Case Series of Transfers In and Out of a Remote Border Lead Level 3 Trauma Center 2013 vs 2017
John W. Hovorka, MD FACS, Kimberly Powers, RN
McAllen Medical Center, Mcallen, TX
Background--McAllen Medical Center (MMC), designated by Texas as a Lead Level 3 adult trauma center has a special population of pediatric patients. Location is 75 miles south of the Mexican border checkpoint. No ACS verified pediatric level 1/2 facilities exist south of this border checkpoint. Institute of Medicine IOM concepts of Safety (having patient at appropriate facility for injury) conflicts with Patient Centered care. Parents including mother can be removed (forcibly in some cases) from the child if there exists or is perceived to exist a lack of documentation of citizenship or immigration status due to need to cross the border checkpoint for higher level pediatric trauma care.
Methods -- Reviewed state as well as ACS surveys from 2013 and 2017 as well as pediatric guidelines available. The Optimal book appeared to have the most specificity. Regarding practice patterns it has been perceived that pediatric trauma transfers have increased as practitioners as well as survey through the Pediatric Trauma Society listserv suggests transfer for more severe injuries. Trauma registry was queried from 2013 and 2017 as these years had ACS survey as well.
Results -- Transfers out have increased & Transfers in have increased overall particularly for lower ISS (see attached table).
Conclusions -- Increasing transfers out>ISS=16 hasn't lowered total transfers in. Psychological effects of forcible separation of mother and child due to transfer requirements has not been described to our knowledge. Further discussion regarding guidelines and application in unique trauma systems is recommended.
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