Adapting the Centers for Disease Control Guidelines for Field Triage of Injured Patients to a Rural EMS System: the “50 Minute Rule”

Objective Traumatic injury is a leading cause of death in the United States; in rural areas patient outcomes are notably worse. The Centers for Disease Control’s “Guidelines for Field Triage of Injured Patients” provides guidance to help EMS providers recognize patients likely to benefit from transport directly to a Trauma Center. While these guidelines have proven successful in urban areas, little research has been done in rural settings, where transport times may be prolonged. In 2014, Vermont Emergency Medical Services (EMS) adapted the CDC guidelines for our rural EMS system by introducing the “50 Minute Rule”, which directs that patients meeting CDC physiologic or anatomic criteria should be transported directly to a Trauma Center if there is one within 50 minutes and the patient does not require immediate airway or other stabilization not possible in the field.This study evaluates the safety of long transport intervals for severely injured patients diverted to trauma centers in a rural EMS system. Methods All University of Vermont Medical Center Trauma Team patients who had a Vermont EMS patient encounter between January 1, 2014 and December 31, 2017 were examined, and 1,568 adult patients with trauma seen by both services were identified. Patients were grouped by whether they were taken directly to the trauma center, transferred from another hospital, or diverted by the protocol under evaluation. Odds of deterioration, 30-day mortality, and 60-day mortality were determined through logistic regression, adjusting for identified confounding variables. Results Patients diverted using the “50 Minute Rule” were found to carry no significantly different odds of deterioration [OR 1.37, 95% CI (0.75-2.52), p \u3c 0.29], 30-day mortality [OR 0.7, 95% CI (0.26-1.92), p \u3c 0.49], or 60-day mortality [OR 0.78, 95% CI (0.31-1.96), p \u3c 0.61]. The regression model was powered to detect a ~10% change in absolute risk of each primary outcome. Conclusions We found appropriately selected patients were able to be safely diverted directly from the field and transported in excess of 50 minutes to receive Trauma Center care. Adaptation of the CDC Guidelines by introducing the “50 Minute Rule” may be beneficial for other rural EMS systems