Prehospital Transportation and Optimal Utilization of Resources

  • Sanjay Konakondla
  • Shelly D. TimmonsEmail author


Prehospital guidelines for the management of severe traumatic brain injury (sTBI) outline issues of injury prevention, initial evaluation, early treatment goals, and triage concerns and call for specific resuscitative efforts and neurologic assessments. All of these measures are aimed at the avoidance of secondary insults contributing to secondary injury cascades in the brain following TBI. Several factors including regional geography, topography, weather patterns, available modes of transportation, and the locales of health-care institutions and trauma centers must all be taken into account when devising transportation and prehospital treatment strategies to improve patient outcomes. Controversies regarding best type of transportation, direct-to-trauma center versus closest hospital transport, still exist, but data are emerging to support transporting sTBI patients to the highest-level trauma center available as soon as possible. Telemedicine services will aid better coordination of care in the future.


Prehospital Field triage Transportation Resuscitation Regionalization Definitive care Trauma systems 


  1. 1.
    Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HMA, Jagoda AS, et al; BTF Center for Guidelines Management. Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehosp Emerg Care. 2008;12 Suppl 1:S1–52.Google Scholar
  2. 2.
    Georgoff P, Meghan S, Mirza K, Stein S. Geographic variation in outcomes from severe traumatic brain injury. World Neurosurg. 2010;74(2–3):331–45.CrossRefGoogle Scholar
  3. 3.
    Timmons SD, Bee T, Webb S, Diaz-Arrastia RR, Hesdorffer D. Using the abbreviated injury severity and Glasgow coma scale scores to predict 2-week mortality after traumatic brain injury. J Trauma. 2011 Nov;71(5):1172–8.CrossRefGoogle Scholar
  4. 4.
    Chapter 4. Interhospital transfer. In: Rotondo MF, Cribari C, Smith RS, editors. Resources for optimal care of the injured patient. Committee on Trauma American College of Surgeons; 2014. pp. 30–34.
  5. 5.
    Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, et al; Centers for Disease Control and Prevention (CDC). 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.Google Scholar
  6. 6.
    Wasserman EB, Shah MN, Jones CM, Cushman JT, Caterino JM, Bazarian JJ, et al. Identification of a neurologic scale that optimizes EMS detection of older adult traumatic brain injury patients who require transport to a trauma center. Prehosp Emerg Care. 2015;19(2):202–12.CrossRefGoogle Scholar
  7. 7.
    Härtl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J. Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma. 2006;60(6):1250–6; discussion 1256.CrossRefGoogle Scholar
  8. 8.
    Mans S, Reinders Folmer E, de Jongh MA, Lansink KW. Direct transport versus inter hospital transfer of severely injured trauma patients. Injury. 2016;47(1):26–31.CrossRefGoogle Scholar
  9. 9.
    Prabhakaran K, Petrone P, Lombardo G, Stoller C, Policastro A, Marini CP. Mortality rates of severe traumatic brain injury patients: impact of direct versus nondirect transfers. J Surg Res. 2017 Nov;219:66–71.CrossRefGoogle Scholar
  10. 10.
    Fuller G, Woodford M, Lawrence T, Coats T, Lecky F. Do prolonged primary transport times for traumatic brain injury patients result in deteriorating physiology? A cohort study. Prehosp Emerg Care. 2014;18(1):60–7.CrossRefGoogle Scholar
  11. 11.
    Dunn LT. Secondary insults during the interhospital transfer of head-injured patients: an audit of transfers in the Mersey Region. Injury. 1997;28:427–31.CrossRefGoogle Scholar
  12. 12.
    Sugerman DE, Xu L, Pearson WS, Faul M. Patients with severe traumatic brain injury transferred to a Level I or II trauma center: United States, 2007 to 2009. J Trauma Acute Care Surg. 2012;73(6):1491–9.CrossRefGoogle Scholar
  13. 13.
    Majidi S, Siddiq F, Qureshi AI. Prehospital neurologic deterioration is independent predictor of outcome in traumatic brain injury: analysis from National Trauma Data Bank. Am J Emerg Med. 2013;31(8):1215–9.CrossRefGoogle Scholar
  14. 14.
