The ultimate goal was to identify recent, existing and incoming patient and facility factors that would contribute to a predictive model facilitating optimum trauma triage by prehospital and emergency medical evacuation providers, and also to better inform trauma centre bypass decisions. Our hypothesis was that overcrowding, a surge of admissions and high patient acuity would contribute to increase the mortality risk for incoming new admissions. The objective of this study was to evaluate the impact of admitting area occupancy rate, recent admissions, patient demographics and patient acuity on the mortality of incoming patients in an academic state referral centre for trauma. Interaction among the paradigms of trauma triage, access to emergency care and crowding, resource availability and utilisation, and ambulance diversion must all be dynamically balanced for optimal patient outcomes. Originally conceptualised based on a military model, this study was undertaken to see if definitive treatment be delayed 10, 20, 30 min or more, to reach a facility with greater resources and manpower? Which treatment facility is best prepared to care for a specific casualty at a given time? These patient-acuity factors, combined with information about facility-resource factors, would allow an aeromedical evacuation team to best decide ‘Should I Land Now?’ at the closest hospital or proceed to the nearest functional trauma centre.įrom a practical perspective, should aeromedical transport flyover the closest trauma centre to another facility based on the volume/acuity of patient care ongoing? In a mature trauma system, trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient, and whether to bypass the closest facility. Ideally, casualties would have the best possible prediction of their needs based on initial injuries and initially obtainable physiologic information, to minimise undertriage and to deliver casualties expediently to the most appropriate echelon of care. At times, primary assessment and initial treatment may be delayed until the casualty and medic are in the transport vehicle. Medical manpower availability at the initial treatment area, which can be limited due to social unrest or battlefield situations, influence the treatment of injuries. However, in combat or civilian mass casualty situations, resources may be limited and casualties may be transported with vehicles of opportunity such as passenger cars, trucks or military transport vehicles, rather than with emergency ambulances or helicopters from the incident scene to the treatment area. Trauma care involves time-critical assessments and therapeutic actions. 11 Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USAĭr D B Powers, Director, Craniomaxillofacial Trauma Program, Duke University Hospital, Durham, NC 27710, USA.9 Center for Sustainment of Trauma and Readiness Skills - Baltimore, US Air Force Medical Service, Baltimore, Maryland, USA.8 US Air Force Materiel Command, Wright-Patterson AFB, Ohio, USA.7 Shock Trauma and Anesthesiology Research - Organized Research Center (STAR-ORC), University of Maryland School of Medicine, Baltimore, Maryland, USA.6 National Yunlin University of Science and Technology, Douliou, Taiwan.5 University of Maryland Medical Center, Baltimore, Maryland, USA.3 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.2 Director, Craniomaxillofacial Trauma Program, Duke University Hospital, Durham, North Carolina, USA.1 R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.