Accuracy of EMS trauma transport destination plans in North Carolina

Chailee Moss, Christopher S. Cowden, Laurie Meyer Atterton, Meredith H. Arasaratnam, Antonio R. Fernandez, Jeff S. Evarts, Brian Barrier, E. Brooke Lerner, N. Clay Mann, Chad Lohmeier, Frances S. Shofer, Jane H. Brice

Research output: Contribution to journalArticle

Abstract

Objective. Planning for time-sensitive injury may allow emergency medical services (EMS) systems to more accurately triage patients meeting accepted criteria to facilities most capable of providing life-saving treatment. In 2010, North Carolina (NC) implemented statewide Trauma Triage and Destination Plans (TTDPs) in all 100 of North Carolina's county-defined EMS systems. Each system was responsible for identifying the specific destination hospitals with appropriate resources to treat trauma patients. We sought to characterize the accuracy of their hospital designations.

Methods. In this cross-sectional study, we collected TTDPs for each county-defined EMS system, including their assigned hospital capabilities (i.e., trauma center or community hospital). We conducted a survey with each EMS system to determine how their TTDP was constructed and maintained, as well as with each TTDP-designated hospital to verify their capabilities. We determined the accuracy of the EMS assigned hospital designations by comparing them to the hospital's reported capabilities.

Results. The 100 NC EMS systems provided 380 designations for 112 hospitals. TTDPs were created by EMS administrators and medical directors, with only 55% of EMS systems engaging a hospital representative in the plan creation. Compared to the actual hospital capabilities, 97% of the EMS TTDP designations were correct. Twelve hospital designations were incorrect and the majority (10) overestimated hospital capabilities. Of the 100 EMS systems, 7 misclassified hospitals in their TTDP. EMS systems that did not verify their local hospitals' capabilities during TTDP development were more likely to incorrectly categorize a hospital's capabilities (p = 0.001).

Conclusions. A small number of EMS systems misclassified hospitals in their TTDP, but most plans accurately reflected hospital capabilities. Misclassification occurred more often in systems that did not consult local hospitals prior to developing their TTDP. The potential of the TTDP to improve communication between EMS agencies and the facilities with which they work has not been fully realized. EMS agencies or systems should verify local hospital capabilities when engaging in destination planning efforts.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalPrehospital Emergency Care
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Emergency Medical Services
Triage
Wounds and Injuries
Physician Executives
Trauma Centers
Community Hospital
Administrative Personnel

Keywords

  • Emergency medical services
  • Transportation of patients
  • Triage

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Moss, C., Cowden, C. S., Atterton, L. M., Arasaratnam, M. H., Fernandez, A. R., Evarts, J. S., ... Brice, J. H. (2015). Accuracy of EMS trauma transport destination plans in North Carolina. Prehospital Emergency Care, 19(1), 53-60. https://doi.org/10.3109/10903127.2014.916021

Accuracy of EMS trauma transport destination plans in North Carolina. / Moss, Chailee; Cowden, Christopher S.; Atterton, Laurie Meyer; Arasaratnam, Meredith H.; Fernandez, Antonio R.; Evarts, Jeff S.; Barrier, Brian; Lerner, E. Brooke; Mann, N. Clay; Lohmeier, Chad; Shofer, Frances S.; Brice, Jane H.

In: Prehospital Emergency Care, Vol. 19, No. 1, 01.01.2015, p. 53-60.

Research output: Contribution to journalArticle

Moss, C, Cowden, CS, Atterton, LM, Arasaratnam, MH, Fernandez, AR, Evarts, JS, Barrier, B, Lerner, EB, Mann, NC, Lohmeier, C, Shofer, FS & Brice, JH 2015, 'Accuracy of EMS trauma transport destination plans in North Carolina', Prehospital Emergency Care, vol. 19, no. 1, pp. 53-60. https://doi.org/10.3109/10903127.2014.916021
Moss C, Cowden CS, Atterton LM, Arasaratnam MH, Fernandez AR, Evarts JS et al. Accuracy of EMS trauma transport destination plans in North Carolina. Prehospital Emergency Care. 2015 Jan 1;19(1):53-60. https://doi.org/10.3109/10903127.2014.916021
Moss, Chailee ; Cowden, Christopher S. ; Atterton, Laurie Meyer ; Arasaratnam, Meredith H. ; Fernandez, Antonio R. ; Evarts, Jeff S. ; Barrier, Brian ; Lerner, E. Brooke ; Mann, N. Clay ; Lohmeier, Chad ; Shofer, Frances S. ; Brice, Jane H. / Accuracy of EMS trauma transport destination plans in North Carolina. In: Prehospital Emergency Care. 2015 ; Vol. 19, No. 1. pp. 53-60.
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abstract = "Objective. Planning for time-sensitive injury may allow emergency medical services (EMS) systems to more accurately triage patients meeting accepted criteria to facilities most capable of providing life-saving treatment. In 2010, North Carolina (NC) implemented statewide Trauma Triage and Destination Plans (TTDPs) in all 100 of North Carolina's county-defined EMS systems. Each system was responsible for identifying the specific destination hospitals with appropriate resources to treat trauma patients. We sought to characterize the accuracy of their hospital designations.Methods. In this cross-sectional study, we collected TTDPs for each county-defined EMS system, including their assigned hospital capabilities (i.e., trauma center or community hospital). We conducted a survey with each EMS system to determine how their TTDP was constructed and maintained, as well as with each TTDP-designated hospital to verify their capabilities. We determined the accuracy of the EMS assigned hospital designations by comparing them to the hospital's reported capabilities.Results. The 100 NC EMS systems provided 380 designations for 112 hospitals. TTDPs were created by EMS administrators and medical directors, with only 55{\%} of EMS systems engaging a hospital representative in the plan creation. Compared to the actual hospital capabilities, 97{\%} of the EMS TTDP designations were correct. Twelve hospital designations were incorrect and the majority (10) overestimated hospital capabilities. Of the 100 EMS systems, 7 misclassified hospitals in their TTDP. EMS systems that did not verify their local hospitals' capabilities during TTDP development were more likely to incorrectly categorize a hospital's capabilities (p = 0.001).Conclusions. A small number of EMS systems misclassified hospitals in their TTDP, but most plans accurately reflected hospital capabilities. Misclassification occurred more often in systems that did not consult local hospitals prior to developing their TTDP. The potential of the TTDP to improve communication between EMS agencies and the facilities with which they work has not been fully realized. EMS agencies or systems should verify local hospital capabilities when engaging in destination planning efforts.",
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AU - Cowden, Christopher S.

