Disparate resource allocation during the COVID-19 pandemic among trauma centers: A Western Trauma Association national survey

Alexis M Moren; Malika Waschmann; Matthew J Martin; Robert C McIntyre Jr; Lewis J Kaplan

doi:10.1016/j.amjsurg.2022.03.031

Disparate resource allocation during the COVID-19 pandemic among trauma centers: A Western Trauma Association national survey

Am J Surg. 2022 Aug;224(2):761-768. doi: 10.1016/j.amjsurg.2022.03.031. Epub 2022 Apr 2.

Authors

Alexis M Moren¹, Malika Waschmann², Matthew J Martin³, Robert C McIntyre Jr⁴, Lewis J Kaplan⁵

Affiliations

¹ Salem Health Department of Trauma, Critical Care and Acute Care Surgery, 890 Oak St SE, Salem, OR, 97301, USA; Oregon Health & Sciences University, Division of Trauma, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. Electronic address: alexismoren@gmail.com.
² Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. Electronic address: waschman@ohsu.edu.
³ Scripps Mercy Hospital, Associate Director of Trauma Research Scripps Mercy Hospital, 550 Washington St., Suite 641, San Diego, CA, 92103, USA; Uniformed Services University of the Health Sciences Department of Surgery, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. Electronic address: traumadoc22@gmail.com.
⁴ Trauma, and Endocrine University of Colorado Hospital, 12505 E, 16th Avenue Anschutz Inpatient Pavilion 2, First floor Aurora, CO, 80045, USA. Electronic address: ROBERT.MCINTYRE@cuanschutz.edu.
⁵ Perelman School of Medicine, University of Pennsylvania Professor of Surgery, Department of Surgery, Division of Trauma, Surgical Critical Care and Emergency Surgery, USA; Surgical Critical Care, Corporal Michael J Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA. Electronic address: Lewis.Kaplan@va.gov.

Abstract

Background: During the pandemic, hospitals implemented disaster plans to conserve resources while maintaining patient care. It was unclear how these plans impacted injury care and trauma surgeons.

Study design: A 16 question survey assessing COVID-related hospital policy and resource allocation pre-COVID-19 peak (March), and a 19 question post-peak (June) survey was distributed to Trauma/Critical Care attending's via social media and the Western Trauma Association member email list.

Results: There were 120 pre- and 134 post-peak respondents. Most (95%) altered trauma PPE components, a nd 67% noted changes in their admission population pre-peak while 80% did so post-peak. Penetrating injury increased 56% at Level 1 centers and 27% at Level 2 centers. Altered ICU and transfusion criteria were noted with 25% relocating TBI patients, 17% revised rib fracture admission criteria, and 23% adjusted transfusion practices. Importantly, 12% changed their massive transfusion protocol, with 11% reducing the symptomatic transfusion threshold from 7 g/dL to 6 g/dL. Half (50%) disclosed impediments to patient care including PPE shortages and COVID test-related procedural delay (Fig. 2). While only 14% felt their institution was overwhelmed by COVID, the vast majority (81%) shared durable concerns about personal health and safety.

Conclusions: Disparate approaches to COVID-19 preparedness and response characterize survey respondent facility actions. These disparities, especially between Level 1 and Level 2 centers, represent opportunities for the trauma community to coordinate best-practice planning and implementation in light of future consequence infection or pandemic care.

Keywords: COVID-19; Critical care; Disaster preparedness; Resources; Trauma.

MeSH terms

COVID-19* / epidemiology
Hospitals
Humans
Pandemics
Resource Allocation
SARS-CoV-2
Trauma Centers