title: Secondary transfer of trauma patients: rationale and characteristics.
abstract: BACKGROUND
  Trauma systems were created in order to provide optimal care for trauma patients. Hence, patients transferred to level I trauma centers are assumed to be transferred due to medical reasons as a result of complex injuries.
  
  
  OBJECTIVE
  To explore the reasons for transfer of patients from regional to level I trauma centers in Israel as a basis for establishing a national policy regarding transfers.
  
  
  METHODS
  The data on patients transferred to five level I trauma centers during a 6 month period were collected using a structured form.
  
  
  RESULTS
  The study population comprised 929 patients transferred from regional hospitals. Most transfers were due to the need for a specialty unavailable at the first hospital (65%) or for special diagnostic equipment (3% in Jews, 23% in Arabs). Only 3.6% of the transferred patients were transferred because of multi-system injury. Some casualties were transferred following their own request, 26% Jews and 3% Arabs.
  
  
  CONCLUSIONS
  Most patient transfers concur with the recommendations of the Ministry of Health, namely, the absence of a certain specialty or equipment. The fact that many of the transfers reflect a lack of available resources at the first evacuation destination suggests that increasing the availability of these resources can help reduce secondary triage. It is recommended that a cost-benefit analysis be conducted.
authors.affiliation: Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel. malkaa@gertner.health.gov.il
authors.forename: Malka
authors.initials: M
authors.lastname: Avitzour
authors.forename: Limor
authors.initials: L
authors.lastname: Aharonson-Daniel
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007557:Israel; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration*; D012041:Regional Medical Programs / Q000458:organization & administration; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*