A prospective review of 53 multiple injured patients (ISS≥16) initially treated at local community hospitals and subsequently transported more than 50km to a referral emergency center was completed. All injury mechanisms were blunt, and among
them
traffic accidents occupied the 54.7%. Revised Trauma Score ranged from 0 to 12 (mean, 10.4) and Injury Severity Score ranged from 16 to 50(mean, 24.3). No prior notification of patient transfer to the referring facility was received in 52 (98.1%)
cases,
and absent or very incomplete records were evident in 44 (83.0%) cases.
The quality of care during initial stabilization and transport was evaluated by ATLS guidelines for airway management, cervical immobilization, breathing support, treatment of shock, fracture immobilization, neurologic evaluation, secondary
assessment.
Lifc-threatening deficiencies were identified in 10 (18.9%) patients and serious deficiencies in 32 (60.4%). Most frequent departures from these standards involved failure to place a nasogastric tube before transport (58.5%), inadequate breathing
support (30.2%), inadeguate cervical immobilization (24.5%) and inadequate shock treatment (17.0%).
This study demonstrates the need for education of emergency physicians about priorities in trauma management and ATLS courses. Furthermore guidelines for transport and interhospital communication must be established in rural area.
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