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.
• 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.