Fundamental Components of Trauma Care
Injury Prevention
• Each State will have a core injury prevention program that
provides assistance to local areas, with information and materials coordinated
via a central repository or clearinghouse.
• Trauma registry data will help with problem identification
and program evaluation and will be fully coordinated with the EMS and
public health systems.
• A comprehensive study of the epidemiology of injuries and
trauma will be conducted and predictive models regarding injury occurrence
will be developed.
• Injury prevention legislation will be enacted, where compelling
evidence exists.
• Injury prevention efforts will be conducted on a collaborative
basis, with input from and the involvement of multiple stakeholders and
constituency groups.
• Injury prevention will be recognized as a legitimate public
and governmental activity, similar to other safety programs such as fire
prevention. Proper funding will be secured for injury prevention, with
a greater portion of public health dollars allocated for injury prevention.
• Injury prevention efforts will be seen as a legitimate
health care cost that is directly reimbursable to providers.
• Injury prevention programs, and their availability to the
general public, will be required by lead agencies who designate all levels
of trauma centers and by the public health systems.
• Injury prevention will be integrated into existing health
delivery systems, such as pediatric and rural health clinics, and prevention
materials will be readily available at places where families usually
receive care.
• EMS and first responders will be more integrated within
the health care system, with links to prevention and acute care, and
will be more focused on promoting overall community health, as described
more fully in the EMS Agenda for the Future.
• Trauma care will be coordinated and integrated using standard
protocols and triage. Triage criteria will be redesigned to ensure more
accurate assessment, which facilitates direction and placement of patients
to the most appropriate care setting.
• Transport vehicles (air and ground) will be strategically
placed rather than facility based and will be used appropriately to facilitate
rapid access and response, especially in areas that are least accessible.
• A national 911 system, covering both wireless and wireline
telephone systems, will be developed and implemented, with standard,
seamless protocols that are evidence-based and that address bystander
interface. Access to prehospital trauma care in rural areas will be greatly
enhanced through development of consistent standards and more efficient
deployment of limited resources.
• Enhanced communications among all components of the trauma
care team during the pre-hospital phase will speed deployment of resources,
produce more appropriate triaging, and result in better patient outcomes.
• There will be a distributed system of acute care facilities
and trauma care systems will be implemented across the country.
• Research will be conducted to determine the effectiveness
of the current tiered resource allocation guidelines.
• The appropriate volume of patients with specific injuries
that are needed at the highest echelon of care will be studied and clearly
identified so that research and treatment options can be continually
explored.
• Trauma systems will be linked on a regional basis through
databases and technology to ensure efficient and effective patient care
nationwide.
• There will be consistent standards for rural and urban
trauma services, with the goal of every community having access to a
consistent level of trauma care.
• All injury care providers within a community will be recognized
as part of the system and will provide data to a system-wide database,
and injury care will be monitored throughout the system.
• Most facilities, whether small community hospitals or large
tertiary care centers, will have a designated role to play in the trauma
system and the capacity to manage injured patients to one degree or another.
• Facilities in the system will have multi-casualty capabilities.
• The appropriate match of resources will be identified for
injured patients with special needs, such as elderly, remote rural, or
pediatric patients.
• Innovative treatment methods will be explored, including
utilization of mobile trauma units for rural areas.
- Long-term care coverage will be available, affordable, and encouraged
to help address post-hospital care needs.
- Post-hospital care will focus on helping patients achieve greater
independence,
a higher degree of functionality, and a faster return to productivity.
- Functional recovery will go beyond traditional rehabilitation and
include psychological support.
• Home-based care and monitoring will be used to manage costs
and speed recovery, especially in areas lacking access to care.
• Appropriate support groups will be established and encouraged.
• Trauma Registry data will include post-hospital care and
rehabilitation so that the value and cost-effectiveness of the full cycle
of trauma care can be more readily assessed.
• Research concerning the effectiveness of post hospital
care will be supported.
• A National Trauma System Leadership Council will be developed
to advocate for system development in a facilitative manner, serve as
the locus for policy development and support, and coordinate the work
of federal agencies and professional organizations with injury-related
programs.
• All states will establish a Lead Agency to coordinate and
administer trauma system development.
• A best practices study will be conducted to identify the
optimal components and configuration for local and state lead agencies.
• The effectiveness of trauma system elements will be continually
examined.
• State legislators and governors will be informed about
the need for an identified and adequately funded lead agency for trauma
systems in their region .
- Professional resources in the system will be patient focused, team-oriented
and physician led.
- New categories of providers and the use of physician extenders will
address the need for additional resources.
- Creative opportunities for recruitment and retention of personnel
will be explored.
• Reimbursement for all types of providers will be appropriate
and sufficient so as to encourage participation in trauma care.
• Incentives for attracting trauma specialization, including
addressing the burden of liability, will be explored.
- Ongoing professional education opportunities will be available and
accessible.
- Volunteers will supplement career resources and will be enlisted
to promote injury prevention as well as deliver care.
• A compelling educational campaign will be launched to position
trauma and injury as a disease rather than a random occurrence and to
increase public awareness of the need for injury prevention and the value
of trauma care.
