ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2026.
Volume 15.
Number 1: 91-95 P-ISSN.
E-ISSN: 2302-2914
Analysis of the application value and safety of the in-hospital emergency mode in tertiary medical institutions for the treatment of severe trauma Lukai Lv1.
Mingyan Fan1.
Lei Li1.
Ping Xu1* ABSTRACT Background: Severe trauma is a major cause of death and disability and requires rapid, coordinated management.
Traditional emergency care is often fragmented across departments, which may delay critical interventions.
This study evaluated the effectiveness of the Trauma Center emergency model, an integrated multidisciplinary system with standardized protocols, compared with conventional care in patients with severe trauma.
Methods: This non-randomized time-series study included 100 patients with severe trauma admitted to Zigong Fourth PeopleAos Hospital from January to December 2025.
Severe trauma was defined as a Shock Index >0.
Patients were assigned chronologically to a control group receiving traditional emergency care and a study group managed under the Trauma Center model, with 50 patients in each group.
Outcomes included time to intravenous access, emergency department processing time, complication rate, and rescue success rate.
Results: Compared with the control group, the Trauma Center group had significantly shorter time to intravenous access .
17 A 3.
43 vs.
79 A 5.
88 min.
mean difference 7.
62 min, 95% CI 5.
p-value < 0.
and shorter emergency department processing time .
32 A 25.
42 vs.
54 A 39.
27 min.
mean difference 25.
min, 95% CI 11.
P < 0.
The complication rate was lower .
0% vs.
p-value = 0.
, while rescue success was higher .
0% vs.
p-value = 0.
Conclusion: Implementation of the Trauma Center emergency model in severe trauma care significantly reduces critical time intervals, lowers complication rates, and improves rescue success.
Department of Emergency.
Zigong Fourth PeopleAos Hospital.
Sichuan.
Zigong.
China.
*Corresponding to:
Ping Xu.
Department of Emergency.
Zigong Fourth PeopleAos Hospital.
Sichuan.
Zigong.
China.
xp1657@126.
Received: 2026-01-08 Accepted: 2026-02-25 Published: 2026-04-16 Keywords: Clinical application, safety, severe trauma, trauma center emergency model, treatment outcomes.
Cite This Article: Lv.
Fan.
Li.
Xu.
Analysis of the application value and safety of the in-hospital emergency mode in tertiary medical institutions for the treatment of severe trauma.
Bali Medical Journal 15.
DOI: 10.
15562/bmj.
INTRODUCTION
The acceleration of societal modernization has been accompanied by a substantial burden of severe trauma, which remains a leading cause of death and disability Epidemiological consistently show that injuries claim millions of lives annually and account for a major share of premature mortality and disability, with a disproportionate impact on younger populations.
2 Beyond the immediate loss of life, severe trauma is associated with substantial long-term disability and imposes a considerable social and economic burden on patients, families, and healthcare systems.
3,4 This escalating crisis underscores an urgent public health imperative to refine and strengthen trauma systems of care to reduce preventable death and disability.
The clinical management of severe trauma is critically time-sensitive, with mortality classically described in a trimodal distribution.
5 While the first peak of death occurs within minutes of injury due to unsurvivable injuries, the second peak occurs within hours and represents a crucial opportunity for During this period, deaths from potentially reversible conditions, particularly hemorrhage and other severe but treatable injuries, may be prevented with prompt definitive care.
5,6 Timely and systematic intervention during this phase can reduce mortality, making it a critical window for trauma resuscitation.
7Ae9 Despite this knowledge, significant clinical gaps persist.
Outcomes for severely injured Open access:Journal Bali Medical 15.
: 91-95 | doi: 10.
15562/bmj.
patients vary widely and are influenced by the efficiency, organization, and maturity of the receiving hospitalAos trauma response 3,8,10 Previous studies have shown that optimizing in-hospital trauma pathways and implementing organized trauma systems are associated with improved survival and faster delivery of key interventions for severely injured 8Ae10 However, the comparative effectiveness of different emergency care models, particularly the specialized Trauma Center approach, in addressing this early preventable mortality still requires further rigorous investigation.
