Development, Implementation and Quality Improvement in Trauma Systems
1Emergency Medicine, University of California, Davis, United States of America
Regionalized trauma care refers to an expeditious transport of an injured patient to facilities able to provide the appropriate level of trauma care. This represents all individuals (from prehospital to rehabilitation) and all levels of trauma centers. The trauma system is the oldest example of regionalized emergency care system and several other diseases (STEMI, Stroke, etc) are now developing regionalized systems to maximize disease specific care after the trauma model.
Regionalized trauma care first developed with the concept of the “Golden Hour” and development of trauma centers. Both of these ideas are primarily attributable to R. Adams Cowley, MD. In the 1960s and 1970s as trauma centers “opened” in the United States, several realized that additional resources were necessary and simply having a trauma center with on-call/in-house trauma surgeons was not sufficient for optimal trauma care. Initial efforts demonstrated the need for a lead group to coordinate the complex effort of organizing trauma care for large regions. These thoughts launched the idea and development of the regionalized trauma system.
Substantial evidence now exists demonstrating trauma centers decrease morbidity and mortality. The evidence for regionalized trauma systems, however, is less clear but also favors decrease morbidity and mortality with regionalized trauma systems.
Despite the evidence, the optimal design for a regionalized trauma system remains unknown and requires further study. In addition, appropriate metrics are needed to evaluate trauma systems and ensure appropriate care throughout the continuum of trauma. These metrics must be agreed upon by all involved and not favor particular constituents. Data should be continuously monitored and improvements in the trauma system should be made based on this data.