a trauma desert in NYC (OR, 0.03; 95% CI, 0.01-0.11) and LA (OR, 0.30; 95% CI, 0.22-0.40), but slightly more likely in Chicago (OR, 2.38; 95% CI, 1.56-3.64). In this study, black majority census tracts were the only racial/ethnic group that appeared to be associated with disparities in geographic access to trauma centers.

Validating a model of benzodiazepine refractory nerve agent-induced status epilepticus by evaluating the anticonvulsant and neuroprotective effects of scopolamine, memantine, and phenobarbital

IntroductionOrganophosphorus nerve agents (OPNAs) irreversibly block acetylcholinesterase activity, resulting in accumulation of excess acetylcholine at neural synapses, which can lead to a state of prolonged seizures known as status epilepticus (SE). Benzodiazepines, the current standard of care for SE, become less effective as latency to treatment increases. In a mass civilian OPNA exposure, concurrent trauma and limited resources would likely cause a delay in first response time. To address this issue, we have developed a rat model to test novel anticonvulsant/ neuroprotectant adjuncts at delayed time points. MethodsFor model development, adult male rats with cortical electroencephalographic (EEG) electrodes were exposed to soman and administered saline along with atropine, 2-PAM, and midazolam 5, 20, or 40 min after SE onset. We validated our model using three drugs: scopolamine, memantine, and phenobarbital. Using the same procedure outlined above, rats were given atropine, 2-PAM, midazolam and test treatment 20 min after SE onset. ResultsUsing gamma power, delta power, and spike rate to quantify EEG activity, we found that scopolamine was effective, memantine was minimally effective, and phenobarbital had a delayed effect on terminating SE. Fluoro-Jade B staining was used to assess neuroprotection in five brain regions. Each treatment provided significant protection compared to saline + midazolam in at least two brain regions. DiscussionBecause our data agree with previously published studies on the efficacy of these compounds, we conclude that this model is a valid way to test novel anticonvulsants/ neuroprotectants for controlling benzodiazepine-resistant OPNA-induced SE and subsequent neuropathology.

Association Between Emergency Medical Service Response Time and Motor Vehicle Crash Mortality in the United States

Motor vehicle crashes (MVCs) are a leading public health concern. Emergency medical service (EMS) response time is a modifiable, system-level factor with the potential to influence trauma patient survival. The relationship between EMS response time and MVC mortality is unknown. To measure the association between EMS response times and MVC mortality at the population level across US counties. This population-based study included MVC-related deaths in 2268 US counties, representing an estimated population of 239 464 121 people, from January 1, 2013, through December 31, 2015. Data were analyzed from October 1, 2017, through April 30, 2018. The median EMS response time to MVCs within each county (county response time), derived from data collected by the National Emergency Medical Service Information System. The county rate of MVC-related death, calculated using crash fatality data recorded in the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration. During the study period, 2 214 480 ambulance responses to MVCs were identified (median, 229 responses per county [interquartile range (IQR), 73-697 responses per county]) in 2268 US counties. The median county response time was 9 minutes (IQR, 7-11) minutes. Longer response times were significantly associated with higher rates of MVC mortality (≥12 vs <7 minutes; mortality rate ratio, 1.46; 95% CI, 1.32-1.61) after adjusting for measures of rurality, on-scene and transport times, access to trauma resources, and traffic safety laws. This finding was consistent in both rural/wilderness and urban/suburban settings, where a significant proportion of MVC fatalities (population attributable fraction: rural/wilderness, 9.9%; urban/suburban, 14.1%) were associated with prolonged response times (defined by the median value, ≥10 minutes and ≥7 minutes, respectively). Among 2268 US counties, longer EMS response times were associated with higher rates of MVC mortality. A significant proportion of MVC-related deaths were associated with prolonged response times in both rural/wilderness and urban/suburban settings. These findings suggest that trauma system-level efforts to address regional disparities in MVC mortality should evaluate EMS response times as a potential contributor.

A descriptive analysis of casualties evacuated from the Africa area of operations.

