Trauma System Agenda for the Future


What is Trauma

What is Trauma Systems

The Vision

Executive Summary


Comprehensive Trauma Care System: Fundamental Components of Trauma Care

Comprehensive Trauma Care System: Key Infrastructure Elements





Pre-Hospital Care

Current Status

Pre-hospital care and access is a critical component that will be further enhanced in the trauma care system of the future. Currently, out-of-hospital EMS provider agencies are predominantly isolated from other health services and respond to acute illness and injury episodes. They are primarily financed for service to individuals in need and are accessible through fixed-point and wireless telephones, though there are deficiencies in the current 9-1-1 emergency telephone system. EMS delivery is quite diverse at the local level, including a variety of configurations, funding, staffing, geography and mode of delivery (e.g., volunteer, municipal, private, etc.).

There are clear inequities in distribution of EMS resources. The "rural paramedic paradox" is a reality --- rural areas farthest from a hospital have the greatest need for EMS yet have the most trouble maintaining those services. Field stabilization in rural areas is particularly critical because transport times can exceed 1 or 2 hours and total pre-hospital times can exceed 3 or 4 hours. 26 Integration of Critical Access Hospitals (CAHs) with the EMS system and regional trauma systems is also of paramount importance for the rural health infrastructure.

In urban areas, there is an increasing problem of hospital overcrowding and ambulance diversion throughout the country, and there have been cases of inappropriate triage, both under and over-triage, to regional trauma centers.

The Vision

•  EMS and first responders will be more integrated within the health care system, with links to prevention and acute care, and will be more focused on promoting overall community health, as described more fully in the "EMS Agenda for the Future". 27 This will facilitate faster access, improved pre-hospital care, and more seamless patient care throughout the continuum of care. Critical Access Hospitals will be better integrated with EMS systems. EMS will continue to serve as the community's safety net and will be funded more reliably and appropriately for service to the community.

•  Trauma care will be coordinated and integrated using standard protocols and triage. Triage criteria will be redesigned to produce a more accurate predictive model, which facilitates direction of patients to the most appropriate care setting.

•  Transport vehicles (air and ground) will be strategically placed rather than facility based and will be used appropriately to facilitate timely access and response, especially in areas that are least accessible.

•  A national 911 system, covering both wireless and conventional wireline telephone systems, will be developed and implemented, with standard, seamless protocols that are evidence-based and that address bystander interface. Rural addressing will be accomplished, where needed, to enable enhanced 911 systems and to ensure that all citizens have better access to EMS and other public safety resources. Dispatcher training will be standardized and EMS response will be based upon medical priority.

•  Access to prehospital trauma care in rural areas will be greatly enhanced through development of consistent standards and more efficient deployment of limited resources.

•  Enhanced communications among all members of the trauma care team during the pre-hospital phase will speed deployment of resources, produce more appropriate triaging, and result in better patient outcomes. Greater use of wireless technology should enable team members to speak to other hospitals and providers in the field and to give direction and assistance wherever the care is being provided. Discovery (Automatic Collision Notification -ACN), Access (wireless), and Coordination (telemedicine) all will be enhanced through improved technology.