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KEY POINTS

KEY POINTS

  • Overtriage of minimally injured patients will impair trauma center efficiency, whereas undertriage of severely injured patients will increase the risk of preventable death and disability.

  • The major goal of an inclusive trauma system is complete control of all aspects of injury, from effective prevention to successful societal reintegration of injury victims.

  • Only 60% of the United States has statewide trauma systems, and approximately 20% has no system at all.

  • The numbers and levels of trauma centers should reflect population distribution and the burden of injury within the region.

  • Level I trauma centers are distinguished from Level II centers by admission volume requirements, presence of a surgically directed critical care service, educational leadership, and trauma-related research.

  • Most current data estimate that 63.1% of the population of the United States can reach a major trauma center within an hour by ambulance, a figure that increases to 90.4% with the inclusion of helicopter services.

  • A multiple-casualty incident may exceed the resources of one hospital trauma center, but care can be provided by adjacent hospitals within the city or region without outside help.

  • The Simple Triage and Rapid Treatment (START) triage system developed in California includes assessments of the patient’s ability to ambulate and the patients’ respiratory function, systemic perfusion, and level of consciousness.

TRAUMA SYSTEM DEFINITION

Trauma System Mission

A trauma system is an integrated collaboration of health care providers, agencies, and institutions dedicated to the control of the entire spectrum of injury from effective prevention to efficient societal reintegration of injury survivors. At the system’s core is coordinated and comprehensive care of acutely injured patients within a defined geographic area.1-4 Its services are multidisciplinary and comprehensive and encompass a continuum that includes all phases of patient need.2,3,5-7

Trauma System Goals

Because geographical coverage exceeds that of a single hospital or health system, trauma systems provide seamless regionalization of resources to facilitate efficient use of available and qualified health care facilities. Cost-efficient and efficacious coordination of resources is a defining characteristic of an effective trauma system, as is disaster preparedness. The institutions and agencies that form the trauma system provide the regional response to care for victims of natural or manmade disasters. The US Department of Health and Human Services has compiled a set of guidelines and standards for Model Trauma System Planning and Evaluation.8,9 This comprehensive document was initially released in 2006 and remains an excellent source of information for every aspect of trauma system design and planning. More recently, the National Academies of Sciences, Engineering, and Medicine published its report entitled A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.9-11 This document recognizes that although there are variations in patterns of injury in civilian and military environments, the spectrum of injury, when ...

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