Rural rendezvous: How multiple EMS transfers impact trauma outcomes.
The American journal of emergency medicine · 2025-05-30 · Registry study
Abstract
BACKGROUND: Rural townships without immediate emergency services may rely on handover dispatch based upon prehospital EMS personal judgment for transport. OBJECTIVE: To evaluate rendezvous in the rural pre-hospital setting and the impact on clinical decline, acuity, and mortality on arrival. METHODS: This single-center Trauma Registry study was conducted from (23 years) January 1, 2000, to December 31, 2023. The data collected patient demographics, injury details, pre-hospital transport, morbidity, and mortality. The inclusion criteria were all trauma patients who were directly transported and were grouped into categories based upon the number of EMS rendezvous. This analysis utilized regression models with the primary outcomes; emergency department (ED) disposition to the intensive care unit (ICU) or morgue; Glasgow Coma Scale (GCS) and shock index ratio (SIR) on arrival. Each model controlled for age, sex, payor, injury type, and injury severity score (ISS). RESULTS: 11,937 patients were included in the initial sample; 49 % experienced rendezvous. Patients who experienced one or two rendezvous were more likely to ED disposition to the ICU (OR 2; OR 3) or the morgue (OR 5.6; OR 5.97) when compared to direct transport. The more rendezvous the lower the GCS and higher the SIR was reported when compared to direct transports (all models p values < .01). CONCLUSION: Trauma patients who experienced pre-hospital rendezvous were more likely to arrive in clinical decline with high acuity and ED mortality. This research highlights the need for improving access to definitive trauma care and coordinating key transport components in a regional trauma system.