| Abstract|| |
Introduction: Distance and other factors may play a significant role in both the implementation of care and the number of secondary health outcomes. The distance from an injury site can play a substantial impact on the mortality of different injuries and access to health-related services. Within this study, we sought to understand the effect of the site to treating center distance and access to relevant health-care services on effect and secondary injuries of coal mining-related injuries. Methods: We evaluated patient demographics, coal mining locations, and patient outcomes. This study is a retrospective review of patients with coal mining hand injuries included in our Level 1 trauma database as well as the amount of health-related resources defined by WV GIS Health Care (Hospitals). The sample consists of coal mine workers. All patients had to meet the study criteria and were admitted during the study period of January 1, 2005, through March 31, 2015. We then were able to locate the coal mines where these coal miners were injured based on information from their medical records and the availability of health-care resources (hospitals) around the zones of injury, as well as health-related resources from the WV GIS database. The sample size was n = 104. Data were collected in an Excel spreadsheet. Stata 11.2 was used to conduct a multinomial logistic regression. A hub analysis was performed to understand the overall distance associated with the injury site and care using Arch GIS 10.6. A hotspot analysis was also performed in order to understand the differences of different zones of concern of injury sites in Southern West Virginia, from January 1, 2005, to March 31, 2015. Results: Variables collected are as follows: a total number of coal miners were 104, with an average age of miners being similar in age demographics at 19–62. Coal mines are registered on the map with relevance to injury based on location; severity scale is presented. The most common injuries were fractures at 42.3% (47/104) followed by amputations at 26.9% (28/104). The index finger had an overall higher rate of injury at 28.8% (30/104). To understand the overall impact of specific injuries of coal miners based on the location, we peered into the number of injuries sustained at particular sites over the 10 years. Within this, the attached group, the average distance per injury to a medical center that was able to assist with hand injuries, was 46.1 miles. The shortest distance was within one mile of the center, and the most prolonged distance was 83.3 miles. The highest concentration of coal mining injuries were over 5 miles away from any health care organizations. The at-risk area of coal mining injuries was identified at (P = 0.001) and outside of health-care resources that can be seen within the hotspot analysis tested within this analysis. Conclusion: Specific injuries appear to be more at risk on different portions of the hand, as described in our initial data analysis. We also found that particular coal mines seem to harbor more coal mining hand injuries. Rural health care has the challenge of injuries occurring at extended distances and requires that treatment becomes as efficient as possible to maximize the chances of a full recovery. Aim and Objectives: The objective of this study is to understand if the distance between the location of injury and trauma center plays a role in the outcome of coal mines related to hand injuries treated at Charleston Area Medical Center.
Keywords: Health-care resources, health economics, rural health
|How to cite this article:|
Viradia R, Annie FH, Kali M, Pollock F, Hayes JD. Hand injuries of coal miners in Southern West Virginia: A pilot study on health-care resources in Southern West Virginia. J Emerg Trauma Shock 2021;14:18-22
|How to cite this URL:|
Viradia R, Annie FH, Kali M, Pollock F, Hayes JD. Hand injuries of coal miners in Southern West Virginia: A pilot study on health-care resources in Southern West Virginia. J Emerg Trauma Shock [serial online] 2021 [cited 2021 Apr 18];14:18-22. Available from: https://www.onlinejets.org/text.asp?2021/14/1/18/311797
| Introduction|| |
The distribution of health-care resources is critical for the distribution of management of health-care within rural areas [Figure 1]. In geography, health services planning first focused on the organization and the use of health services. The utilization of health-care delivery has become more widespread as new technologies have allowed for the optimizing of health care organizations. The geography of health care and the distribution of resources is divided into two areas of study: the spatial distribution of health-care resources and access and utilization [Figure 2].
The spatial concept of health care has been explored using statistical relationships that determine the patient's use of medical services, accompanied by an analysis of the social, cultural, and economical distribution of care., Related work further explored the structure of governmental policies that influence community health and health services.,, Government policies established minimum requirements for care, which has increased health-care utilization. Health service access is also controlled by the marketplace. The distribution of health resources and access is essential, especially for rural health care.
The goals of this study were to identify the trend and differences of coal mine-related hand injuries treated at Charleston Area Medical Center and to understand if any specific mine locations, and distance to hospitals played a role on the long term health consequences of these patients. We assessed patient demographics, mechanism and type of injuries, comorbid conditions, substance use, mine location, and distance to our trauma center.
The evaluation of and triage of hand injuries is essential for effective treatment and the reduction of long term complications., Likewise, proper destination decision-making for injured coal miners can be critical for their medical and surgical management in the rural parts of West Virginia. Change of destination, time to destination, alternate quicker routes to hospitals, and trauma center versus nontrauma center based on the medical and surgical treatment provided to them at our Level 1 trauma center.
