Improved trauma system multicasualty incident response: comparison of two train crash disasters.
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.
Cryer
H Gill
HG
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California 90095-1711, USA. hcryer@mednet.ucla.edu
Hiatt
Jonathan R
JR
Eckstein
Marc
M
Chidester
Cathy
C
Raby
Stephanie
S
Ernst
Timothy G
TG
Margulies
Dan
D
Putnam
Brant
B
Demetriades
Demetrios
D
Gaspard
Donald
D
Singh
Rambir
R
Saad
Shawki
S
Samuel
Christojohn
C
Upperman
Jeffery S
JS
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*