Trauma & Critical Care

Rural Enhancement of Access and Care for Trauma (REACT)

REACT, Rural Enhancement of Access and Care for Trauma, is a National Highway Traffic Safety Administration-funded demonstration and evaluation project developed in an attempt to improve trauma care in the eastern region of North Carolina. The project is a follow-up to the Rural Preventable Mortality Study (RPMS) conducted in 1995 by the Trauma Service at Pitt County Memorial Hospital. Results of the RPMS suggested that approximately 29% of the trauma deaths that were reviewed for the study were preventable. Factors identified as contributing to the deaths were broken down into prehospital and hospital factors. Primary prehospital components identified were airway management, chest trauma management, and fluid resuscitation. Some of the major hospital concerns identified were too long in the ED or X-ray before definitive treatment, airway management, and chest trauma management. REACT was initiated to address these areas.

The components of the REACT project are data collection, feedback based on the data collected, and education. Trauma care guidelines have been developed for both the prehospital and hospital settings that address the concerns identified above. Data collection sheets have also been developed based on these guidelines. As of July , 1997, area emergency departments that are participating in the project are collecting data about the care provided to trauma patients by prehospital personnel. If a patient is transferred to the PCMH trauma center, the ED staff at PCMH or EastCare staff will document care rendered at the referring hospital on a data collection form. The project coordinator will contact the designated person from the ED to advise them of the status of transferred patients. On a quarterly basis, the project coordinator will meet with ED and EMS personnel to provide a summary of trauma patient care for that area and discuss any education issues. Additionally, we will be contacting the EMS continuing education coordinator for each county to set up educational sessions about REACT and trauma care that will meet some of the mandatory objectives for trauma education.

Beginning in July, 1998 the Rural Preventable Mortality Study will be repeated. A decrease in the number of preventable deaths will indicate that the demonstration-evaluation process was a success.