| Methods|| |
We evaluated patient demographics, coal mining locations, and patient outcomes. This study is a retrospective review of patients with coal mining hand injuries obtained from our Level 1 trauma database. The sample consists of coal mine workers that were injured and transported to Charleston Area Medical Center General Hospital. All patients met the study criteria and were admitted during the study period of January 1, 2005, through March 31, 2015. We then were able to locate the coal mines where these coal miners were injured based on information from their medical records. The sample size was 104. Data were collected in an Excel Spreadsheet. Stata 11.2 was used to conduct a multinomial logistic regression. A hub analysis was performed to understand the overall distance associated with injury site and care using Arch GIS 10.6 and to the time and distance to our trauma center. We also evaluated range to hospital-related resources to understand the health delivery access issues that might influence human health in the region. A hotspot analysis was also performed to understand the different cases concerning health-care-related resources.
| Results|| |
The variables collected are as follows: the total number of coal miners was 104, with an average age of miners being similar in age demographics at 19–62. Coal mines are registered on the map with relevance to injury based on location; severity scale is presented. The most common injuries were fractures at 42.3% (47/104) followed by amputations at 26.9% (28/104). The index finger had an overall higher rate of injury at 28.8% (30/104), as illustrated in [Table 1]. To understand the overall impact of specific injuries of coal miners based on the location, we peered into the number of injuries sustained at particular sites over the 10 years. Within this, the attached group, the average distance per injury to a medical center that was able to assist with hand injuries, was 46.1 miles. The shortest distance was within one mile of the center, and the most prolonged distance was 83.3 miles [Figure 1]. There is a statistically significant zone of injuries (P = 0.001), as seen in [Figure 2], that fall outside the 5-mile buffer of hospital-related resources within these hotspot analyses.
| Discussion|| |
Throughout the past decade, the safety of coal mining in Southern West Virginia has been a hot topic of debate, especially concerning the safety regulations that have been enforced and the mine disasters that have unfortunately taken place. Multiple miners tragically lost their lives to an accidental mining shaft disaster and explosion at the Big Branch Mine disaster in 2009. Our previous research had enabled us to shed light on the types of injuries that coal miners sustain correctly to their hands on the job, which in turn gave us more information on how medical personnel can be better equipped to take care of coal mining hand injuries at outlying tertiary centers. Furthermore, our findings lead us in the current study to examine the distribution and accessibility of health resources for coal miners of rural Southern West Virginia.,
First, to understand the overall impact of specific injuries of coal miners based on the location, we looked at the number of injuries sustained at particular sites over the 10 years.
Moreover, we found that the average distance per injury to a medical point of care with hand injuries was 46.1 miles. The shortest distance was within one mile of the center, and the most prolonged interval was 83.3 miles. Second, the average travel time to our level 1 center for a patient to be transported to or from injury was 1 h.
Doumouras et al. examined road travel distance between the sites of injury, and the nearest trauma center was estimated using a geographic information system. They reported differential distance between the nearest nontrauma versus trauma center, which was associated with lower compliance with triage protocol in an urban setting. Our study emphasized traumatic hand injuries and the status of patients being sent to our Level 1 trauma center, either from the location of the injuries or transferred from outlying facilities. We agree (1) that the triage protocols in place are not standardized, (2) EMS performance at the system level, and (3) outcomes of patients transported to nontrauma centers are variable. The results are in alignment with the Doumouras findings to improve systems efficacy and costs; we must ensure that patients with minor injuries do not overwhelm trauma center resources and it is important to identify the severely injured patients that should be sent to trauma centers. Health delivery access is also an essential issue within Appalachia, especially within Southern West Virginia, the central focus of our study.
Brice et al. evaluated the effect of the implementation of North Carolina statewide trauma triage [Figure 3] and destination plan to address these challenges. They reported no difference in the percentage transported to community hospital Level I, II, or III trauma center as their first destination. However, there was a decrease in the number of patients transported to a Level I or II trauma center, and those carried to the Level I trauma center also decreased postimplementation. However, they reported no change in EMS scene times and transport time. Our research expands on locations and coal mining injury distance analysis to our level 1 trauma center from outlying facilities, as well as directly to the local tertiary center with a focus on specific injuries and availability to health-care resources.,,,,,,, Furthermore, we clarify the types of injuries that were transferred to our Level 1 trauma center. Moreover, our findings strongly support the enhancement of EMS personnel training for planning shorter routes, alternate quicker routes to hospitals, and choosing optimal destination to nontrauma or Level I and II centers when appropriate in the target of improving the average travel time to our Level 1 center for patients who are transported to or from injury site of 1 h.
| Conclusion|| |
Health delivery resources are challenging issues within rural America as well as Appalachia. Our study illustrates that health delivery resources play a significant role in the implantation of care, in particular the elements of accessibility and distribution of support. Hence, factoring in proper destination, time to destination, alternate quicker routes to hospitals, and trauma center versus nontrauma center for injured coal miners can be critical for their medical and surgical management in the rural parts of West Virginia.
This study was conducted within the Appalachian region but is not limited to this region as delivery access, and the role of that access to patient care is essential to understand the need for patient care.
This paper investigated the potential relationship between coal mining hand injuries and distance to the areas of care, such as the Level I CAMC trauma facility. There were possible confounders such as the knowledge of training of workers and other variables that were not controlled for in our study. However, the authors believe that the study does attempt to control for as many confounders as possible with the data available for our analysis.
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Conflicts of interest
There are no conflicts of interest.
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Dr. Frank H Annie
CAMC Health Education and Research Institute, 3200 Maccorkle Ave., Charleston, West Virginia 25304
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]