Transport Time Overrated in Public’s Mind

Everything I know about public health leads me to the conclusion that the existence of Alameda Hospital causes harms to Alamedans.  One of the candidates for Director wants to emphasize how close the Alameda Hospital ER is (although I think he uses the wrong numbers and the actual difference is less than 10 minutes and more likely an average around 5 to 8 minutes).

Nonetheless, I thought that perhaps this was just my bias against the Hospital so I went to PubMed and did a search on “transport”, “time”, and “mortality”.    1451 articles came up many of them having nothing to do with the subject I was interested in.  All of the ones that appeared to be relevant concluded that within a narrow range, that transport to resource rich hospitals bypassing local community hospitals either made no difference or resulted in better outcomes.  The one article abstract that said it best was on trauma (and, to be fair, EMS protocol, I believe already dictates that trauma patients NOT go to Alameda Hospital).  “Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer’s effect on mortality,” states in its conclusion, “Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality.”  Without getting into specific details of all the studies (Lauren Do can go try to cherry pick or misunderstand those irrelevant, not-really-a-study sources available that contradicts the overwhelming evidence, but I’ll refrain from debating her.), the conclusion I come to is:

1.  Reducing transport time has a powerful conventional wisdom logic to it that is pretty much contradicted by the actual evidence.

2.  In most cases, the determinative timing factors are initial call to EMS (witnessed events), beginning of BLS (AEF’s, bystander assistance), and the start of ACLS (the arrival of the ambulance).  Again, transport time is a non-factor in the ranges we are talking about.

3.  Bypassing the local hospital for a more resourced, higher level of care alternative leads to better outcomes.

4.  Stops at local hospitals caused delay in treatment, introduced error, and resulted in increased mortality.

The results appear to be generalizable with specific studies showing this general result for cardio and trauma.

Now I don’t know whether this is related and demographics vary greatly but here are available the latest raw mortality numbers for each hospital in California.  The % for the latest period reported (7/1/11 to 12/31/11) is 3.7% for Alameda Hospital which seems considerably higher than other facilities in Alameda County that I spot-checked.

About egorelick

Gadfly. Former City of Alameda Healthcare District Board member.
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1 Response to Transport Time Overrated in Public’s Mind

  1. I have heard the exact same information from other sources in years past when I was in nursing school (UCSF Class of 1981) and in nurse practitioners’ training (Stanford 1984) but I am impressed you researched the studies yourself. Not surprisingly, the data remains consistent. Thanks you.
    Leland Traiman, RN/FNP
    Hospital Board Candidate

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