Trauma System Agenda for the Future
 

Index

What is Trauma

What is Trauma Systems

The Vision

Executive Summary

Introduction

Comprehensive Trauma Care System: Fundamental Components of Trauma Care

Comprehensive Trauma Care System: Key Infrastructure Elements

Conclusion

Glossary

References

Appendices

Acute Care Facilities

Current Status

Definitive care of the injured takes place at various levels within the health care system, ranging from primary care settings to highly sophisticated tertiary trauma care facilities. Trauma care providers have identified a continuum of resources necessary to provide optimal care for injured patients, which have been refined through a process that is not often replicated in other areas of medicine. Similarly, improvements in trauma care within a facility depend upon coordinated care of multiple providers and often have led to improvements in care for other patient populations within that same facility. A performance improvement process should continuously be used to enhance the system.

However, resource staging across a trauma system has not been tested, and states or local regions have varied in how they have applied this concept. Resources are often inconsistently allocated. Provider training and research capabilities at the highest echelon of care ultimately may be compromised by an insufficient number of encounters with patients who have specific types of injuries. Volume is important to performance.

It is recognized that rural hospitals are a port of entry for many patients and they should have consistent high standards. This is an area that needs considerable attention, resources and support in order to reduce the disproportionately high rural death rate. Rural America is disproportionately affected by trauma with rural residents nearly twice as likely to die as a result of trauma than their urban counterparts. 26 Rural inhabitants are more often engaged in occupations with a high risk of injury such as farming and manufacturing. Approximately two-thirds of all fatal motor vehicle accidents occur in rural areas and rural trauma patients frequently have multiple severe injuries, co-existing disease, and less prehospital care. 26

Attention should be focused on exploring systems for rural access such as mobile trauma units and military connection, and other transport/telecommunications models.

The Vision

•  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. All facilities that participate in the trauma system will contribute to the national trauma database and there will be a mechanism to fund such a trauma database at the state and national levels.

•  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. Each participating facility's available resources will be catalogued and capabilities defined to facilitate patient management/movement decisions.

•  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.