The second phase of the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) project builds on the first phase which used a single State as a test site. This phase has three objectives:

1) Data Objective
The first objective entails the evaluation of candidate States required to adequately test an enhanced version of the TRAMAH. Of the candidate States, 13 have been selected based on the availability of specific geographic data pertaining to severely injured patients, trauma care facilities, and travel times. Hospital Discharge, Vital Statistics, U.S. Census Bureau, American Hospital Association, and Association of Air Medical Services data will be accessed for each of these 13 States.

2) Formulation and Testing Objective
The second objective will involve the enhancement of the prior TRAMAH in order to simulate improved locations of trauma center hospitals and the ambulances that serve these hospitals as well as the addition of hospital volume constraints and ambulance backup constraints. The new model will be serially tested on synthetic environments of increasing size. Testing will involve three strategies using various response time standards: evaluation of the existing system of trauma centers and helicopter depots, the relocation of single and multiple helicopter depots, the relocation of single and multiple trauma centers.

3) Application Objective
The new model will then be applied to the 13 previously selected State trauma systems using the compiled geographic data. This will allow us to make comparisons between the States and to assess the model's generalizability and flexibility for future trauma system planning and evaluation. During this process, EMS and Trauma leadership in each State will be contacted for their feedback and adjustments will be made before the release of final reports and recommendations.

Funding for the second phase of the TRAMAH is being provided by the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ) under Grant Number: 1R01HS010914-01