IntroductionThe United States (US) military has expanded its area of operations into Africa. This medically immature theater is spread across a large region where prolonged field care (PFC) events are likely to occur. We describe trauma cases reported in the Africa Command (AFRICOM) area of operations to date within the Department of Defense Trauma Registry (DODTR).MethodsWe queried the DODTR for all subjects evacuated from the AFRICOM area of operations from January 2002 to June 2017.ResultsThere were 49 subjects in the registry during our time frame from AFRICOM. Most of the evacuations came from Djibouti (53%). The median age was 29 years, most evacuees being male (92%). Non-battle injuries accounted for most of the injuries (82%), and most were US military (90%). All battle injuries were gunshot wounds (GSW). Composite injury scores were low (median 4, IQR 4–9.5). All subjects survived to hospital discharge. GSWs (22%) and sports injuries (24%) accounted for most evacuations. Serious injuries most frequently involved the extremities (18%) and the thorax (12%). The most frequent major injuries were open fractures (22%) and abdominal injuries (10%). The most frequent facility-based interventions performed were wound debridement (29%) and fracture/joint dislocation reduction (22%).DiscussionBased on this dataset, most of the injuries from AFRICOM were non-battle injuries. All battle injuries were GSWs. Our study highlights the differences in casualty care needs in this region which contrast the primary explosive-based injuries seen within United States Central Command (CENTCOM) operations. The limitations of this dataset highlight the potential value of a Joint Trauma Service (JTS) data collection mandate and resource support for units within this region to facilitate targeted improvements in medical care.

Rural Level III centers in an inclusive trauma system reduce the need for interfacility transfer.

Development of Level III trauma centers in a regionalized system facilitates early stabilization and prompt transfer to a higher level center. The resources to care for patients at Level III centers could also reduce the burden of interfacility transfers. We hypothesized that the development and designation of Level III centers in an inclusive trauma system resulted in lower rates of transfer, with no increase in morbidity or mortality among the non-transferred patients. State trauma registry data from January 2009 through September 2015 were examined from five rural hospitals that transfer patients to our highest (Level II) trauma center and resource hospital. These five rural hospitals began receiving state support in 2010 to develop their trauma programs and were subsequently verified and designated Level III centers (three in 2011, two in 2013). Multivariate logistic regression was used to examine the adjusted odds of patient transfers and adverse outcomes, while controlling for age, gender, penetrating mechanism, presence of a traumatic brain injury, arrival by ambulance, and category of Injury Severity Score. The study period was divided into "Before" Level III center designation (2009-2010) and "After" (2011-2015). 7,481 patient records were reviewed. There was a decrease in the proportion of patients who were transferred After (1,281/5,737) compared to Before (516/1,744) periods (22% vs. 30%, respectively). After controlling for the various covariates, the odds of patient transfer were reduced by 32% (p < 0.0001) during the After period. Among non-transferred patients, there were no significant increases in adjusted odds of mortality, or hospitalizations of seven days or more, Before versus After. Development of rural Level III trauma centers in a regionalized system can significantly reduce the need for transfer to a remote, higher level trauma center. This may benefit the patient, family, and trauma system, with no adverse effect upon patient outcome. Epidemiological, level III.

Pediatric vascular trauma practice patterns and resource availability: A survey of American College of Surgeon-designated pediatric trauma centers.

Variation exists in pediatric vascular trauma management. We aim to determine practice patterns for vascular trauma management at American College of Surgeons verified pediatric trauma centers and evaluate the resources available for management of vascular trauma at both freestanding children's hospitals (FSCH) and pediatric hospitals within general adult hospitals. Pediatric surgeons and trauma medical directors at American College of Surgeons designated pediatric surgery trauma centers completed a survey designed to evaluate anticipated management of traumatic arterial injuries and resource availability. Hospital setting comparisons were made using Fisher exact tests and t tests. Binomial tests were used to compare pediatric and vascular surgeons' responses to clinical vignettes. p Values of 0.05 or less were significant. One hundred seventy-six (42%) of 414 pediatric surgeons participated. Vascular surgeons are more likely to operatively manage vascular trauma at all anatomic sites except subclavian artery when compared to pediatric surgeons, regardless of hospital setting (p <0.001). Forty-eight percent of the pediatric trauma medical directors completed their portion of the survey. At FSCHs, 36% did not have a fellowship-trained vascular surgeon on-call schedule, 27% did not have endovascular capabilities, and 18% did not have a radiology technologist always available. Vascular surgeons are more likely to manage pediatric vascular trauma regardless of hospital setting. However, FSCH have fewer resources available to provide optimal care. Care management, level IV.

TRR's Warrior Camp: An Intensive Treatment Program for Combat Trauma in Active Military and Veterans of All Eras.

