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





Executive Summary

Trauma kills. Trauma maims. Trauma is a disease; it is not an accident. Like heart dis­ease and cancer, trauma has identifiable causes with established methods of treat­ment and defined methods of prevention. Much can and should be done to reduce the incidence of trauma and to improve trauma treatment in this country.

Most commonly, injury happens to one or two individuals at a time. Less frequently, disasters strike tens or hundreds of people at once. Injury results from motor vehicle collisions, falls, stabbings and gunshot wounds, or other blunt or penetrating forces. Injuries also may be caused by an act of terrorism utilizing explosives and/or chemical, biological or nuclear agents.

In 1995, in the United States, nearly 148,000 lives were cut short due to trauma. 4 To add to the tragedy, most of those lost were young. Ten times that number of Americans survive traumatic events, only to face the future with life-long disability that takes its toll not only on the injured themselves but also on their families and the community. 4 The total cost of injury in the United States in 1995 was estimated at $260 billion and injury and its consequences accounted for 12 percent of all medical spending. 4

Consider the experience of hundreds of thousands of injured people each year, whether the injury occurs as a single incident or as part of a national disaster, such as the Oklahoma City bombing or the attacks on September 11, 2001. The emotional and financial impact is devastating. Prevention activities could keep many from experiencing trauma. For others, improved systems of care for the injured can increase the chances of optimal recovery. Regardless of the number of injured or the source of injury, advanced planning, preparation, and coordination are essential for optimal response and care.

Responding to a growing trauma problem and ever increasing trauma care challenges, stakeholders including the American Trauma Society, the National Highway Traffic Safety Administration, Health Resources and Services Administration, the American College of Surgeons, the American College of Emergency Physicians, Society of Trauma Nurses, the National Association of State EMS Directors, the National Association of EMS Physicians, among others, developed an action plan for the nation and all persons and organizations involved in trauma care. The plan addresses the prevention of trauma and improvement of care of injuries resulting from both day-to-day emergencies and disasters.

This report presents a Trauma System Agenda for the Future, reflecting the synergism of ideas generated from literally hundreds of professionals and based on decades of experience. These professionals believe this is the appropriate time to launch a new initiative, attacking trauma on all fronts to make a difference to our country and to each victim or potential victim.

Trauma systems, when fully implemented throughout the U.S., will enhance community health through an organized system of injury prevention, acute care and rehabilitation that is fully integrated with the public health system in a community. Trauma systems will possess the distinct ability to identify risk factors and related interventions to prevent injuries in a community, and will maximize the integrated delivery of optimal resources for patients who ultimately need acute trauma care. Trauma systems will address the daily demands of trauma care and form the basis for disaster preparedness. The resources required for each component of a trauma system will be clearly identified, deployed and studied to ensure that all injured patients gain access to the appropriate level of care in a timely, coordinated and cost-effective manner.

To realize this vision, the Trauma System Agenda for the Future identifies key issues in addressing four fundamental components of the trauma care system and eight key infrastructure elements that are critical to trauma system success. The four Fundamental Components of the Trauma Care System addressed in this document are:

•  Injury Prevention

•  Prehospital Care

•  Acute Care Facilities

•  Post-hospital Care

In addition to the fundamental operational components of the trauma system, the following key infrastructure elements must be in place to support any comprehensive trauma care system:

•  Leadership

•  Professional Resources

•  Education and Advocacy

•  Information Management

•  Finances

•  Research

•  Technology

•  Disaster Preparedness and Response - Conventional & Unconventional

The current status and a set of vision statements or recommendations are included for each of the above areas. A summary of the recommendations can be found in the appendices.

The benefits of successful implementation of this plan include: (1) a reduction in deaths caused by trauma; (2) a reduction in the number and severity of disabilities caused by trauma; (3) an increase in the number of productive working years seen in America through reduction of death and disability; (4) a decrease in the costs associated with initial treatment and continued rehabilitation of trauma victims; (5) a reduced burden on local communities as well as the Federal government in support of disabled trauma victims; and (6) a decrease in the impact of the disease on "second trauma" victims - families.

Trauma is predictable. It happened yesterday, it is happening today, and it will happen tomorrow. Fortunately some answers already exist. There is tremendous consensus among trauma stakeholders. Multidisciplinary teams of professionals have outlined a plan to reduce death and disability from the disease of trauma. What they need now is support-support from policy makers, support from other health providers, and support from the community. Achieving this vision will not only serve thousands of Americans who are injured in single incidents across the nation on a daily basis, but will also add greatly to the readiness of the nation for future disasters. This is an urgent call for action. When it comes to trauma, time is truly a life and death matter.