NumberMay2004
422specifictothetreatmentofpatientswithtraumawouldberecognized.Animportantpartoftheresourceassessmentofagiveninstitutionistheinternaldisasterplan.Beforeanycatastrophicevent,theresponsivenessanddepthofeachhealthcarefacilityinagivenregionwouldbeestab-lishedclearly;(2)Regularlyscheduledsiteevaluationsensurethatestablishedstandardsaremetbyalldesignatedtraumacentersinaregionalsystem(theaccreditationpro-cess);(3)ActiveinvolvementofallEMScomponents(po-lice,fire,basiclifesupportandadvancedlifesupport)withoversightbytheleadorganizationwouldprovideanorga-nizedapproachintheprehospitalphaseofcare.Suchanapproachwouldincludeadisasterplanthatisreviewedonaregularbasis;(4)Anestablishedsetoffieldtriagecri-teriawouldaimtomatchinjuryseveritywiththeappro-priateresources.Therefore,especiallyinthemasscasualtyscenario,tertiarytraumacarecenters(LevelsIandII)arenotinundatedwithminimallyinjuredpatientswhocouldbetreatedsafelyatLevelIIIorLevelIVtraumacentersoracommunityhospitalwithintheregion;(5)Continuousadministrativeoversightestablishedtodoregularneedsassessmentoftheregion,ensurequalityimprovement,andidentifyareasforeducationatalllevels;(6)Communica-tionofthehighestlevelbetweenallcomponents(prehos-pital,intrafacility)withpredeterminedlinkstoprovideim-mediateavailabilityofthenecessaryresourcesand,whennecessary,interfacilitytransfer.
Unfortunately,regionaltraumasystemsarenotavail-ableuniversally.Althoughmorepopulation-denseareasusuallyhavesomeversionofatraumasysteminplace,approximately40%oftheUnitedStatespopulationlivesinstateswithoutatraumasystem.14Moreover,manyex-istingsystemslackessentialcomponentsasoutlinedintheModelTraumaCareSystemPlan.Manysystemsarenottrulyinclusive.Asaresult,thereisnodefinedroleforthenondesignatedhospital,particularlyduringregionaldisas-terormasscasualtysituations.Intrafacilityandregionaldisasterplansareessentialtooptimizetreatmentinthefaceoflargescalecasualties.8Aneffectiveregionaltraumasystemlogicallyfacilitatesallaspectsofdisasterplanningandworkstooptimizepatientcareduringextremesitua-tions.
Comparedwithmanyoftheclinicaladvancementsintraumacare,traumasystemdevelopmentisarelativelynewconcept.Traumasystemshavetheirrootsinmilitarymedicine,whereitwasrecognizedthatoutcomescouldbeimprovedbydevisingmethodstoreducethetimetode-finitivecare.Basedonthemilitarymodel,civiliantraumacentersbegantoevolveinthe1970s.Thesuccessofor-ganizedtraumacarewithrespecttopatientoutcomehasbeenshown.Apopulation-basedstudyreporteda9%re-ductionincrudemortalityrateforstateswithtrauma
TraumaSystemDevelopmentinNorthAmerica21
systems.14Basedonthisstatistic,moreuniversalavail-abilityoftraumasystemswouldresultinthousandsoflivessaved.
Asintimeofwar,asystemsapproachtotraumacareideallyissuitedtothecivilianmasscasualtyscenario.Unfortunately,therearemanyobstaclestofulldevelop-mentoftraumasystemsintheUnitedStates.Individualtraumacentersrequireextensivecommitmentofmaterialandpersonnelresourcesandmanyhospitalsarenotwillingtoriskfiscalshortfalls.Insomestates,thecostofmedicalmalpracticeinsurancehaslimitedtheavailabilityofsub-specialistsnecessarytomaintaintraumacenteraccredita-tion.Thepoliticalimplicationsoftraumacenterdesigna-tionalsoremainasignificantissue;theeffectonnondes-ignatedhospitalsisusedfrequentlytolimitexpansionoftraumasystems.
Traumasystemdevelopmentmustbeencouragedtoensureastateofpreparedness.Now,morethanever,gov-ernmentagenciesandtheprivatesectorshouldfacilitatemovementtowardaModelTraumaCareSystem.Re-cently,theNationalTraumaStakeholders(NTS)groupwasestablishedtoadviseandprovidecounseltotheDe-partmentofHealthandHumanServices.Hopefully,theinfluenceofgroupsliketheNTScangeneratearenewedsenseofenthusiasmabouttraumasystemsdevelopmentforthesakeofthecitizens.References
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