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AU - Arasaratnam, Meredith H.

AU - Fernandez, Antonio R.

AU - Evarts, Jeff S.

AU - Barrier, Brian

AU - Lerner, E. Brooke

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N2 - Objective. Planning for time-sensitive injury may allow emergency medical services (EMS) systems to more accurately triage patients meeting accepted criteria to facilities most capable of providing life-saving treatment. In 2010, North Carolina (NC) implemented statewide Trauma Triage and Destination Plans (TTDPs) in all 100 of North Carolina's county-defined EMS systems. Each system was responsible for identifying the specific destination hospitals with appropriate resources to treat trauma patients. We sought to characterize the accuracy of their hospital designations.Methods. In this cross-sectional study, we collected TTDPs for each county-defined EMS system, including their assigned hospital capabilities (i.e., trauma center or community hospital). We conducted a survey with each EMS system to determine how their TTDP was constructed and maintained, as well as with each TTDP-designated hospital to verify their capabilities. We determined the accuracy of the EMS assigned hospital designations by comparing them to the hospital's reported capabilities.Results. The 100 NC EMS systems provided 380 designations for 112 hospitals. TTDPs were created by EMS administrators and medical directors, with only 55% of EMS systems engaging a hospital representative in the plan creation. Compared to the actual hospital capabilities, 97% of the EMS TTDP designations were correct. Twelve hospital designations were incorrect and the majority (10) overestimated hospital capabilities. Of the 100 EMS systems, 7 misclassified hospitals in their TTDP. EMS systems that did not verify their local hospitals' capabilities during TTDP development were more likely to incorrectly categorize a hospital's capabilities (p = 0.001).Conclusions. A small number of EMS systems misclassified hospitals in their TTDP, but most plans accurately reflected hospital capabilities. Misclassification occurred more often in systems that did not consult local hospitals prior to developing their TTDP. The potential of the TTDP to improve communication between EMS agencies and the facilities with which they work has not been fully realized. EMS agencies or systems should verify local hospital capabilities when engaging in destination planning efforts.

AB - Objective. Planning for time-sensitive injury may allow emergency medical services (EMS) systems to more accurately triage patients meeting accepted criteria to facilities most capable of providing life-saving treatment. In 2010, North Carolina (NC) implemented statewide Trauma Triage and Destination Plans (TTDPs) in all 100 of North Carolina's county-defined EMS systems. Each system was responsible for identifying the specific destination hospitals with appropriate resources to treat trauma patients. We sought to characterize the accuracy of their hospital designations.Methods. In this cross-sectional study, we collected TTDPs for each county-defined EMS system, including their assigned hospital capabilities (i.e., trauma center or community hospital). We conducted a survey with each EMS system to determine how their TTDP was constructed and maintained, as well as with each TTDP-designated hospital to verify their capabilities. We determined the accuracy of the EMS assigned hospital designations by comparing them to the hospital's reported capabilities.Results. The 100 NC EMS systems provided 380 designations for 112 hospitals. TTDPs were created by EMS administrators and medical directors, with only 55% of EMS systems engaging a hospital representative in the plan creation. Compared to the actual hospital capabilities, 97% of the EMS TTDP designations were correct. Twelve hospital designations were incorrect and the majority (10) overestimated hospital capabilities. Of the 100 EMS systems, 7 misclassified hospitals in their TTDP. EMS systems that did not verify their local hospitals' capabilities during TTDP development were more likely to incorrectly categorize a hospital's capabilities (p = 0.001).Conclusions. A small number of EMS systems misclassified hospitals in their TTDP, but most plans accurately reflected hospital capabilities. Misclassification occurred more often in systems that did not consult local hospitals prior to developing their TTDP. The potential of the TTDP to improve communication between EMS agencies and the facilities with which they work has not been fully realized. EMS agencies or systems should verify local hospital capabilities when engaging in destination planning efforts.

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KW - Transportation of patients

KW - Triage

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