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2013-1 Optimal Care of Trauma Patients

Patients who experience a severe traumatic event and subsequent injury are optimally cared for at a Trauma Center

Brief summary of the issue   
The American public is largely unaware that most hospitals/health systems are not trauma centers.  The assumption is frequently made that every hospital with a designated emergency department is equipped to optimally manage a trauma patient.  Currently, the resources to inform the American public on the numerous hospital resources needed to care optimally for the trauma patient are limited. 


Background on Trauma Center Development

What constitutes a trauma center?  This has been formally defined by the American College of Surgeons (ACS) since 1976.  Trauma Centers have been traditionally delineated through a formal review process by either the ACS or a designated state agency.  Trauma centers are categorized as level I –V, with Level I providing the highest level of care. 


Level I trauma centers have been shown to reduce the mortality of the severely injured trauma victim by up to 25%.  Several studies have shown the expertise for managing the trauma patient is at a trauma center. Trauma centers include specialized personnel such as emergency and trauma physician specialists, nurses, emergency technicians, radiology personnel, social workers, physical therapists, rehabilitation specialists, speech therapists, respiratory therapists and advanced practice physician extenders.  All trained and well practiced in providing trauma care.  Optimal trauma care is a concerted team effort, which requires coordination of many resources throughout the entire span of care from transport, through emergency care, acute care to rehabilitation not normally available at most institutions. 


In addition, the trauma center is considered the hub of a regional trauma system through which established protocols help to coordinate patient transfers (ground and air), medical records and radiological data (PACS), communication from outside hospitals and transfer protocols. Trauma centers play an important role in injury prevention, outreach and education to the community and neighboring hospitals as well as performing critical research to improve the care of trauma patients and education for preventing injury and improving trauma care.  


The American Trauma Society believes:

  • Patients who experience a severe traumatic event and subsequent injury are optimally cared for at a Trauma Center.
  • Trauma Centers save lives, decrease morbidity and increase a trauma victim’s productive years of life.
  • Trauma Centers are a vital component of the health care system and needs to be supported locally, regionally and nationally.
  • Trauma Centers need to be available to the entire population of the United States.

Approved by ATS Board of Directors February 2013

References To Support Statements:

  • Branas, CC, MacKenzie, EJ, Williams, JC, Schwab, CW, Teter, HM, Flanigan, MC, Blatt, AJ, ReVelle, CS, Access to Trauma Centers in the United States. JAMA. 2005;293: 2626-2633.
  • Haas B, Jurkovich GJ, Wang J, et al. Survival advantage in trauma centers: expeditious intervention or experience? J Am Coll Surg. 2009;208:28-36.
  • Haas, B, Stukel, TA, Gomez, D, Zagorski, B, De Mestral, C, Sharma, SV, Rubenfeld, MD, GD, Nathens, AB, The mortality benefit of direct trauma center transport in aregional trauma system: A population-based analysis. J Trauma Acute Care Surg.2012;72: 1510-1515.
  • MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354: 366-378.
  • Prada, SI, Salkever, D, MacKenzie, EJ Level-I Trauma Center Effects on Return-to-Work Outcomes
  • Rotondo, MF, Bard, MR, Sagraves, SG, Toschlog, EA, Schenarts, PJ, Goettler, CE, Newell, MA, Roberts, MJ What Price Commitment: What Benefit? The Cost of a Saved Life in a Developing Level I Trauma Center. J Trauma 2009; 67: 915-921.





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