Holding in place the nine trauma centers of the existing system, approximately the same percent coverage as the existing system - 70.3% - potentially could be achieved within 15 minutes by optimally locating significantly fewer helicopter depots, a benefit to taxpayers. If all eight aeromedical depots were retained and optimally located, the response time to severe injuries within 15 minutes would improve by 15.1%, to 85.4%.
The researchers also considered a different variation, holding in place the eight aeromedical depots of the existing system. Removal and optimal replacement of single trauma center sites increased coverage within 15 minutes by an average of 4.2%. The optimal replacement of any one of the nine trauma centers in the existing system would therefore provide trauma system access to hundreds more severely injured people each year.
In the past decade, say the authors, substantial progress has been made in developing guidelines for the location of trauma care resources. But, they say, political concerns and historical patterns have interfered. In response, the researchers used operations research to bolster trauma systems design.
TRAMAH was applied and tested from two different perspectives. The first assumed that no existing trauma care resources were present. Resources were thus located as if the state were a "clean slate." The second perspective began with the existing configuration of trauma resources and made incremental changes to this configuration. The two perspectives show TRAMAH's flexible application to both highly and less developed trauma systems.
The authors, nonetheless, caution that this first application was not
necessarily meant to be an evaluation of Maryland. Rather, it was more of a
probationary demonstration of TRAMAH's adaptability to any state. Further
research, including the incorporation of
Contact: Barry List
Institute for Operations Research and the Management Sciences