Building a Rural Trauma Hemorrhage Control Pathway: A Multidisciplinary Model for Achieving the ACS-COT 60-Minute Embolization Benchmark

BackgroundThe American College of Surgeons Committee on Trauma (ACS-COT) recommends that Level I and II trauma centers initiate interventional radiology (IR) procedures for hemorrhage control within 60 minutes of the request. Achieving this benchmark requires rapid multidisciplinary coordination. This study outlines the system based workflow and institutional processes developed to achieve compliance with updated guidelines.MethodsThis retrospective case series reviewed 24 consecutive trauma patients receiving emergency IR embolization in a single Level I American College of Surgeons verified trauma center over 28 months (Aug 2022-Dec 2024). Patient demographics, injury details, and the time from embolization decision to arterial puncture were explored to determine adherence to contemporary guidelines. In parallel, institutional workflow modifications designed to optimize time-to-embolization were reviewed, including communication pathways, staffing models, anesthesia activation processes, and imaging integration systems.ResultsThe average patient age was 51 years (range 18-85), and the cohort included 15 males and 9 females. The average injury severity score (ISS) was 38.0 (16-66), with the most frequent injury type being motor vehicle collision (MVC, 38%). The average time from embolization decision to arterial puncture was 57.3 minutes and ranged from 28 to 88 minutes. 58% of patients had an embolization time <60min.ConclusionSuccessful implementation of the ACS-COT 60-minute benchmark for trauma embolization requires coordinated multidisciplinary infrastructure and repeatable operational pathways. Our center approaches the benchmark through specific system-level interventions, offering a replicable model for similarly resourced centers. Continued data monitoring and further improvements are needed to ensure better adherence to new guidelines.