Consequently, this study aims to evaluate the application value and safety of the Trauma Center emergency model in the treatment of severe trauma.
ORIGINAL ARTICLE
METHODS
Study Design and Population.
This study employed a non-randomized, time series design to compare two emergency care models for severe The research was conducted at Zigong Fourth PeopleAos Hospital from January to December 2025.
Patients with suspected severe trauma presenting to the Emergency Department and Trauma Center were screened using a Shock Index (SI) > 0.
8 as the primary criterion.
A total of 100 patients meeting the criteria for severe trauma were enrolled and assigned to either the study group .
dmitted JulyAe December 2025, n=.
or the control group .
dmitted January-June 2025, n=.
based on chronological order of Inclusion criteria were: age Ou4 years.
Shock Index >0.
8, and time from injury to hospital admission <24 hours.
Exclusion criteria included: cardiac arrest or clinical death upon admission, severe traumatic brain injury precluding shock index assessment, pregnancy or lactation, severe underlying diseases affecting prognosis .
nd-stage renal disease, advanced malignanc.
, and incomplete data or loss to follow-up.
Baseline characteristics were comparable between groups.
The study group .
males, 25 females.
13A3.
57 year.
had injury causes including falls .
, traffic accidents .
, blunt force trauma .
, crush injuries .
, and burns .
The control group .
males, 25 females.
mean age 70A3.
49 year.
presented with falls .
, traffic accidents .
, blunt force trauma .
, crush injuries .
, and burns .
No statistically significant differences were observed in demographic or clinical characteristics between groups .
-value>0.
All patients or their families provided informed consent, and the study received approval from the hospitalAos Medical Ethics Committee.
Study Variables and Procedures Control Group (Traditional Emergency Mode.
: Patients received care under the conventional consultation-based system, characterized by sequential processing:
individually, multiple patient transfers, and verbal handovers between pre-hospital and in-hospital teams.
Management focused on basic life support, including airway maintenance, artificial respiration, and external chest compressions.
Study Group (Trauma Center Emergency Mode.
: Patients were managed through an integrated multidisciplinary approach with the following components:
Trauma Team Organization: A dedicated trauma team was established, led by an experienced senior physician, incorporating pre-hospital emergency orthopedics, critical care, and diagnostic All completed standardized severe trauma Three distinct nursing roles were designated: a primary nurse (N2 level or abov.
managing airway, assessment, and an associate primary nurse (N1 leve.
responsible for vascular access, monitoring, and anti-shock therapy.
liaison nurse (N0 leve.
handling supplies, blood products, and green channel Protocol Implementation:
Upon arrival, triage nurses conducted an initial assessment and activated the primary nurse, who initiated the trauma response and green channel.
The assembled trauma team performed rapid focused assessment .
irway, breathing, circulation, consciousnes.
, with simultaneous shock management, bleeding control, and diagnostic procedures.
Individualized treatment plans were formulated following diagnosis confirmation, with streamlined transfer pathways to the operating room or intensive care unit as indicated.
Activation and Operational Protocols:
Activation followed explicit physiological criteria .
ystolic blood pressure <90 mmHg.
Glasgow Coma Scale O13, penetrating injury, high-energy mechanis.
, with flexibility for clinical judgment.
A twotier on-call system ensured 24/7 coverage, with attending physicians available within 15 minutes.
Priority access to computed tomography and operating rooms was secured through protocolbased coordination, including designated Augreen channel priorityAy surgical capacity.
Dynamic staffing allocation ensured at least two dedicated nurses per trauma Quality control included monthly multidisciplinary case reviews and quarterly department-level process Outcome Measures The primary outcome was time to intravenous access establishment, with secondary outcomes being emergency department processing time, total complication rate, and rescue success Complications neurological injury, shock, and extensive tissue necrosis, assessed within 24 hours of admission.
