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There were 1,154 hospital trauma centers in the US in 2002, compared to 471 in 1991. However, the per capita number of trauma centers ranges from 0.19 per million people in Arizona to 42 per million people in North Dakota. Many states have no level III, IV, and V trauma centers to treat more advanced injuries.

Objective: It is well established that seriously injured older adults are under-triaged to tertiary trauma centers. However, the survival benefit of tertiary trauma centers (TC) compared to a non-tertiary trauma centers (Non-TCs) remains unclear for this patient population. Using improved methodology and a larger sample, we hypothesized that there was a difference in hospital mortality between injured older adults treated at TCs and those treated at Non-TCs. Methods: This was a retrospective cohort study of injured older adults (> =55 years) reported to the Oklahoma statewide trauma registry between 2005 and 2014. The outcome of interest was 30-day in-hospital mortality and the exposure variable of interest was level of definitive trauma care (TC vs Non-TC). Overall survival benefit of treatment at a TC as well as the survival benefit of transferring injured older adults to a TC were evaluated using multivariable survival analyses as well as propensity score-adjusted analyses. Results: Of the 25,288 patients eligible for analysis, 43% (10,927) were treated at TCs. Multivariable Cox regression analyses revealed effect modification by age group and time. After adjusting for potential confounders within the age strata, overall, patients treated at TCs were significantly less likely to die within 7 days of admission and this effect was stronger for patients aged 55–64 years (HR 0.41, 95% CI 0.31–0.52) compared to those > =65 years (HR 0.62, 95% CI 0.55–0.70). Overall survival benefit of TCs beyond 7 days was also observed (HR 0.68, 95% CI 0.56–0.83). Similarly, for the survival benefit of transferring injured older adults, after adjusting for the propensity to be transferred and other confounders, transfer to a TC was associated with lower 30-day mortality both for patients less than 65 years old (HR 0.36, 95% CI: 0.27–0.49) and those 65 years and older (HR 0.55, 95% CI: 0.48–0.64). Conclusions: Our results suggest a survival benefit for injured older adults treated at TCs. This benefit was also observed for patients transferred from non-tertiary trauma centers. Further research should focus on identifying specific subgroups of patients who would especially benefit from this level of care to minimize trauma triage inefficiencies. [ABSTRACT FROM AUTHOR]

The tragic loss of lives on September 11 followed by the Anthrax contaminations reinforced the need for work already underway through the Metropolitan Medical Response System (MMRS). Through leadership from the Medical Director for the Medical Control Board and EMSA, Oklahoma City and Tulsa have been the beneficiaries of nearly $1.5 million dollars in funding to prepare for nuclear, chemical or bioterrorism. The two Oklahoma cities were among the second wave of cities invited in 1999 to participate in the federally funded program for Metropolitan Medical Response. Many of the requirements of the contract have already been met under the capable guidance of Michael Murphy, a 23 year paramedic with 12 years of management experience with EMSA. Among the plans completed or underway are a Development Plan, MMRS System Plan, Forward Movement of Patients Plan, Pre-hospital Response Plan, a Biological Incident Plan, a Hospital Response Plan, a Training Plan and an Equipment and Pharmaceutical Plan. Coordinated planning between the two cities bring the added benefit of seamless sharing of personnel between both ends of the turnpike should a disaster impact one rather than both communities.