Chapter 4: Trauma Systems, Triage, and Transport

TRAUMA SYSTEM DEFINITION

A trauma system is an integrated collaboration of agencies and institutions organized to control the disease of injury. Its mission extends from effective prevention and public education 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.^1,2,3 Its services are multidisciplinary, comprehensive, and encompass a continuum that includes all phases of patient need.^2,3,4,5,6

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 within a defined geographic area. Cost efficient and efficacious coordination of resources is a defining characteristic of an effective trauma system. Disaster preparedness is also an important function of trauma systems. The institutions and agencies that form the trauma system are, by default, the platforms from where the regional response to care for victims of natural or manmade disasters are coordinated. The US Department of Health and Human Services has compiled a set of guidelines and standards for Model Trauma System Planning and Evaluation.⁷ This comprehensive document is an excellent source of information for every aspect of trauma system design and planning.

Transforming From Exclusive to Inclusive Trauma Systems

Elimination of preventable death by ensuring expeditious access to the resources of a designated trauma center is predicated on the recruitment of institutions committed to providing these resources. The need for triage of acutely injured patients at risk of death or disability to these centers resulted in development of field triage systems to identify those patients. Trauma systems thus evolved as networks of high capacity centers available for all injury victims, especially those at greatest risk. As understanding of what is required for efficacious population based management of the disease of injury has progressed, it has become clear that effective control of this disease requires participation of the entire community. To achieve optimal control of the disease of injury, systems that had developed for the exclusive care of the most severely injured required transformation to an inclusive regional enterprise that address all phases of injury control. This included effective integration and collaboration of designated trauma centers with all regional health care facilities. As American health care system shifts from reaction to patient disease to preemptive management of population wellness all trauma systems must be configured as inclusive.

TRAUMA SYSTEM DEVELOPMENT

The Nature of the Disease of Injury

The disease of injury affects all age groups with devastating personal, psychological, and economic consequences. Analysis of regional, national, age, and gender specific mortality for 240 causes of death comparing 1990 to 2013 clearly defines the primacy of injury as a global threat, ...