The total complication rate was calculated as .
umber of cases with complications / total case.
y 100%.
Rescue success was defined as recovery of spontaneous heartbeat, normalization of skin color, pupil constriction, restoration of spontaneous breathing, and regained The rescue success rate or resuscitation after arrest was calculated as .
umber of successful rescues / total case.
y 100%.
Statistical Analysis Data were analyzed using SPSS statistical Measurement data were expressed as mean A standard deviation (SD) with intergroup comparisons using independent samples t-tests.
Count data were expressed as frequencies .
and percentages (%) with intergroup comparisons using NA tests.
Statistical significance was set at p-value<0.
RESULTS
Comparison of Intravenous Access Time and Emergency Department Processing Time Between the Two Groups.
The time required to establish intravenous access and the emergency department processing time were both significantly shorter in the study group compared to the control group, with the differences being statistically significant (P < 0.
(Table Compared with the control group, the study group demonstrated a significantly shorter time to establish intravenous access, with a mean difference of 7.
% CI: 5.
71 to 9.
p-value < 0.
Additionally, the emergency department processing time was also significantly reduced in the study group.
Bali Medical Journal 2026.
: 91-95 | doi: 10.
15562/bmj.
ORIGINAL ARTICLE
with a mean reduction of 25.
22 minutes .
% CI: 11.
89 to 38.
55, p-value<0.
(Table .
Comparison of Complication Rates and Rescue Success Rates Between the Two Groups.
The overall complication rate in the study group was significantly lower than that in the control group, while the rescue success rate was significantly higher.
Both differences were statistically significant .
-value<0.
(Table .
DISCUSSION
The Trauma Center model represents a shift from traditional consultant-led emergency care toward an integrated, multidisciplinary system that brings key surgical and diagnostic services into the emergency care pathway.
This model is intended to provide timely, comprehensive, and systematic assessment and treatment for patients with severe trauma, while standardizing care pathways and improving outcomes.
11,12
In the present study, implementation of this model at Zigong Fourth PeopleAos Hospital was associated with shorter times to intravenous access and emergency department processing, lower complication rates, and higher rescue success than conventional care, supporting the value of the Trauma Center approach in the Chinese healthcare setting.
The reduction in time-based indicators observed in our study is consistent with previous evidence on trauma system optimization.
Georgiou and Lockey showed that effective hospital trauma teams improve the timeliness of resuscitation, imaging, and transfer to definitive care by enabling simultaneous specialist input rather than sequential 11 Murphy et al.
also found that simulation-based multidisciplinary trauma team training reduced time to critical operations, while Nonis et al.
reported shorter emergency department length of stay and faster progression to definitive management after trauma team 13,14 These findings suggest that the efficiency of the Trauma Center model mainly arises from parallel task execution, predefined role allocation, and anticipatory resource mobilization, which Table 1.
Comparison of Intravenous Access Time and Emergency Department Processing Time Between the Two Groups Variable Control .
= .
Study .
= .
Mean Difference .
% CI) p-value Time to Establish Intravenous Access .
79 A 5.
17 A 3.
71 Ae 9.
<0.
Emergency Department Processing Time .
54 A 39.
32 A 25.
89 Ae 38.
<0.
*Statistically significant at p-value<0.
05 based on an independent t-test.
Table 2.
Comparison of Overall Complication Rates and Rescue Success Rates Between the Two Groups Control .
= .
Study .
= .
p-value Neurological Injury, n (%) 11 .
Shock, n (%) 4 .
Extensive Tissue Necrosis, n (%) 5 .
Total Complications, n (%) 20 .
Rescue Success, n (%) 40 .
Variable *Statistically significant at p-value<0.
