Primary trauma diversion: Initial experience in Hong Kong

Abstract

BACKGROUND: Trauma is a leading cause of death and loss of workdays in Hong Kong. Reports have suggested that timely provision of care in dedicated trauma centers can improve outcomes. Until recently, ambulances were required to take trauma patients to the nearest hospital's emergency department. This paper reports on the initial experience of primary trauma diversion from scene to a dedicated trauma center in Hong Kong. METHODS: This prospective study involved the establishment of primary trauma diversion in the area served by Alice Ho Nethersole Hospital (AHNH), a general hospital in the New Territories. Trauma patients who fulfilled diversion criteria were taken directly to the Prince of Wales Hospital (PWH) in Shatin, a university teaching hospital and trauma center for the area. Data were collected to determine the change in time to definitive care for trauma patients and an impact analysis on PWH services was performed. RESULTS: There were 60 patients who underwent primary trauma diversion and 35 patients underwent secondary diversion after initial treatment at AHNH. This represented two extra trauma patients per week at PWH. Median Injury Severity Score (ISS) was 9 and 52% of patients had been involved in a traffic crash. Of eligible patients, 76% (69 out of 91) diverted correctly according to protocol. Primary trauma diversion patients reached definitive care 97 minutes faster than patients undergoing secondary diversion. CONCLUSION: Primary trauma diversion is feasible in Hong Kong and means that patients reach definitive care 97 minutes faster than going to the nearest hospital. Primary trauma diversion protocols should be extended throughout Hong Kong. © 2006 Lippincott Williams & Wilkins, Inc.