Effective treatments for combat trauma in military service members exist, but barriers to care abound, including poor access, stigma, and dropout. Although the effects of post-traumatic stress disorder (PTSD) can be severe, recovery is possible when proper treatment is implemented. Trauma and Resiliency Resources, Inc.'s Warrior Camp (WC) program is designed to address the effects of combat trauma in military service members and veterans. This intensive, 7-d treatment incorporates eye movement desensitization and reprocessing therapy, equine-assisted psychotherapy, yoga, and narrative writing in context of community. This single-group pretest-posttest design included paired t-tests and effect size analyses for 85 participants of WC. Outcome measures included the Mississippi Scale for Combat-related PTSD, the Patient Health Questionnaire, the Revised Adult Attachment Scales, and the Moral Injury Events Scale. Clinician-administered measures included the Davidson Trauma Scale and the Dissociative Experiences Scale. All measures showed statistically significant reductions in distress. The effect sizes ranged from small to large. Results suggest that WC participants experienced significant improvement in PTSD, depression, moral injury, dissociation and adult attachment. Clinicians should consider the potential benefits of this short-term, intensive treatment when addressing combat-related PTSD among military service members and veterans.

Severe traumatic brain injuries in children: Does the type of trauma center matter?

BackgroundTraumatic brain injury (TBI) is the leading cause of death among injured children. Depending on geographic location, and trauma resources, pediatric patients may be treated at pediatric (PTC), adult (ATC), or mixed trauma centers (MTC). The effect of the type of trauma center on outcomes in severe TBI is not known. MethodsNTDB study (2007–2014), level 1 trauma centers, patients ≤14years with severe isolated TBI (head AIS≥3 and extracranial AIS≤2). Demographic, clinical and injury characteristics were abstracted. Logistic regression was used to compare outcomes between the three types of trauma centers. Results10,402 patients met inclusion criteria. 4430 (42.6%) were admitted in PTC, 4044 (38.9%) in ATC and 1928 (18.5%) in MTC. Overall, 39.9% of patients had head AIS 3, 55.5% had AIS 4 and 4.6% AIS 5. Mortality was 3.2% (2.0% in PTC, 4.5% in ATC and 3.3% in MTC). On logistic regression, treatment at ATC was associated with significantly higher mortality than PTC (OR 1.55, p=0.011). There was no significant difference between PTC and MTC (p=0.394). There was no significant difference in mortality between the 3 types of trauma centers in the subgroups of patients with head AIS 3 or 5. However, patients with head AIS 4 treated at MTC had significantly lower mortality (OR 0.163, 95% CI 0.053–0.501, p=0.002). ConclusionPatients with isolated severe TBI treated at PTC have significantly better survival than patients treated at ATC, but not MTC. In the subgroup of patients with isolated TBI and a head AIS score of 4, patients treated at MTC have improved survival than those treated at PTC. Level of evidenceIII.

Trauma resource designation: an innovative approach to improving trauma system overtriage

BackgroundEffective triage of injured patients is often a balancing act for trauma systems. As healthcare reimbursements continue to decline,1 innovative programs to effectively use hospital resources are essential in maintaining...

Polytrauma and concomitant traumatic brain injury : The role of the trauma surgeon

Concomitant traumatic brain injury (TBI) increases mortality and reduces quality of life of polytrauma patients. These facts demand effective treatment strategies while the growing specialization of medicine is questioning the role of the trauma surgeon in the management of these patients. Which factors influence outcome of polytrauma with concomitant TBI? Who should be responsible for the management of these patients and what is the limit of management? Aliterature search using Medline via PubMed was performed with Medical Subject Headings and text word search. The crucial factors for outcome are absence of hypotension, adherence to pre- and in-hospital standards like fast transportation to appropriate centers, priority-based diagnostic and therapeutic strategies and strict adherence to principles of damage control surgery. Patients with polytrauma and TBI are treated by different specialties around the world based on the trauma system, geographic circumstances and resources. Investigations of operative and conservative management by different medical specialties showed comparable outcomes. In an age of standardization and ahigh degree of specialization in the field of medicine, the trauma surgeon still seems to be able to ensure an optimal treatment of polytrauma and concomitant TBI by focusing on priority-based diagnostic and therapeutic strategies and adhering to principles of damage control surgery.

