Skip to main content
SpringerLink
Log in

Strategic Decision-Making in Trauma Systems

  • Conference paper
  • First Online:
Dynamics of Information Systems (DIS 2023)

Part of the book series: Lecture Notes in Computer Science ((LNCS,volume 14321))

Included in the following conference series:

  • 93 Accesses

Abstract

Trauma care and trauma systems are vital community assets. A trauma system manages the treatment of severely injured people and spans the full spectrum of prevention and emergency care to recovery and rehabilitation. While most trauma-related studies concern the operational and tactical levels of trauma care and trauma systems, little attention has been given to a strategic level (top-down) approach to a trauma system from a financial and investment perspective. In this paper, we analyze a statewide trauma system and model it as a network of trauma centers, hospitals and emergency medical services (EMS). We develop a theoretical model and a general-purpose computational framework that facilitates the allocation and utilization of resources by the statewide trauma system. Given a local trauma network profile, injury distribution and resource requests, the modeling and computational framework enable the creation of the set of all feasible and Pareto-efficient portfolios where limited funding is allocated across numerous resource requests from trauma centers, hospitals and EMS providers. Using the computational framework, decision-makers can quantitatively analyze the impact of each feasible portfolio on the trauma system’s performance measures via the Trauma System Simulator. Sensitivity analysis can be conducted to determine the best decision or policy for transporting and transferring patients and to observe how changes in system inputs affect the return on investment (ROI) and resource utilization. Using the trauma system data in Georgia, our findings confirm that such dynamic and strategic resource-allocation analyses empower decision-makers to make informed decisions that benefit the entire trauma network. The design is a top-down approach at a strategic level that simultaneously uses tactical-level decisions to evaluate several strategies to improve the trauma system.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nathens, A.B., Brunet, F.P., Maier, R.V.: Development of trauma systems and effect on outcomes after injury. Lancet 363(9423), 1794–1801 (2004). https://doi.org/10.1016/S0140-6736(04)16307-1

    Article  Google Scholar 

  2. MacKenzie, E.J., Rivara, F.P., Jurkovich, G.J., et al.: The national study on costs and outcomes of trauma. J. Trauma Acute Care Surg. 63(6), S54–S67 (2007). https://doi.org/10.1097/TA.0b013e31815acb09

    Article  Google Scholar 

  3. Mullins, R.J., Veum-Stone, J., Hedges, J.R., et al.: Influence of a statewide trauma system on location of hospitalization and outcome of injured patients. J. Trauma Acute Care Surg. 40(4), 536–546 (1996). https://doi.org/10.1097/00005373-199604000-00004

    Article  Google Scholar 

  4. Hulka, F., Mullins, R.J., Mann, N.C., et al.: Influence of a statewide trauma system on pediatric hospitalization and outcome. J. Trauma Acute Care Surg. 42(3), 514–519 (1997). https://doi.org/10.1097/00005373-199703000-00020

    Article  Google Scholar 

  5. Candefjord, S., Asker, L., Caragounis, E.C.: Mortality of trauma patients treated at trauma centers compared to non-trauma centers in Sweden: a retrospective study. Eur. J. Trauma Emerg. Surg. 48(1), 1–12 (2022). https://doi.org/10.1007/s00068-020-01446-6

    Article  Google Scholar 

  6. Danner, O.K., Wilson, K.L., Heron, S., et al.: Benefit of a tiered-trauma activation system to triage dead-on-arrival patients. W. J. Emerg. Med. 13(3), 225 (2012). https://doi.org/10.5811/westjem.2012.3.11781

    Article  Google Scholar 

  7. Haas, B., Stukel, T.A., Gomez, D., et al.: The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis. J. Trauma Acute Care Surg. 72(6), 1510–1517 (2012). https://doi.org/10.1097/TA.0b013e318252510a

    Article  Google Scholar 

  8. Ariss, A.B., Bachir, R., El Sayed, M.: Factors associated with survival in adult patients with traumatic arrest: a retrospective cohort study from US trauma centers. BMC Emerg. Med. 21(1), 1–10 (2021). https://doi.org/10.1186/s12873-021-00473-9

