Building a Rural Trauma Hemorrhage Control Pathway: A Multidisciplinary Model for Achieving the ACS-COT 60-Minute...

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Healthcare Systems Engineering

Background:

• The American College of Surgeons Committee on Trauma (ACS-COT) mandates a 60-minute interventional radiology (IR) benchmark for hemorrhage control in trauma centers.
• Rapid multidisciplinary coordination is crucial for meeting this time-sensitive guideline.

Purpose of the Study:

• To outline system-based workflows and institutional processes implemented to achieve ACS-COT's 60-minute IR embolization benchmark.
• To evaluate adherence to contemporary guidelines for emergency IR embolization in trauma patients.

Main Methods:

• Retrospective case series of 24 trauma patients undergoing emergency IR embolization over 28 months.
• Analysis of patient demographics, injury details, and time from embolization decision to arterial puncture.
• Review of institutional workflow modifications including communication, staffing, anesthesia activation, and imaging integration.

Main Results:

• Average time from decision to arterial puncture was 57.3 minutes (range 28-88 minutes).
• 58% of patients met the <60-minute embolization goal.
• Most frequent injury was motor vehicle collision (38%); average Injury Severity Score (ISS) was 38.0.

Conclusions:

• Implementing the ACS-COT 60-minute benchmark necessitates a coordinated multidisciplinary infrastructure and standardized operational pathways.
• System-level interventions can facilitate compliance, offering a replicable model for trauma centers.
• Continuous data monitoring and process improvement are essential for sustained adherence.