title: Statewide tracking of crash victims' medical system utilization and outcomes.
abstract: BACKGROUND
  For the study year, the state of Massachusetts had the lowest fatal motor vehicle crash rate in the nation. The state was interested in exploring new approaches to save additional lives. The study goal was to determine the potential for Massachusetts's medical system to reduce fatalities through alternative utilization of existing transport methods, treatment hospital types, and victim pathways.
  
  
  METHODS
  This was a 1-year retrospective statewide population-based study of all persons involved in a trafficway motor vehicle crash in which at least one person died within 30 days. Database linkage was used to track the pathway and outcome of every involved victim from the crash scene, including air medical and ground ambulance utilization, community or trauma center treatment, and interhospital transfers; air and trauma center (TC) scene triage levels were computed retrospectively. All crash and hospital locations were geomapped and confounding factors were included.
  
  
  RESULTS
  Air and ground scene transports to TCs were underutilized by 7:1 and 4.5:1, respectively. No request was the major reason for air underutilization. Underutilization was associated with reduced lived-to-died ratio (L/D) by pathway of up to 10:1. Statewide, air transport to Level I trauma centers had both the highest (1.0, scene) and lowest L/Ds (0.6, interfacility). A 4.5:1 difference in L/D was associated with fulfilled versus unfulfilled air requests. By emergency medical service region, L/D varied by nearly 3:1 and utilization of scene air and TC transports by 5:1 and 4:1. Victim helicopter emergency medical services transport to a TC with an Injury Severity Score > or =19 was identified as critical and was associated with L/D differences of 3.7:1. The paradox of lower L/D for scene air transports to TCs occurring simultaneously with higher overall system L/D was observed and explained. System-based L/D differences of 1.8:1 were observed associated with increases in appropriate triage. Results that explain the "golden hour" effect are shown and discussed.
  
  
  CONCLUSIONS
  Appropriate scene triage decision-making and the resulting victim pathways are associated with systemwide L/D increases of 1.8:1. On that basis, potentially 53 to 90 lives in this study (13% to 22% of the statewide total) could have been saved.
authors.affiliation: Health and Safety Research, Inc., Marblehead, MA, USA. hsresearch@attglobal.net
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mango
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Garthe
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000379:methods; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods