title: Improved trauma system multicasualty incident response: comparison of two train crash disasters.
abstract: BACKGROUND
  Two train crash multicasualty incidents (MCI) occurred in 2005 and 2008 in Los Angeles. A postcrash analysis of the first MCI determined that most victims went to local community hospitals (CHs) with underutilization of trauma centers (TCs), resulting in changes to our disaster plan. To determine whether our trauma system MCI response improved, we analyzed the distribution of patients from the scene to TCs and CHs in the two MCIs.
  
  
  METHODS
  Data from the emergency medical services and TC records were interrogated to compare patients triage status, type of transport, and the destination in the 2008 MCI to the 2005 MCI. Clinical data from the 2008 MCI were tabulated to evaluate severity of injuries, need for immediate and delayed operation, need for intensive care unit, and need for specialty surgical services, and appropriate distribution of patients.
  
  
  RESULTS
  In 2005, 14 (56%) of the 25 severely injured patients and 75 (71%) of the 106 total patients were transported to four CHs. In 2008, 53 (93%) of 57 of the severely injured patients were transported to TCs and only 34 (35%) of 98 of total patients were transported to nine CHs. In 2008, more TCs were used (8 vs. 5) and more patients were transported by air (34 vs. 2). In 2008, the most severely injured victims were transported to four level I TCs (median injury severity score, 16; range, 1-43; 10 emergent operations) and four level II TCs (median injury severity score, 10; range, 1-22; 4 emergent operations). Only 11 patients were admitted to CHs, and no operations were required.
  
  
  CONCLUSIONS
  A trauma system performance improvement program allowed us to significantly improve our response to MCIs with improved utilization of TCs and improved distribution of victims according to injury severity and needs.
authors.affiliation: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California 90095-1711, USA. hcryer@mednet.ucla.edu
authors.forename: H Gill
authors.initials: HG
authors.lastname: Cryer
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Marc
authors.initials: M
authors.lastname: Eckstein
authors.forename: Cathy
authors.initials: C
authors.lastname: Chidester
authors.forename: Stephanie
authors.initials: S
authors.lastname: Raby
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ernst
authors.forename: Dan
authors.initials: D
authors.lastname: Margulies
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: Donald
authors.initials: D
authors.lastname: Gaspard
authors.forename: Rambir
authors.initials: R
authors.lastname: Singh
authors.forename: Shawki
authors.initials: S
authors.lastname: Saad
authors.forename: Christojohn
authors.initials: C
authors.lastname: Samuel
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Upperman
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D006301:Health Services Needs and Demand; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015141:Los Angeles; D011890:Railroads; D014187:Transportation of Patients / Q000379:methods* / Q000592:standards; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage; D014947:Wounds and Injuries / Q000628:therapy*