NumberMay2004
422withaseverelydeformedleftfemurandobviousopenleftanklefracture.Thepatientisintubatedimmediately,intra-venousaccessisobtained,andfluidsareadministered.Recognizingthelimitedresourcesavailableathishospital,theemergencyphysiciancontactstheclosesttraumacenterandarrangementsaremadetotransportthepatientbyhelicopterwhileactiveresuscitationproceeds.Atthetraumacenter,themanreceivesdefinitivetreatmentforhisneuro-logicandorthopaedicinjuries,fromwhichherecoverswith-outcomplication.Hesubsequentlyistransferredtoaninpa-tientrehabilitationfacilityandsubsequentlyreturnedhomewitharrangementsforfollowupwithanorthopaedicsurgeoninhiscommunity.
In1990,theTraumaCareSystemsPlanningandDe-velopmentActmandatedthedevelopmentofaglobaltraumaplan.Asaresult,theBureauofHealthResourcesDevelopmentconvenedagroupofconsultantstowritetheModelTraumaCareSystemsPlan,whichremainsthees-sentialtextontraumasystems.23Theplanwasthefirstiterationoftheessentialcomponentsofaninclusivetraumasystem.Beforethisinnovation,traumasystems,basedontheguidelinessetforthbytheACS-COT,con-sistedofhospitalsthatchosetoberecognizedfortheircommitmenttocaringforpatientswithtrauma.Thesefa-cilitiesweredesignatedastraumacenters(exclusivetraumasystem).
Inaninclusivetraumasystem,thecontributionsofallhealthcarefacilitiestothecareofpatientswithtraumaandproviderswithinageographicareaarerecognizedregard-lessofdesignationasatraumacenter.ThemajorityofpatientswithtraumahaveinjurieswhichareclassifiedasminorormoderateanddonotrequiretheresourcesofaLevelIorIItraumacenter(Fig1).Therefore,theabilityofallacutecarehospitalstotreatinjuredpatientsmustbeconsideredwiththecaveatthatallfacilitieshavesomelinkagetoaLevelIorIItraumacenter.3Theultimategoalistomatchtheresourcesofthefacilityorprovidertotheneedsoftheinjuredpatient.
TheessentialcomponentsofthemoderntraumasystemareshowninFigure2.Activitiesshownontheringfacili-tateandsupportthecentralcomponentsofthesystem.Trainingforalllevelsofprovidersensuresoptimalclinicalcareforpatients.Populationandinjury-specificpreventionandoutreachactivitiesareintendedtoreducetheoverallincidenceandseverityoftrauma.Finally,thetraumasys-temmusthavesomeprovisionforcontinuousperformanceimprovementandevaluation.Tomaintainsuccessfulac-creditation,individualtraumacentersmustshowactiveperformanceimprovementprograms.Fromasystem-wideperspective,regularsitevisitsdonebyteamsofoutsidesurveyorsensurethatindividualtraumacenterscontinuetomeetestablishedstandards.
TraumaSystemDevelopmentinNorthAmerica19
Fig1.ThegraphshowstheInclusiveTraumaCareSystem.(ReprintedwithpermissionfromtheU.S.DepartmentofHealthandHumanServices,Washington,DC.)
Thecentralcoreconsistsoftheclinicalcomponentsrequiredforpatientcare.Prehospitalcarerequireseffec-tivecommunicationandreliablemedicalcommand.Ap-propriatematchingofpatientstoresourcesentailstriagecriteriathatmaybeappliedeasilyinthefield.A
discus-
Fig2.ThegraphshowstheessentialcomponentsofanIn-clusiveTraumaCareSystem.(ReprintedwithpermissionfromtheU.S.DepartmentofHealthandHumanServices,Wash-ington,
DC.)