State-level geographic variation in prompt access to care for children after motor vehicle crashes

BackgroundMotor vehicle crashes (MVCs) are a principal cause of death in children; fatal MVCs and pediatric trauma resources vary by state. We sought to examine state-level variability in and predictors of prompt access to care for children in MVCs. Materials and methodsUsing the 2010-2014 Fatality Analysis Reporting System, we identified passengers aged <15 y involved in fatal MVCs (crashes on US public roads with ≥1 death, adult or pediatric, within 30 d). We included children requiring transport for medical care from the crash scene with documented time of hospital arrival. Our primary outcome was transport time to first hospital, defined as >1 or ≤1 h. We used multivariable logistic regression to establish state-level variability in the percentage of children with transport time >1 h, adjusting for injury severity (no injury, possible injury, suspected minor injury, suspected severe injury, fatal injury, and unknown severity), mode of transport (emergency medical services [EMS] air, EMS ground, and non-EMS), and rural roads. ResultsWe identified 18,116 children involved in fatal MVCs from 2010 to 2014; 10,407 (57%) required transport for medical care. Median transport time was 1 h (interquartile range: [1, 1]; range: [0, 23]). The percent of children with transport time >1 h varied significantly by state, from 0% in several states to 69% in New Mexico. Children with no injuries identified at the scene and crashes on rural roads were more likely to have transport times >1 h. ConclusionsTransport times for children after fatal MVCs varied substantially across states. These results may inform state-level pediatric trauma response planning.

Why We Don't Ride: Equine Assisted Psychotherapy, Military Veterans and Moral Injury

While programs using horses with war veterans proliferate few aim specifically at Moral Injury. Many believe that riding horses constitutes therapy for Post-Traumatic Stress Disorder. While there may be a benefit because the movement of the horse is regulating to the nervous system, this practice is contraindicated for warriors with Moral Injury which we see as separate and distinct from PTSD, and not a disorder. Our definition of Moral Injury is that it is an existential/spiritual crisis that is the result of having been trained to override the instinctual aversion to the taking of human life. It can also be the consequence of having perpetrated acts during combat operations, necessary at the time for survival, that damage one’s conscience or moral compass. To the extent that warriors may have both PTSD and Moral Injury, the latter requires a different clinical approach. Warriors who attend Trauma and Resiliency Resources Inc.’s Warrior Camp® program do not ride nor do they have access to halters, lead lines or other instruments of domination or control. Our work at TRR is in accordance with the EAGALA model of Equine Assisted Psychotherapy. This method best suits warriors with Moral Injury because it allows for a more robust use of the horse’s capacity for nonjudgmental intuitive mirroring. In particular, a horse’s ability to intuitively target post-war attachment disruptions caused by morally injurious combat experiences is best employed when the veterans keep their feet on the ground.

Location Optimization Using a Hierarchical Location-Allocation Model for Trauma Centers in Shenzhen, China

Trauma is considered a “modern civilized sickness”, and its occurrence substantially affects all of society, as well as individuals. The implementation of trauma emergency systems in cities with young, prosperous, and highly mobile populations is necessary and significant. A complete trauma emergency system includes both low-level trauma centers that offer basic emergency services and high-level trauma centers that offer comprehensive services. GIS and operational research methods were used to solve the location problem associated with these centers. This study analyzed the spatial distribution characteristics of trauma demands and the candidate locations of trauma centers based on a spatial analysis and presented a hierarchical location-allocation model for low- and high-level trauma centers in Shenzhen. The response, coverage, treatment and cost capacities of the trauma center locations were considered, and an ant colony optimization was used to calculate the optimal solution. The objectives of this study were to optimize trauma center locations, improve the allocation of medical trauma resources and reduce the rate of deaths and disabilities due to trauma.

Schools and Natural Disaster Recovery: The Unique and Vital Role That Teachers and Education Professionals Play in Ensuring the Mental Health of Students Following Natural Disasters

There is growing evidence that children are vulnerable to poor psychological outcomes following exposure to a range of potentially traumatic events. Teachers are in a unique and well-placed position to provide vital support to children following potentially traumatic events and to also provide a vital role in helping to identify children who may be experiencing ongoing psychosocial difficulties. We present a review of mental health trauma resources available for use in educational settings within Australia and New Zealand, with a primary focus on post-disaster resources. We describe the design, development, and dissemination of our resources and training package, Childhood Trauma Reactions: A Guide for Educators from Preschool to Year 12, and present data on how these resources were received. Trauma-informed practices within the school and classroom will enable better outcomes in the immediate post-trauma environment and beyond for all children. Our model focuses on: (1) increasing awareness and understanding of children's post-trauma reactions, (2) exploring effective strategies for teachers within the classroom, and (3) developing policy and procedures for the identification and referral of children who may be at risk. More funding is required to help distribute training and resources and to make mental health following trauma a higher priority.

