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

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

Alexis M Moren  1 , Malika Waschmann  2 , Matthew J Martin  3 , Robert C McIntyre Jr  4 , Lewis J Kaplan  5
Affiliations

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

Alexis M Moren et al. Am J Surg. 2022 Aug.

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Location of respondent by state pre and post 1st COVID peak.
Fig. 2
Fig. 2
Changes made to blood product allocation pre- and post-1st COVID-19 peak between Level 1 and Level 2 Trauma centers.
Fig. 3
Fig. 3
Themes from a qualitative analysis indicating changes to blood product usage among Level 1 and 2 Trauma centers during the pre- and post-peak surveys.
Fig. 4
Fig. 4
How institutions adapted to assessing a trauma patient regarding PPE and precautions taken during the first COVID peak.
Fig. 5
Fig. 5
Observations by survey participants of their trauma population from March to June during the first COVID-19 peak.
Fig. 6
Fig. 6
Changes to ICU admission criteria by level of trauma center.
Fig. 7
Fig. 7
Barriers faced by survey participants while caring for COVID patients in March (pre-peak) and in June (post-peak).
See this image and copyright information in PMC

References

    1. Franco-Paredes C., Carrasco P., Preciado J.I. The first influenza pandemic in the new millennium: lessons learned hitherto for current control efforts and overall pandemic preparedness. J Immune Base Ther Vaccine. 2009;7:2. - PMC - PubMed
    1. Santos-Preciado J., Franco-Paredes C., Hernandez-Flores I., Tellez I., Del Rio C., Tapia-Conyer R. What have we learned from the novel influenza A (H1N1) pandemic in 2009 for strengthening pandemic influenza preparedness? Arch Med Res. 2009;40(8):673–676. - PMC - PubMed
    1. Markel H., Lipman H.B., Navarro J.A., et al. Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA. 2007;298(6):644–654. - PubMed
    1. WHO Director-General's Opening Remarks at the Media Briefing on COVID-19. World Health Organization; 2020.
    1. Ranney M.L., Griffeth V., Jha A.K. Critical supply shortages - the need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020;382(18):e41. - PubMed