Trauma Transfer Times & Mortality: Billings Clinic Study Findings

March 7, 2026 Ananya Mittal - World Editor

The race against time is central to trauma care. The concept of the “golden hour”—the first hour after a traumatic injury—is deeply ingrained in emergency medicine, emphasizing the critical need for rapid assessment and intervention to improve patient outcomes. But what happens when distance and limited resources complicate that equation, as is often the case in rural settings? Recent research from Billings Clinic in Montana sheds light on the challenges of rural trauma care, revealing how transfer times can significantly impact the timeline for definitive treatment, even as overall mortality rates align with established injury severity metrics.

Rural Trauma: A Different Timeline

Investigators at Billings Clinic, a regional trauma center serving a large geographic area, analyzed data from trauma patients to compare those arriving directly from the scene of their injury with those transferred from other facilities. The study, published in the Journal of Trauma Nursing in July 2025, found that patients transferred from other hospitals experienced considerably longer times to reach the tertiary care center. This delay underscores a fundamental tension in rural trauma systems: the need to stabilize patients locally while recognizing the limitations of smaller facilities to provide comprehensive trauma care. The full study is available through LWW.

The research team, led by Tessa C. Savell, BSN, RN, and colleagues, tracked key metrics including time to definitive care and mortality rates. While transfer status didn’t directly correlate with increased mortality, the extended timelines associated with transfers highlight a critical vulnerability in rural trauma systems. The study included data on Injury Severity Score (ISS), a standardized measure used to assess the severity of trauma injuries. The average ISS observed in the study population was 9.16, with a range of 8.8 to 9.9. More details on the study methodology and findings can be found on the National Institutes of Health website.

Understanding the Injury Severity Score

The Injury Severity Score (ISS) is an anatomical scoring system used to assess the overall severity of trauma injuries. It assigns scores based on the severity of injuries to different body regions, providing a standardized way to compare the severity of injuries across patients. A higher ISS generally indicates more severe injuries and a greater risk of mortality. The Montana Department of Public Health and Human Services (DPHHS) also utilizes ISS in its trauma reporting. The 2022 Trauma Report from DPHHS provides further context on ISS and trauma data in Montana.

Beyond Transfer Times: Factors Influencing Outcomes

Interestingly, the Billings Clinic study found that adjusted mortality rates were more closely linked to factors like Injury Severity Score, patient age, length of hospital stay, and shock index (a measure of the body’s response to blood loss) than to whether or not a patient was transferred. This suggests that while timely access to a trauma center is crucial, the underlying severity of the injury and the patient’s overall physiological status play a more significant role in determining outcomes. The study also noted the importance of mental health screening in trauma patients, recognizing that emotional trauma often accompanies physical injuries. The study details the feasibility and impact of mental health screening in a rural trauma center.

Shock index, calculated by dividing heart rate by systolic blood pressure, is a quick and readily available indicator of the body’s compensatory mechanisms in response to blood loss or other forms of shock. A higher shock index often suggests a greater degree of physiological stress and a potentially worse prognosis.

The Challenge of Rural Access

The findings from Billings Clinic are particularly relevant given the unique challenges of providing trauma care in rural areas. These challenges include longer transport distances, limited availability of specialized personnel, and fewer resources for advanced life support. These factors can contribute to delays in care and potentially worsen outcomes for trauma patients. The “golden hour” becomes less a guarantee and more an aspiration when patients must be transported over significant distances to reach a higher level of care.

What Does This Indicate for Patients?

For patients in rural areas, this research reinforces the importance of robust prehospital care systems and efficient transfer protocols. It also highlights the need for ongoing investment in rural healthcare infrastructure and training to improve the quality of care available at local facilities. While the study doesn’t offer a simple solution, it provides valuable data to inform strategies for optimizing trauma care in resource-constrained settings. It’s crucial to remember that this study focuses on a specific region (Montana) and may not be generalizable to all rural areas. Further research is needed to understand the specific challenges and opportunities in different geographic contexts.

Looking Ahead: System-Level Improvements

The implications of this research extend beyond individual patient care. It underscores the need for a system-level approach to improving rural trauma care, including:

  • Enhanced prehospital care: Investing in training and equipment for emergency medical services (EMS) personnel in rural areas.
  • Telemedicine integration: Utilizing telemedicine to connect rural hospitals with specialists at tertiary care centers for real-time consultation and guidance.
  • Regionalization of trauma care: Strengthening regional trauma systems to ensure that patients are transported to the most appropriate level of care in a timely manner.
  • Continued research: Conducting further studies to identify best practices for rural trauma care and to evaluate the effectiveness of different interventions.

The process of improving rural trauma care is ongoing. Regular reviews of trauma data, coupled with ongoing surveillance of key metrics, are essential for identifying areas for improvement and tracking progress. Guidance from organizations like the American College of Surgeons Committee on Trauma (ACS COT) provides a framework for developing and maintaining effective trauma systems.