• Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, and Michael Lekawa.
• Division of Trauma and Critical Care Surgery, Department of Surgery, University of California-Irvine, Orange, CA. Electronic address: ekuncir@uci.edu.
• J. Am. Coll. Surg. 2018 Jan 1; 226 (1): 64-69.

BackgroundInterfacility transfer of undertriaged patients to higher-level trauma centers has been found to result in a delay of appropriate care and an increase in mortality. To address this, for the last 10 years our region has used 911 emergency medical services (EMS) paramedics for rapid re-triage of undertriaged patients to our institution's Level I trauma center. We sought to determine whether using 911 EMS for re-triage to our institution was associated with worse outcomes-with mortality as the primary end point-compared with direct EMS transport from point of injury.Study DesignWe retrospectively reviewed all trauma activations to our institution during a 16-month period; 3,394 active traumas were analyzed.ResultsTwo hundred and seventy patients (8%) arrived via 911 EMS re-triage and 3,124 (92%) arrived via direct EMS transport. Total EMS transport time was significantly longer (122.5 minutes vs 33.7 minutes; p < 0.001) between the 2 groups, but there was no significant difference in mortality rates (4.1% vs 3.6%; p = 0.67).ConclusionsThese data show that although using 911 EMS for re-triage is associated with an increase in total transport time, it does not result in an increase in mortality compared with direct EMS transport. We conclude that the use of 911 EMS can be considered a safe method to re-triage patients to higher-level trauma centers.Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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