Accuracy of Perceived Estimated Travel Time by EMS to a Trauma Center in San Bernardino County, California.

IntroductionMobilization of trauma resources has the potential to cause ripple effects throughout hospital operations. One major factor affecting efficient utilization of trauma resources is a discrepancy between the prehospital estimated time of arrival (ETA) as communicated by emergency medical services (EMS) personnel and their actual time of arrival (TOA). The current study aimed to assess the accuracy of the perceived prehospital estimated arrival time by EMS personnel in comparison to their actual arrival time at a Level II trauma center in San Bernardino County, California.MethodsThis retrospective study included traumas classified as alerts or activations that were transported to Arrowhead Regional Medical Center in 2013. We obtained estimated arrival time and actual arrival time for each transport from the Surgery Department Trauma Registry. The difference between the median of ETA and actual TOA by EMS crews to the trauma center was calculated for these transports. Additional variables assessed included time of day and month during which the transport took place.ResultsA total of 2,454 patients classified as traumas were identified in the Surgery Department Trauma Registry. After exclusion of trauma consults, walk-ins, handoffs between agencies, downgraded traumas, traumas missing information, and traumas transported by agencies other than American Medical Response, Ontario Fire, Rialto Fire or San Bernardino County Fire, we included a final sample size of 555 alert and activation classified traumas in the final analysis. When combining all transports by the included EMS agencies, the median of the ETA was 10 minutes and the median of the actual TOA was 22 minutes (median of difference=9 minutes, p<0.0001). Furthermore, when comparing the difference between trauma alerts and activations, trauma activations demonstrated an equal or larger difference in the median of the estimated and actual time of arrival (p<0.0001). We also found month and time of day to be associated with variability in the difference between the median of the estimated and actual arrival time (p=0.0082 and p=0.0005 for month and time of the day, respectively).ConclusionEMS personnel underestimate their travel time by a median of nine minutes, which may cause the trauma team to abandon other important activities in order to respond to the emergency department prematurely. The discrepancy between ETA and TOA is unpredictable, varying by month and time of day. As such, a better method of estimating patient arrival time is needed.

Low Energy Trauma in Older Persons: Where to Next?

The global population is increasing rapidly with older persons accounting for the greatest proportion. Associated with this rise is an increased rate of injury, including polytrauma, for which low energy falls has become the main cause. The resultant growing impact on trauma resources represents a major burden to the health system. Frailty, with its related issues of cognitive dysfunction and sarcopenia, is emerging as the unifying concept that relates both to the initial event and subsequent outcomes. Strategies to better assess and manage frailty are key to both preventing injury and improving trauma outcomes in the older population and research that links measures of frailty to trauma outcomes will be critical to informing future directions and health policy. The introduction of “Geriatric Emergency Departments” and the development of “Fracture Units” for frail older people will facilitate increased involvement of Geriatricians in trauma care and aid in the education of other health disciplines in the core principles of geriatric assessment and management. Collectively these should lead to improved care and outcomes for both survivors and those requiring end of life decisions and palliation.

Resources, Exposure to Trauma, and the Behavioral Health of Youth Receiving Public System Services

Using Conservation of Resources Theory (COR), the current study examined the relationship between exposure to trauma, resources, and behavioral health in a prospective longitudinal cohort of youth in a public behavioral health system. The sample includes 303 youth, aged 5–19, who had received 6 months of treatment-as-usual in an urban, diverse public behavioral health system, and who had experienced at least one type of trauma. Youth entered treatment with an average of four types of trauma and five accessible resources. Consistent with COR, multivariate regression model results showed that both lifetime exposure to trauma and youth resources were significantly associated with behavioral health needs, upon entry to treatment and after 6 months of treatment. Losing resources over 6 months of treatment was associated with greater behavioral health needs, while maintaining or gaining resources over 6 months of treatment was associated with fewer behavioral health needs. This study highlights the need to explore resource gain and resource loss among clients with trauma exposure receiving services in a public system, further test COR-related hypotheses in treatment settings, and develop applicable, multi-level interventions.