Introduction
COVID-19 emerged from Wuhan, China, and it was declared a pandemic by the World Health Organization on March 11, 2020. The first reported cases in Italy were confirmed on January 30, 2020 in Rome. On March 19, 2020, Italy overtook China as the country with the most SARS-CoV-2-related deaths in the world, after reporting 3405 fatalities from the pandemic [1, 2]. Currently, on April 7, 22,837 COVID-19 patients are hospitalized in Italy and the number of deaths has risen to 16,523.
Severe trauma care in Lombardy is normally based on six specialized trauma centres, for a population of about 9,850,000 inhabitants. According to trauma registers, it is possible to estimate 1800 major trauma patients per year, who need an average of 6.2 days of intensive care unit hospitalization each, and an overall requirement of 20–25 intensive care beds [3].
After SARS-CoV-2 infection outbreak, Lombardy has been the first and most affected Italian region. On March 8, 2020, the Regional Government approved a temporary reorganization for healthcare assistance activities [3]. Inspiring principles were redistribution of human and technological resources to pneumology, infectious disease, and intensive care units, to face rapid SARS-CoV-2 infection spread [4–8]. All elective and non-urgent outpatient and inpatient activities were closed. However, some time-dependent clinical conditions were identified, such as stroke, cardiovascular emergencies, neurosurgical emergencies, and trauma. For those services, an organization based on a “hub-and-spoke” model was adopted.
Three “hub” hospitals for major trauma were identified in the region, where all trauma activities that could not be postponed were concentrated. The three hub hospitals guarantee 24/7 acceptance of emergency cases, and they were chosen on geographical bases, by covering roughly one third of Lombardy territory each, divided into western, central, and eastern. The other hospitals were assigned to one of the three hubs as “spokes.” A fourth hub hospital, the regional centre for paediatric major trauma, has been re-allocated for urgent paediatric patients coming from all the other hospitals of the region.
Requirements for being selected as hub included the presence of an integrated trauma team 24/7 on active duty and supplementary surgical teams available on call, fast-track access to Emergency Department to reduce interpersonal contact between patients, activation of separated pathways to assist and operate on COVID-19 and non-COVID-19 patients, and integration of local medical teams with those of the spoke centres [9–11].
The purpose of the present study was to describe organization and operational strategies of trauma service in a hub hospital for major trauma in Lombardy, the “Spedali Civili” Hospital in Brescia.