Compliance with Closest Hospital Transport Protocol

Hypothesis: Paramedics accurately estimate the closest trauma hospital for ground transport. Population: Ground ambulance scene transports of trauma system patients to six participating trauma hospitals in Multnomah County, Oregon from 1 January 1986 to 1 January 1987 were studied. Transports involving multiple patients or pediatric patients were excluded. Methods: A retrospective analysis was performed on consecutive patient transports to be taken to the closest trauma hospital as required by protocol. The availability of each hospital to receive trauma patients was monitored continuously by a central communications facility. Paramedics were provided hospital availability data at the time of patient system entry. When several hospitals were available, the paramedics were required by protocol to select the “ctos-est” hospital. Subsequently, the vector distance from the trauma site to each of the available hospitals was measured using a grid map. This method was validated by odometer measurement (r2 - 0.924). Chi-square analysis was used to analyze hospital bypasses to specific hospitals. Results: Of the 1193 eligible, patients entered into the trauma system, 160 (13%; 93% Cl = 11-15%) transports bypassed the closest available hospital for a receiving hospital ≧1 mile more distant. There were 11 (1%; 0-2%) patients transported to a hospital more than five miles more distant. Of the 132 patients with a trauma score (TS)