Hub System and Ground Transport for Trauma Victims

A study has demonstrated that using a hub-and-spoke system with rotating paramedics and nurses on ground transportation can be just as effective as using helicopters or other air transport to get trauma patients to the emergency department in a timely way and without compromising the outcome. The study, conducted by researchers at Duke University Medical Center (Durham, NC, USA), was presented at the 2001 clinical Congress of the American College of Surgeons (ACS) in New Orleans (LA, USA).

The study involved 96 critically ill children who were transported from three outlying referral hospitals located 42, 62, and 122 miles away from the medical center. About half of the children were transported by air and the rest were transported over ground. The mortality was 0.85% for the ground group and 1.8% for the air transport group. Total hospital stay was 8.8 days for the ground group and 9.9 for the air group. Total transit time by air was 132 minutes, while ground time was 159 minutes. The researchers note that one of the problems with transporting critically ill children is the lack of specialty crews to maintain an intensive neonatal or pediatric environment and provide high-acuity care. The Duke system rotates paramedics and nurses from actual transport crews between the three outlying facilities on a weekly basis. These crew members are highly skilled in mobile intensive care support of adult and pediatric patients They work in concert with local emergency medical systems and helicopter crews at Duke.

"As recently as 1999, most trauma centers felt an air transport system was the most beneficial for interhospital transfer of critically ill patients, but we're not seeing a difference in outcomes,” said Shawn Safford, M.D., a surgical resident at Duke's medical center. "We're trying to ensure the quickest transport possible by the most efficient means possible.”



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