    Article  Google Scholar 

  9. Rittenberger, J.C., Callaway, C.W.: Transport of patients after out-of-hospital cardiac arrest: closest facility or most appropriate facility? Ann. Emerg. Med. 54(2), 256–257 (2009). https://doi.org/10.1016/j.annemergmed.2009.01.009

    Article  Google Scholar 

  10. Taylor, B.N., Rasnake, N., McNutt, K., McKnight, C.L., Daley, B.J.: Rapid ground transport of trauma patients: a moderate distance from trauma center improves survival. J. Surg. Res. 232, 318–324 (2018). https://doi.org/10.1016/j.jss.2018.06.055

    Article  Google Scholar 

  11. Cameron, P.A., Zalstein, S.: Transport of the critically ill. Med. J. Aust. 169(11–12) (1998). https://doi.org/10.5694/j.1326-5377.1998.tb123434.x

  12. Schneider, A.M., Ewing, J.A., Cull, J.D.: Helicopter transport of trauma patients improves survival irrespective of transport time. Am. Surg. 87(4), 538–542 (2021). https://doi.org/10.1177/0003134820943564

    Article  Google Scholar 

  13. Han, H.R., Miller, H.N., Nkimbeng, M., et al.: Trauma informed interventions: a systematic review. PLoS ONE 16(6), e0252747 (2021). https://doi.org/10.1371/journal.pone.0252747

    Article  Google Scholar 

  14. Richardson, M., Eagle, T.B., Waters, S.F.: A systematic review of trauma intervention adaptations for indigenous caregivers and children: insights and implications for reciprocal collaboration. Psychol. Trauma 14(6), 972–982 (2022). https://doi.org/10.1037/tra0001225

    Article  Google Scholar 

  15. Hamilton, S.M., Breakey, P.: Fluid resuscitation of the trauma patient: how much is enough? Can. J. Surg. 39(1), 11 (1996)

    Google Scholar 

  16. Haukoos, J.S., Byyny, R.L., Erickson, C., et al.: Validation and refinement of a rule to predict emergency intervention in adult trauma patients. Ann. Emerg. Med. 58(2), 164–171 (2011). https://doi.org/10.1016/j.annemergmed.2011.02.027

    Article  Google Scholar 

  17. Awwad, K., Ng, Y.G., Lee, K., Lim, P.Y., Rawajbeh, B.: Advanced trauma life support/advanced trauma care for nurses: a systematic review concerning the knowledge and skills of emergency nurse related to trauma triage in a community. Int. Emerg. Nurs. 56, 100994 (2021). https://doi.org/10.1016/j.ienj.2021.100994

    Article  Google Scholar 

  18. Stojek, L., Bieler, D., Neubert, A., Ahnert, T., Imach, S.: The potential of point-of-care diagnostics to optimise prehospital trauma triage: a systematic review of literature. Eur. J. Trauma Emerg. Surg. 49(4), 1–13 (2023). https://doi.org/10.1007/s00068-023-02226-8

    Article  Google Scholar 

  19. Vles, W.J., Steyerberg, E.W., Meeuwis, J.D., Leenen, L.P.H.: Pre-hospital trauma care: a proposal for more efficient evaluation. Injury 35(8), 725–733 (2004). https://doi.org/10.1016/j.injury.2003.09.006

    Article  Google Scholar 

  20. Savoia, P., Jayanthi, S., Chammas, M.: Focused assessment with sonography for trauma (FAST). J. Med. Ultrasound 31(2), 101–106 (2023). https://doi.org/10.4103/jmu.jmu_12_23

    Article  Google Scholar 

  21. Kannikeswaran, N., Ehrman, R.R., Vitale, L., et al.: Comparison of trauma and burn evaluations in a pediatric emergency department during pre, early and late COVID-19 pandemic. J. Pediatr. Surg. 58(9), 1803–1808 (2023). https://doi.org/10.1016/j.jpedsurg.2023.03.008

    Article  Google Scholar 

  22. Amato, S., Vogt, A., Sarathy, A., et al.: Frequency and predictors of trauma transfer futility to a rural level I trauma center. J. Surg. Res. 279, 1–7 (2022). https://doi.org/10.1016/j.jss.2022.05.013

