Shift in Prehospital Mode of Transportation for Trauma Patients During the COVID-19 Pandemic

Colin M Mooney; Kian Banks; Rachel Borthwell; Kealia Victorino; Sophia Coutu; Timothy D Browder; Gregory P Victorino

doi:10.1016/j.jss.2023.02.002

Shift in Prehospital Mode of Transportation for Trauma Patients During the COVID-19 Pandemic

J Surg Res. 2023 Sep:289:16-21. doi: 10.1016/j.jss.2023.02.002. Epub 2023 Feb 22.

Authors

Colin M Mooney¹, Kian Banks², Rachel Borthwell³, Kealia Victorino², Sophia Coutu², Timothy D Browder², Gregory P Victorino²

Affiliations

¹ Department of Surgery, University of California, San Francisco, Oakland, California. Electronic address: cmooney@alamedahealthsystem.org.
² Department of Surgery, University of California, San Francisco, Oakland, California.
³ Department of Surgery, University of California, San Francisco, San Francisco, California.

Abstract

Introduction: Since the start of the COVID-19 pandemic, we experienced alterations to modes of transportation among trauma patients suffering penetrating injuries. Historically, a small percentage of our penetrating trauma patients use private means of prehospital transportation. Our hypothesis was that the use of private transportation among trauma patients increased during the COVID-19 pandemic and was associated with better outcomes.

Methods: We retrospectively reviewed all adult trauma patients (January 1, 2017 to March 19, 2021), using the date of the shelter-in-place ordinance (March 19, 2020) to separate trauma patients into prepandemic and pandemic patient groups. Patient demographics, mechanism of injury, mode of prehospital transportation, and variables such as initial Injury Severity Score, Intensive Care Unit (ICU) admission, ICU length of stay, mechanical ventilator days, and mortality were recorded.

Results: We identified 11,919 adult trauma patients, 9017 (75.7%) in the prepandemic group and 2902 (24.3%) in the pandemic group. The number of patients using private prehospital transportation also increased (from 2.4% to 6.7%, P < 0.001). Between the prepandemic and pandemic private transportation cohorts, there were reductions in mean Injury Severity Score (from 8.1 ± 10.4 to 5.3 ± 6.6: P = 0.02), ICU admission rates (from 15% to 2.4%: P < 0.001), and hospital length of stay (from 4.0 ± 5.3 to 2.3 ± 1.9: P = 0.02). However, there was no difference in mortality (4.1% and 2.0%, P = 0.221).

Conclusions: We found that there was a significant shift in prehospital transportation among trauma patients toward private transportation after the shelter-in-place order. However, this did not coincide with a change in mortality despite a downward trend. This phenomenon could help direct future policy and protocols in trauma systems when battling major public health emergencies.

Keywords: COVID-19; Outcomes; Penetrating; Safety net hospital; Transportation; Trauma.

MeSH terms

Adult
COVID-19* / epidemiology
Emergency Medical Services*
Humans
Injury Severity Score
Pandemics
Retrospective Studies
Transportation of Patients / methods
Trauma Centers
Wounds and Injuries* / therapy
Wounds, Penetrating*