Evaluation of a facility-specific, prehospital transport policy for trauma patients in a health region of New Zealand.

Abstract

Aim: A facility-specific, prehospital trauma destination matrix has been implemented in the Te Manawa Taki (TMT)/Midland Region of Aotearoa New Zealand to support decisions on the most appropriate destination hospital for injured patients. This study evaluates the implementation of this policy.

Methods: Injury data obtained from the TMT Trauma Registry were linked with Global Positioning System (GPS) data from Hato Hone St John and Land Information New Zealand Data Service for trauma events within the region from 1 January to 31 December 2023. Analysis of spatial relationships between injury location, specific injuries and hospital admission was performed using ArcGIS and R statistical programming.

Results: A total of 214 trauma events met the TMT Matrix criteria, of which 163 (76.1%) were transported to a hospital consistent with the destination specified. Lowest consistency (43.8%) of prehospital transport was seen with severe traumatic brain injury likely to require neurosurgery among adults aged >15 years. Approximately 32% of patients with matrix conditions requiring direct transport were lower severity (Injury Severity Score [ISS] <13). When the specified destination was that closest to the incident, there was 93.9% TMT Matrix consistency. Patients with a TMT Matrix condition who did not go directly to the defined facility and had a subsequent transfer took a median 10.5 hours to reach the defined facility.

Conclusions: The majority of trauma patient transports were consistent with the TMT prehospital matrix. A primary influence on compliance was the distance from point of injury to designated facility. This study prompts further exploration of factors associated with appropriate prehospital triage and refinement of TMT prehospital destination policy.