    Article  Google Scholar 

  23. Veenema, K.R., Rodewald, L.E.: Stabilization of rural multiple-trauma patients at level III Emergency departments before transfer to a level I regional trauma center. Ann. Emerg. Med. 25(2), 175–181 (1995). https://doi.org/10.1016/S0196-0644(95)70320-9

    Article  Google Scholar 

  24. Halvachizadeh, S., Teuber, H., Cinelli, P., Allemann, F., Pape, H.C., Neuhaus, V.: Does the time of day in orthopedic trauma surgery affect mortality and complication rates? Patient Saf. Surg. 13(1), 1–8 (2019). https://doi.org/10.1186/s13037-019-0186-4

    Article  Google Scholar 

  25. Prin, M., Li, G.: Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Inj. Epidemiol. 3(1), 1–10 (2016). https://doi.org/10.1186/s40621-016-0084-5

    Article  Google Scholar 

  26. Tote, D., Tote, S., Gupta, D., Mahakalkar, C.: Pattern of trauma in a rural hospital and factors affecting mortality in trauma patients. Int. J. Res. Med. Sci. 4(2), 450–456 (2016). https://doi.org/10.18203/2320-6012.ijrms20160294

  27. Atlas, A., Büyükfirat, E., Ethemoğlu, K.B., Karahan, M. A., Altay, N.: Factors affecting mortality in trauma patients hospitalized in the intensive care unit. J. Surg. Med. 4(11), 930–933 (2020). https://doi.org/10.28982/josam.812409

  28. Sammy, I., Lecky, F., Sutton, A., Leaviss, J., O’Cathain, A.: Factors affecting mortality in older trauma patients - Aasystematic review and meta-analysis. Injury 47(6), 1170–1183 (2016). https://doi.org/10.1016/j.injury.2016.02.027

    Article  Google Scholar 

  29. Hefny, A.F., Idris, K., Eid, H.O., Abu-Zidan, F.M.: Factors affecting mortality of critical care trauma patients. Afr. Health Sci. 13(3), 731–735 (2013). https://doi.org/10.4314/ahs.v13i3.30

    Article  Google Scholar 

  30. Palmer, C.: Major trauma and the injury severity score - where should we set the bar? In: Annual Proceedings - Association for the Advancement of Automotive Medicine (2007)

    Google Scholar 

  31. Cobianchi, L., Dal Mas, F., Agnoletti, V., et al.: Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J. Emerg. Surg. 18(1), 14 (2023). https://doi.org/10.1186/s13017-022-00464-6

    Article  Google Scholar 

  32. Keene, C.M., Kong, V.Y., Clarke, D.L., Brysiewicz, P.: The effect of the quality of vital sign recording on clinical decision making in a regional acute care trauma ward. Chinese J. Traumatol. English Ed. 20(5), 283–287 (2017). https://doi.org/10.1016/j.cjtee.2016.11.008

    Article  Google Scholar 

  33. Little, W.K.: Golden hour or golden opportunity: early management of pediatric trauma. Clin. Pediatr. Emerg. Med. 11(1), 4–9 (2010). https://doi.org/10.1016/j.cpem.2009.12.005

    Article  Google Scholar 

  34. Rogers, F.B., Rittenhouse, K.J., Gross, B.W.: The golden hour in trauma: dogma or medical folklore? Injury 46(4), 525–527 (2015). https://doi.org/10.1016/j.injury.2014.08.043

    Article  Google Scholar 

  35. Brathwaite, C.E.M., Rosko, M., McDowell, R., Gallagher, J., Proenca, J., Spott, M.A.: A critical analysis of on-scene helicopter transport on survival in a statewide trauma system. J. Trauma Injury, Infect. Crit. Care 45(1), 140–146 (1998). https://doi.org/10.1097/00005373-199807000-00029

    Article  Google Scholar 

  36. Duchin, E.R., Neisinger, L., Reed, M.J., Gause, E., Sharninghausen, J., Pham, T.: Perspectives on recovery from older adult trauma survivors living in rural areas. Trauma Surg. Acute Care Open. 7(1), e000881 (2022). https://doi.org/10.1136/tsaco-2021-000881