05 based on FisherAos exact test.
likely also explains the shorter emergency department processing time in our 11,12 The higher rescue success rate in our study, 92% versus 80% in the control group, is likewise in line with the established evidence supporting trauma center MacKenzie et al.
lower mortality in patients treated at trauma centers than at non-trauma centers, especially among those with more severe injury, and Celso et al.
that trauma system implementation was associated with a 15% reduction in mortality risk.
8,15 More recent studies from China reported similar benefits, including lower in-hospital mortality and shorter times to computed tomography, transfusion, and emergency surgery after trauma center establishment or new inhospital trauma care models.
9,12 The larger reduction in complications observed in our study may reflect the relatively unstructured baseline care in the control group, since greater gains are often seen when hospitals move from less organized trauma care to formalized systems rather Bali Medical Journal 2026.
: 91-95 | doi: 10.
15562/bmj.
than when already mature systems undergo incremental refinement.
10,12
Some differences between our findings and prior studies should also be Our study was dominated by traffic accidents and falls, whereas penetrating trauma represents a larger proportion of severe trauma in some North American studies, which may affect generalizability because blunt and penetrating injuries may benefit differently from specific trauma system 16 The predominance of blunt multisystem trauma in our population may have amplified the benefit of coordinated multidisciplinary assessment.
In addition, the tiered nursing structure in our model, with primary, associate, and liaison nurses assigned distinct roles, appears more explicitly organized than in many Western reports.
Although trauma nurse leadership has been shown to improve communication and team performance, formal nursing role differentiation is less often described, and this structured delegation may have contributed to the strong gains in time-based outcomes in ORIGINAL ARTICLE our study.
11,17 More broadly, the Chinese tertiary hospital context, characterized by high patient volumes, centralized leadership, and clearly specified nursing roles, may create favorable conditions for rapid implementation of protocolized trauma care pathways.
12,18
This study has several limitations.
The non-randomized time-series design introduces the possibility of temporal confounding, as improvements may partly reflect growing staff experience or broader trauma system maturation over time rather than the intervention alone.
The single-center design limits generalizability, while the use of Shock Index > 0.
8 as an inclusion criterion may not fully capture injury severity heterogeneity across different trauma types.
The modest sample size prevented subgroup analyses, and variations in clinician performance, team dynamics, and communication may still have influenced outcomes.
addition, follow-up was limited to the immediate post-resuscitation period, so long-term recovery, quality of life, return to work, and cost-effectiveness could not be evaluated.
Future research should therefore use multicenter designs with stronger quasi-experimental or randomized implementation approaches, including stepped-wedge cluster trials where appropriate, to better address temporal trends and improve external Larger studies would allow subgroup analyses by injury mechanism, anatomical pattern, physiological severity, and patient characteristics.
Longer followup is also needed because the impact of trauma care extends beyond early survival and includes long-term disability, functional recovery, and socioeconomic Economic evaluation is equally important, as trauma center care may remain cost-effective despite higher initial Finally, future work should examine implementation barriers and facilitators, optimize team composition and training, and evaluate new technologies such as artificial intelligence and telemedicine as potential enhancements to the Trauma Center model.
CONCLUSION
This study shows that the Trauma Center emergency model improves severe trauma management compared with conventional care, as reflected by faster intravenous access, shorter emergency department processing time, lower complication rates, and higher rescue success, all with statistical significance.
These benefits likely result from multidisciplinary integration, standardized protocols, and coordinated team-based care that support rapid assessment and timely intervention during the critical post-injury period.
These findings support the implementation of Trauma Center models with adaptation to local resources and case mix, strengthened by standardized training and simulationbased team rehearsal.
However, because this was a single-center study, larger multicenter prospective studies are still needed to confirm generalizability, identify patient groups most likely to benefit, and guide policy efforts aimed at reducing severe trauma morbidity and mortality.
ARTIFICIAL INTELLIGENCE
STATEMENT
No generative artificial intelligence or AIassisted tools were used in the writing, editing, analysis, or preparation of this All content was developed and reviewed entirely by the authors, who take full responsibility for the final version of the manuscript.
REFERENCES