Magazine article Risk Management

On the Fast Track to Saving Lives

Magazine article Risk Management

On the Fast Track to Saving Lives

Article excerpt

EMTs make split-second decisions with lives on the line. Where they take their patients can mean life or death.

Imagine an interstate freeway.

Rush hour. A speeding commuter collides with a school bus transporting children on a field trip. Emergency crews are quick to respond, and within minutes more than two dozen victims are whisked away to the nearest hospital, which will soon be overwhelmed by the crowds. Nearly half the injured must wait for medical attention, while only a few more miles away, another emergency room is virtually empty.

Consider a typical suburbanite, painting the shutters on the house, then slipping from the ladder and injuring his head. Emergency crews rush him to the nearest trauma center, only to discover that a needed neurologist is not available. With valuable time already lost, the patient dies during transport to another facility.

As frightening as it seems, these are extremely likely outcomes, whether from sudden disaster or everyday accidents. Except in Birmingham, Alabama, that is, where a one-of-a-kind computer system is saving lives, as well as money.

LifeTrac--Trac, an acronym for triage, routing and communication--has been routing emergency trauma patients every day in the Birmingham area for the past four years, linking emergency teams and up-to-the-minute information on the readiness of area emergency rooms.

"When an emergency crew arrives to transport a patient, they can know within seconds of evaluation which hospital is clear to accept that patient and has specialists available to address the patient's specific injuries," says Joe Acker, head of Birmingham Regional Emergency Medical Services System (BREMSS), which oversees prehospital care in a six-county metropolitan area with a population of about one million.

LifeTrac is the brainchild of BREMSS, Birmingham area surgeons and EMS staff, and the product of Forte Incorporated. "When we were first asked to do this, it seemed so logical, I was surprised this sort of system wasn't already in place somewhere," says Glenn Phillips, head of Forte's design team. "It turned out there was nothing like it anywhere."

Linking Life

It works like this. The system's computers continually monitor overall readiness and the availability of specialists at area emergency rooms. This information is displayed on a computer screen at a central communications center, which is manned twenty-four hours a day. After reaching a patient, the emergency crew contacts the communications center with specific information on the patient and the injury. The information delivered through LifeTrac helps the crew choose the trauma department that is best equipped to treat the specific injury.

"While 911 gets emergency medical personnel to the patient quickly, this system helps EMTs quickly get the patient to the most appropriate medical care," Acker says.

"Most appropriate" is a key distinction in the service LifeTrac provides. For example, a patient with head trauma would be most appropriately treated by a neurologist, "but if the neurologists at the nearest ER are already in surgery, the crew can make a secondary choice and save time," Phillips says.

The first large-scale, real-life test of the system came in April 1998, when an F-5 tornado (the most severe rating on the Fujita-Pearson Scale), with winds exceeding 260 miles per hour, tore a path of destruction 20 miles long and up to a mile wide, leaving 32 people dead and sending 224 to area hospitals.

What could have happened? The most seriously injured patients could have been log-jammed at the hospitals nearest the disaster, while trauma centers only a few miles away stood idle. Since the disaster site was isolated from a majority of the area's hospitals and many victims were taken to hospitals by private citizens, the threat of overcrowding was significant.

Instead, the system got it straight. …

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