Abstract
Aim
The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland.
Methods
We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009–2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility.
Results
A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions.
Conclusions
Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.
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References
MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–78.
Twijnstra MJ, Moons KG, Simmermacher RK, Leenen LP. Regional trauma system reduces mortality and changes admission rates: a before and after study. Ann Surg. 2010;251(2):339–43.
Ruchholtz S, Lefering R, Paffrath T, Oestern HJ, Neugebauer E, Nast-Kolb D, et al. Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int. 2008;105(13):225–31.
Spijkers AT, Meylaerts SA, Leenen LP. Mortality decreases by implementing a level I trauma center in a Dutch hospital. J Trauma. 2010;69(5):1138–42.
Janssens L, Holtslag HR, van Beeck EF, Leenen LP. The effects of regionalization of pediatric trauma care in the Netherlands: a surveillance-based before-after study. J Trauma Acute Care Surg. 2012;73(5):1284–7.
Findlay G, Martin IC, Carter S, Smith N, Weyman D, Mason M. Trauma: who cares?. London: NCEPOD; 2007.
The Royal College of Surgeons of England. Report of the working party on the management of patients with head injury. London: RCSE; 1999.
The Royal College of Surgeons of England and the British Orthopaedic Association. Better care for the severely injured. London: RCSE; 2003.
Davenport RA, Tai N, West A, Bouamra O, Aylwin C, Woodford M, et al. A major trauma centre is a specialty hospital not a hospital of specialties. Br J Surg. 2010;97(1):109–17.
Nathens AB, Brunet FP, Maier RV. Development of trauma systems and effect on outcomes after injury. Lancet. 2004;363(9423):1794–801.
American College of Surgeons. Resources for optimal care of the injured patient. Chicago: ACS; 2006.
Trauma care in Scotland. A report by trauma working group of the Royal College of Surgeons of Edinburgh. Edinburgh: RCSED; 2012.
Scottish Government. Better health, better care. Edinburgh: Scottish Government; 2007.
Goverment Scottish. Final report of the remote and rural implementation group. Remote and Rural Implementation Group. Edinburgh: Scottish Government; 2010.
The Scottish Government. Delivering for remote and rural healthcare. Edinburgh: Scottish Government; 2008.
McGuffie AC, Graham CA, Beard D, Henry JM, Fitzpatrick MO, Wilkie SC, Kerr GW. Scottish urban versus rural trauma outcome study. J Trauma. 2005;59(3):632–8.
Haas B, Gomez D, Zagorski B, Stukel TA, Rubenfeld GD, Nathens AB. Survival of the fittest: the hidden cost of undertriage of major trauma. J Am Coll Surg. 2010;211(6):804–11.
Garwe T, Cowan LD, Neas BR, Sacra JC, Albrecht RM. Directness of transport of major trauma patients to a level I trauma center: a propensity-adjusted survival analysis of the impact on short-term mortality. J Trauma. 2011;70(5):1118–27.
Morrison JJ, McConnell NJ, Orman JA, Egan G, Jansen JO. Rural and urban distribution of trauma incidents in Scotland. Br J Surg. 2013;100(3):351–9.
Scottish Government. Scottish Government Urban Rural Classification http://www.scotland.gov.uk/Topics/Statistics/About/Methodology/UrbanRuralClassification. Accessed 20 Dec 2012.
Office of Chief Statistician, Scottish Government. Scottish Government Urban/Rural Classification 2009–2010. Edinburgh: Scottish Government; 2010.
ISD Scotland data dictionary. http://Www.Datadictionaryadmin.Scot.Nhs.Uk/dictionary-a-z/definitions/index.Asp?Search=H&ID=288&title=hospital. Accessed 20 Dec 2012.
Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, Wald MM, Jurkovich GJ, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1–20.
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Yeap, E.E., Morrison, J.J., Apodaca, A.N. et al. Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility. Eur J Trauma Emerg Surg 40, 295–302 (2014). https://doi.org/10.1007/s00068-014-0383-x
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DOI: https://doi.org/10.1007/s00068-014-0383-x