    Fuller G, Lawrence T, Woodford M, Lecky F. The accuracy of alternative triage rules for identification of significant traumatic brain injury: a diagnostic cohort study. Emerg Med J. 2014;31(11):914–9.CrossRefGoogle Scholar
  15. 15.
    Bulger EM, Guffey D, Guyette FX, MacDonald RD, Brasel K, Kerby JD, et al; Resuscitation Outcomes Consortium Investigators. Impact of prehospital mode of transport after severe injury: a multicenter evaluation from the Resuscitation Outcomes Consortium. J Trauma Acute Care Surg. 2012;72(3):567–73; discussion 573–5; quiz 803.Google Scholar
  16. 16.
    Farach SM, Walford NE, Bendure L, Amankwah EK, Danielson PD, Chandler NM. Helicopter transport from the scene of injury: are there improved outcomes for pediatric trauma patients? Pediatr Emerg Care. 2018;34(5):344–8.Google Scholar
  17. 17.
    Sun H, Samra NS, Kalakoti P, Sharma K, Patra DP, Dossani RH, et al. Impact of prehospital transportation on survival in skiers and snowboarders with traumatic brain injury. World Neurosurg. 2017;104:909–918.e8.CrossRefGoogle Scholar
  18. 18.
    Aiolfi A, Benjamin E, Recinos G, De Leon CA, Inaba K, Demetriades D. Air versus ground transportation in isolated severe head trauma: a National Trauma Data Bank study. J Emerg Med. 2017;54(3):328–34. pii: S0736-4679(17)31094-6.CrossRefGoogle Scholar
  19. 19.
    Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE, Trauma Audit and Research Network. Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study. Lancet. 2005;366(9496):1538–44.CrossRefGoogle Scholar
  20. 20.
    Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ. Specialist neurocritical care and outcome from head injury. Intensive Care Med. 2002;28(5):547–53.CrossRefGoogle Scholar
  21. 21.
    Zhou Q, Rosengart MR, Billiar TR, Peitzman AB, Sperry JL, Brown JB. Factors associated with nontransfer in trauma patients meeting American College of Surgeons’ Criteria for transfer at nontertiary centers. JAMA Surg. 2017;152(4):369–76.CrossRefGoogle Scholar
  22. 22.
    Zulu BMW, Mulaudzi TV, Madiba TE, Muckart DJJ. Outcome of head injuries in general surgical units with an off-site neurosurgical service. Injury. 2007;38:576–83.CrossRefGoogle Scholar
  23. 23.
    Fabbri A, Servadei F, Marchesini G, Stein SC, Vandelli A. Observational approach to subjects with mild-to-moderate head injury and initial non-neurosurgical lesions. J Neurol Neurosurg Psychiatry. 2008;79:1180–5.CrossRefGoogle Scholar
  24. 24.
    Moya M, Valdez J, Yonas H, Alverson DC. The impact of a telehealth web-based solution on neurosurgery triage and consultation. Telemed J E Health. 2010;16:945–9.CrossRefGoogle Scholar
  25. 25.
    Hassan R, Siregar JA, A Rahman Mohd NA. The implementation of teleneurosurgery in the management of referrals to a neurosurgical department in hospital sultanah amninah johor bahru. Malays J Med Sci. 2014;21:54–62.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Carlson AP, Ramirez P, Kennedy G, McLean AR, Murray-Krezan C, Stippler M. Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury. Neurosurg Focus. 2010;29(5):E3.CrossRefGoogle Scholar
  27. 27.
    Breen G-M, Matusitz J. An evolutionary examination of telemedicine: a health and computer-mediated communication perspective. Soc Work Public Health. 2010;25:59–71.CrossRefGoogle Scholar
  28. 28.
    Jacobs J, Caudell T, Wilks D, Keep MF, Mitchell S, Buchanan H, et al. Integration of advanced technologies to enhance problem-based learning over distance: project TOUCH. Anat Rec B New Anat. 2003;270((1):16–22.CrossRefGoogle Scholar
  29. 29.
    Staemmler M, Walz M, Weisser G, Engelmann U, Weininger R, Ernstberger A, Sturm J. Establishing end-to-end security in a nationwide network for telecooperation. Stud Health Technol Inform. 2012;180:512–6.PubMedGoogle Scholar
  30. 30.
    Neuhaus P, Weber T, Dugas M, Juhra C, Breil B. Characterization of image transfer patterns in a regional trauma network. J Med Syst. 2014;38(11):137.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryGeisinger Health SystemDanvilleUSA
  2. 2.Department of NeurosurgeryPenn State University Milton S. Hershey Medical CenterHersheyUSA

Personalised recommendations