    Article  Google Scholar 

  37. Flynn, D., Francis, R., Robalino, S., et al.: A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients. BMC Emerg. Med. 17(1), 1–13 (2017). https://doi.org/10.1186/s12873-017-0118-5

    Article  Google Scholar 

  38. Georgia Trauma Commission. Georgia Trauma System Strategic Plan – Five Years (2021). https://trauma.georgia.gov/planning

  39. MacKenzie, E.J., Hoyt, D.B., Sacra, J.C., et al.: National inventory of hospital trauma centers. JAMA 289(12), 1515–1522 (2003). https://doi.org/10.1001/jama.289.12.1515

    Article  Google Scholar 

  40. Wu, C.H., Hwang, K.P.: Using a discrete-event simulation to balance ambulance availability and demand in static deployment systems. Acad. Emerg. Med. 16(12), 1359–1366 (2009). https://doi.org/10.1111/j.1553-2712.2009.00583.x

    Article  Google Scholar 

  41. Aboueljinane, L., Sahin, E., Jemai, Z.: A review on simulation models applied to emergency medical service operations. Comput. Ind. Eng. 66(4), 734–750 (2013). https://doi.org/10.1016/j.cie.2013.09.017

    Article  Google Scholar 

  42. Lubicz, M., Mielczarek, B.: Simulation modelling of emergency medical services. Eur. J. Oper. Res. 29(2), 178–185 (1987). https://doi.org/10.1016/0377-2217(87)90107-X

    Article  Google Scholar 

  43. Centers for Disease Control and Prevention. Injury Prevention and Control. http://www.cdc.gov/injury/

  44. Trauma System Evaluation and Planning Committee. Regional Trauma Systems: Optimal Elements, Integration and Assessment (2008). https://www.facs.org/media/sgue1q5x/regionaltraumasystems.pdf

  45. Georgia Trauma Annual Report. 2021. Georgia Department of Public Health. https://dph.georgia.gov/trauma

  46. Leonard, T., Lee, E.K.: US-Mexico border: building a smarter wall through strategic security. J. Strateg. Innovation Sustain. 15(1), 156–182 (2020). https://doi.org/10.33423/jsis.v15i1.2735

    Article  Google Scholar 

Download references

Acknowledgement

This work is partially supported by grants from the National Science Foundation IIP-0832390 and IIP-1361532 and the Georgia Trauma Care Network Commission. Findings and conclusions in this paper are those of the authors and do not necessarily reflect the views of the National Science Foundation or the Georgia Trauma Care Network Commission.

Author information

Authors and Affiliations

  1. The Data and Analytics Innovation Institute, Atlanta, GA, 30309, USA

    Eva K. Lee

  2. Georgia Institute of Technology, Atlanta, GA, 30322, USA

    Eva K. Lee, A Oguzhan Ozlu & Taylor J. Leonard

  3. Accuhealth Technologies, Atlanta, GA, 30310, USA

    Eva K. Lee

  4. T-Mobile, Atlanta, GA, USA

    A Oguzhan Ozlu

  5. The United States Department of Air Force, Pentagon, Washinton D.C, 20330, USA

    Taylor J. Leonard

  6. Grady Health Systems, Atlanta, GA, 30303, USA

    Michael Wright

  7. Emory University Hospital Midtown, Atlanta, GA, 30308, USA

    Daniel Wood

Authors
  1. Eva K. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Oguzhan Ozlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taylor J. Leonard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Wood
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva K. Lee .

Editor information

Editors and Affiliations

  1. Jan Evangelista Purkyně University, Ústí nad Labem-město, Czech Republic

    Hossein Moosaei

  2. Charles University, Prague, Czech Republic

    Milan Hladík

  3. University of Florida, Gainesville, FL, USA

    Panos M. Pardalos

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Lee, E.K., Ozlu, A., Leonard, T.J., Wright, M., Wood, D. (2024). Strategic Decision-Making in Trauma Systems. In: Moosaei, H., Hladík, M., Pardalos, P.M. (eds) Dynamics of Information Systems. DIS 2023. Lecture Notes in Computer Science, vol 14321. Springer, Cham. https://doi.org/10.1007/978-3-031-50320-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-50320-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-50319-1

  • Online ISBN: 978-3-031-50320-7

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics

Search

Navigation