Rural rendezvous: How multiple EMS transfers impact trauma outcomes

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Pre-hospital Care

Background:

• Rural emergency medical services (EMS) often rely on pre-hospital rendezvous due to limited immediate resources.
• This practice involves EMS personnel making independent judgments for patient transport decisions.

Purpose of the Study:

• To evaluate the impact of pre-hospital rendezvous on trauma patient outcomes in rural settings.
• Assessing the effect on clinical decline, patient acuity, and mortality upon arrival at the emergency department (ED).

Main Methods:

• A single-center Trauma Registry study analyzed data from January 1, 2000, to December 31, 2023.
• Included 11,937 trauma patients, categorizing them by the number of EMS rendezvous.
• Used regression models to assess outcomes like ED disposition (ICU/morgue), Glasgow Coma Scale (GCS), and shock index ratio (SIR), controlling for patient and injury factors.

Main Results:

• Nearly half (49%) of patients experienced at least one rendezvous.
• Patients with one or two rendezvous showed significantly higher odds of ICU or morgue disposition.
• Increased rendezvous correlated with lower GCS scores and higher shock index ratios (SIR) on arrival (p < .01).

Conclusions:

• Pre-hospital rendezvous in trauma care is associated with increased clinical decline, higher acuity, and greater ED mortality.
• Findings underscore the necessity of enhancing access to definitive trauma care.
• Emphasizes the importance of coordinated transport within regional trauma systems.