• Targeted educational programs will be developed to inform
policy makers about the value of community-based trauma care in order
to promote passage of legislation to support trauma system activities,
including injury prevention.
• Trauma care providers and advocates will form or integrate
into coalitions with trade associations, large corporations (such as
Johnson and Johnson's work with the Safe Kids campaign) and
payers to conduct public education programs about injury and injury prevention
and to advocate for legislation to support injury prevention and trauma
system activities.
• Health insurers will have a clear appreciation of the cost
effectiveness of injury prevention and will provide incentives for safe
behavior.
• Communication, education, and training approaches for the
public and key constituency groups will be thoroughly coordinated yet
distinctly segmented and targeted to achieve maximum impact.
• The number of injuries and trauma cases will be reduced
through education and training of clinicians, management and administrative
personnel, volunteers, community support groups, potential "bystanders," and
other key constituency groups.
• Trauma and injury prevention education and training will
be increased for all healthcare professionals, beginning at post-graduate
levels and continuing throughout their careers, appropriate to the level
of their involvement in health risk assessment, primary care, or injury
care.
• Advocacy efforts will facilitate passage of new laws designed
to reduce injuries and trauma cases (based on evidence) and stronger
enforcement of existing laws.
• Tort reform will be enacted to facilitate greater access
to trauma services and facilities.
• There will increased awareness of the vulnerability of
the older population.
• A national database and uniform data standards will be
used to facilitate hospital operations and provide regional and national
information regarding availability of post-hospital care.
• Trauma care will be designated as a specific research area
for epidemiological study. Predictive models will be developed regarding
outcomes and will be used in making funding and resource deployment decisions.
• Pre-hospital and functional outcomes will be tracked and
used in a Total Quality Management initiative to improve policies, procedures,
and processes throughout the trauma continuum.
• Information related to the complete cycle of trauma-from
prevention to post-hospital care-will be collected, analyzed, and made
available to facilitate improvements in injury prevention, response times,
patient care, and rehabilitation.
• Information systems should be usable for multi-center studies.
• A standardized training course will be used to enable trauma
registrars to collect and categorize data in a consistent, comparable
manner.
• Clear evidence will exist to document the contribution
of an injury management system (prevention and treatment) to a community's
overall health, and additional research will demonstrate which components
of a trauma system provide the most value.
• Tools will be developed and region-specific injury data
will be available to assist communities in making decisions about their
specific needs related to trauma system development, particularly which
components will best meet community health needs.
• The culture of quality improvement will shift from using
data to blame individuals to using the data to improve performance of
the system.
• Access to and appropriate protection of patient records
and quality improvement data will be addressed through legislative and
regulatory changes at state and federal levels.
• Efforts to enhance patient confidentiality should be balanced
with the need for strong research.
• Trauma systems will be recognized as a public good and
therefore valued and adequately funded not only for the clinical care
they actually deliver, but also for the level of readiness required to
meet the needs of all injured persons.
• The appropriate level of readiness in a community will
be determined by a broad-based group of community members, including
citizens, local employers, trauma and health care providers, and payers.
• There will be a "rural modifier" to the Medicare fee schedule
for rural EMS providers.
• There will be dedicated funding for trauma system infrastructure
costs.
• An open dialogue with managed care organizations, public
and private, and other payers will facilitate greater mutual understanding
of the costs of providing health care, ultimately leading to equitable
payment mechanisms, which may include "carve outs" or risk sharing.
• There will be ongoing dialogue and review regarding the
cost-effectiveness of trauma care systems.
• A system will be created for reimbursing providers for
uncompensated trauma care without cost shifting to non-governmental payers
.
• The public will be encouraged to obtain long-term care
coverage to augment other forms of payment for post-hospital care.
• Alternative payment mechanisms will be examined, tested,
and piloted, especially in rural areas.
• Additional funding sources, such as seized drug money,
will be explored.
- Congress will establish a National Institute for Injury, within the
National Institutes of Health.
- Federal agencies involved in or funding trauma research will be coordinated
through a formal institutional process.
- There will be formal efforts to interest young professionals in trauma
research and there will be sponsored training programs in all types
of research.
- Types of research conducted will include fundamental basic research,
crash investigation research, evidence-based medicine, best practices,
clinical trials, clinical guidelines, and health services and systems
research.
• Automotive telematics systems and GPS in motor vehicles
will be used to locate crashes, monitor vital signs, and determine injury
severity. GPS will also provide real-time route navigation for ambulances.
• Access technologies such as ACN and wireless E9-1-1 will
be fully developed.
• Various technological innovations will be used to provide
services remotely.
• Monitoring devices will be used in a variety of settings,
including computer chip implants to monitor patients and the use of monitoring
devices in a patient's home, which would support injury prevention and
rapid response.
• Computer chips will enable automatic transfer of sophisticated
crash information and will permit injury research databases to be utilized
to evaluate and improve auto design.
• An artificial neural network will determine the most appropriate
site for patient care, given the extent of a patient's injury.
• Access numbers will be consolidated to eliminate confusion
and streamline access nationwide.
• Patient simulation technology will be used for provider
education.
• Medical input will be sought early in the design phase
of future technologies to ensure that these developments are coordinated
with the health care system and result in improved patient outcome.
• Dedicated resources will be available for technology analysis.