Trauma care systems in the United States
Section snippets
The trauma system in the USA
Although no national system for trauma care exists in the USA, the American College of Surgeons Committee on Trauma (ACSCOT) [2] and the American College of Emergency Physicians (ACEP) are dedicated to improving the care of the injured patient. ACEP [1] published a new policy statement in August 1999 entitled “Trauma care systems development, evaluation, and funding” which states that “… Patients with time critical injuries should have their needs matched to an appropriate trauma care facility
Introduction to pre-hospital care
Based on rapid evacuation of injured soldiers from the battlefield to proximate surgical care, [4], [6], [8] the Commercial Hospital in Cincinnati, OH established the first civilian, hospital-based ambulance service in 1865. Four years later, the first city service was developed by New York City’s Bellevue Hospital [4].
During the first half of the 20th century, few, if any, standards or regulations for service provision were available or mandated. With the development of the interstate system
Emergency response systems
Various EMS system designs exist and are typically based on the needs of a jurisdiction, or community. Rural community EMS may be private and volunteer, whereas suburban, or urban, systems are typically paid and usually under municipal government (fire department), private company, or set up as a public utility with a governing board charged with developing specifications for performance. Designs may include multiple levels of provider (basic to advanced life support), or the addition of first
Pre-hospital: medical direction
An EMS medical director is a physician with specialised interest in, and knowledge of, patient care activities unique to the pre-hospital environment. System overview extends from the communications centre through to all components of field care, interacting with all clinical, educational, competence teaching activities and quality improvement aspects of the system. Medical direction is categorised as off-line (indirect) and on-line (direct).
Medical accountability for patient care activities is
Pre-hospital: material resources
Prior to the 1960s, ambulances were crude in design and ill-equipped to address basic medical conditions. During the period of federal EMS development, guidelines for emergency vehicle specifications were adopted and equipment lists were proposed. Today, both the ACS and ACEP continue to publish documents that recommend design, equipment, and medications for ambulances [1].
Central to the entire pre-hospital care system is the communications system. This involves multiple components, all
Pre-hospital care: trauma emergencies
Physicians typically agree that early pre-hospital intervention and stabilisation are critical for patients with medical complaints. Equally, emergency physicians and trauma surgeons typically agree that rapid transport with definitive airway control, if necessary, by endotracheal intubation, to the hospital, without spending an inordinate amount of time at the scene, is the most important priority for injured patients. Data on the importance of ALS procedures in trauma patients may appear
Hospital care
The ultimate goal of a trauma system is for the most seriously injured to receive care in an appropriate, designated trauma centre that is well-prepared to deal with their particular injuries. Victims transported initially to the nearest community hospital should be assessed rapidly, stabilised and prepared for transfer to a trauma centre. The Advanced Trauma Life Support (ATLS) course teaches a common framework to expedite this process, directing that only life-saving interventions be
Relationships of specialities
Depending on local arrangements, variable levels of collaboration occur between the acute trauma team and the specialities in the acute resuscitation of the trauma patient. This ranges from complete involvement in all trauma cases to select involvement as deemed necessary on a consultant basis by the trauma team leader. Usually, the specialist orthopaedic surgeon, neurosurgeon or plastic surgeon, unless especially interested in the acute resuscitation phase. maintains a position as a consultant
References (17)
- et al.
Effect of out-of-hospital defibrillation by basic life support providers on cardiac arrest mortality: a metaanalysis
Ann. Emerg. Med.
(1995) Baron Larrey
J. Thorac. Cardiovasc. Surg.
(1986)Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest
Ann. Emerg. Med.
(1996)Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a metaanalysis
Ann. Emerg. Med.
(1996)Prospective validation of a new model for evaluating emergency medical services systems by infield observation of specific time intervals in pre-hospital care
Ann. Emerg. Med.
(1993)- American College of Emergency. Physicians position paper: optimal pre-hospital advanced life support skills,...
- American College of Surgeons. Resources for optimal care of the injured patient. Am Coll Surg...
- Barkley KT. The ambulance. Load N Go Press;...
Cited by (27)
Mobile Intensive Care Unit versus Hospital walk-in patients, in the treatment of first episode ST- elevation myocardial infarction
2020, European Journal of Internal MedicineCitation Excerpt :In foresight, there are different strategies to address this; there are comprehensive care networks for STEMI which involve the Out-of-Hospital Emergency Medical Services (EMS). Services which have gained a pivotal role in the attention of time-dependent pathologies [11–13]. The presence of ambulances equipped with expert teams with an on-board doctor, enables early diagnosis and the initiation of an effective treatment, the pre-activation of the catheter laboratory (CL) at the receiving hospital, the identification and on-scene management of early complications and the transfer of the patient during the most vulnerable period of the IHD with the possibility of reducing times of myocardial ischemia[14–17].
A decompositional analysis of firearm-related mortality in the United States, 2001–2012
2018, Preventive MedicineCitation Excerpt :It was also unexpected that the homicide rate decreased while the rate of injury per FURA increased particularly given the component's approximate 50% RC. A possible explanation for this observation is that, since the early 2000s when only 50% of states had a trauma system, there has been an increased focus on the establishment of regional trauma systems in the United States (Blackwell et al., 2003; Rainer & De Villiers Smit, 2003; Hoyt & Coimbra, 2007), with 90% of states as of 2012 having statewide trauma systems (Bailey et al., 2012). Prior research has reported that trauma care can decrease homicide rates by preventing deaths due to exsanguination and complications following violent crime-related injury (Griffin et al., 2014); thus, as the number of injuries increases there is a concomitant decrease in deaths, resulting in a decreasing homicide rate.
Initial Assessment and Intensive Care of the Trauma Patient
2012, Oral and Maxillofacial TraumaThe impact of emergency medical services on the ED care of severe sepsis
2012, American Journal of Emergency MedicineCitation Excerpt :The cornerstones of the ED management of severe sepsis include timely diagnosis, early administration of appropriate antibiotics, and early aggressive quantitative resuscitation [3-7]. During the last several decades, emergency medical services (EMS) systems have developed an important role in the initial management of patients with life-threatening injury and illness [8-10]. Emergency medical services personnel are required to accurately recognize acute life-threatening conditions and to provide potential life-saving interventions, such as initial resuscitation and airway management, in addition to expeditious transport to the most appropriate medical care facility.