Trauma center activity and surge response during the early phase of the COVID-19 pandemic - The Philadelphia story

The COVID-19 pandemic has stressed all facets of healthcare delivery. Trauma centers serve as regional resource sites for high-acuity patients; so careful planning is required to maintain access to trauma care during an infectious pandemic. Guidance from the American College of Surgeons Committee on Trauma (ACS-COT) provides a general framework for the pandemic response, but these precepts must be contextualized to local and regional factors. The Level I trauma centers in Philadelphia collaborated to implement this guidance and to share insights throughout the early phase of the pandemic. For this report, we examined the volume, acuity, and mechanisms of presenting trauma patients and the number and acuity of COVID-19 admissions during the pandemic. We also assessed the geospatial relationship between firearm incidents and COVID-19 case density. Finally, we collated the collaborative measures taken to maintain trauma access and team safety and evaluated the effect of these measures. Over the first 6 weeks of the pandemic, trauma contacts totaled 1,058 patients across all centers representing a 20% decrease compared with the same time last year. However, the number of penetrating trauma cases increased with a significant correlation between shooting locations and high-density COVID areas. During this time, Philadelphia trauma centers admitted a total of 1,413 confirmed COVID-19 patients, and 23% required mechanical ventilation. Divert status was activated for only 1.6% of available hours, and five of six centers remained open to all trauma transfers over the entire study period. Thus, through deliberate efforts to adapt ACS-COT guidelines and share lessons learned, the Level I trauma centers in Philadelphia maintained trauma access while simultaneously responding to the high-acuity infectious pandemic. This approach can be employed by other metropolitan areas and trauma systems to assure readiness during a prolonged crisis with large volumes of high-acuity trauma and nontrauma patients.