A trauma system is an organized approach to acutely injured patients in a defined geographic area that provides full and optimal care and that is integrated with the local or regional emergency medical service (EMS) system.
A system has to achieve cost efficiency through the integration of resources with local health and EMS system to provide the full range of care (from prehospital to rehabilitation).1–3
Regionalization is an important aspect of trauma as a system because it facilitates the efficient use of health care facilities within a defined geographic area and the rational use of equipment and resources. Trauma care within a trauma system is multidisciplinary and is provided along a continuum that includes all phases of care.2–6
The major goal of a trauma system is to enhance the community health. This can be achieved by identifying risk factors in the community and creating solutions to decrease the incidence of injury, and by providing optimal care during the acute as well as the late phase of injury including rehabilitation, with the objective to decrease overall injury-related morbidity and mortality and years of life lost. Disaster preparedness is also an important function of trauma systems, and using an established trauma system network will facilitate the care of victims of natural disasters or terrorist attacks. The Model Trauma System Planning and Evaluation Standard has recently been completed by the U.S. Department of Health and Human Services.7
The need for a trauma system seems obvious and intuitive. However, trauma is not yet recognized as a disease process. Many people still think of trauma as an accident. Trauma is an epidemic that affects all age groups with devastating personal, psychological, and economic consequences. Recent calculations have estimated the total cost of injury in the United States to be about $260 billion per year.8
Because of the association of injury and personal behavior, trauma is often predictable and preventable.
The modern approach to trauma care is based on lessons learned during war conflicts. Advances in rapid transport, volume resuscitation, wound care management of complex injuries, surgical critical care, early nutritional management, and deep venous thrombosis prophylaxis were all derived from the military experience.
The American College of Surgeons Committee on Trauma (ACSCOT) was created in 1949 and evolved from the Committee on the Treatment of Fractures that was established in 1922. A specific trauma unit was opened in 1961 at the University of Maryland. In 1966, the National Academy of Sciences and the National Research Council published the important “white” paper entitled Accidental Death and Disability: The Neglected Disease of Modern Society.9 The outgrowth of this document was the development and propagation of systems of trauma care. This publication increased public awareness and led to a federal agenda for trauma system development. Two trauma centers were simultaneously formed in Chicago and San ...