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






bypass - transport of an EMS patient past a normally used EMS receiving facility to a designated medical facility for the purpose of accessing more readily available or appropriate medical care

citizen access - the act of requesting emergency assistance for a specific event

communications system - a collection of individual communication networks, a transmission system, relay stations, and control and base stations capable of interconnection and interoperation that are designed to form an integral whole. The individual components must serve a common purpose, be technically compatible, employ common procedures, respond to control, and operate in unison.

Critical Access Hospital (CAH)- a rural limited service hospital that has been converted to a special designation as a Critical Access Hospital under the Medicare Rural Hospital Flexibility Grant Program. The majority of CAHs are in Health Professional Shortage Areas and/or Medically Underserved Areas.

designation - formal recognition of hospitals as providers of specialized services to meet the needs of the severely injured patient; usually involves a contractual relationship and is based on adherence to standards

disaster - any occurrence that causes damage, ecological destruction, loss of human lives, or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community area

dispatch - coordination of emergency resources in response to a specific event

emergency medical services for children (EMS-C) - an arrangement of personnel, facilities and equipment for the effective and coordinated delivery of emergency health services to infants and children that is fully integrated within the emergency medical system of which it is a part

emergency medical services system (EMS) - a system that provides for the arrangement of personnel, facilities, and equipment for the effective and coordinated delivery of health care services in appropriate geographical areas under emergency conditions

field categorization (classification) - a medical emergency classification procedure for patients that is applicable under conditions encountered at the site of a medical emergency

inclusive trauma care system - a trauma care system that incorporates every health care facility in a community in a system in order to provide a continuum of services for all injured persons who require care in an acute care facility; in such a system, the injured patient's needs are matched to the appropriate hospital resources

injury - the result of an act that damages, harms, or hurts; unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical or chemical energy or from the absence of such essentials as heat or oxygen

injury control - the scientific approach to injury that includes analysis, data acquisition, identification of problem injuries in high risk groups, option analysis and implementing and evaluating countermeasures

injury prevention - efforts to forestall or prevent events that might result in injuries

injury rate - a statistical measure describing the number of injuries expected to occur in a defined number of people (usually 100,000) within a defined period (usually 1 year). Used as an expression of the relative risk of different injuries or groups

lead agency - an organization that serves as the focal point for program development on the local, regional or state level

major trauma - that subset of injuries that encompasses the patient with or at risk for the most severe or critical types of injury and therefore requires a systems approach in order to save life and limb

mechanism of injury - the source of forces that produce mechanical deformations and physiologic responses that cause an anatomic lesion or functional change in humans

medical control - physician direction over prehospital activities to ensure efficient and proficient trauma triage, transportation, and care, as well as ongoing quality management morbidity - the relative incidence of disease

mortality rate - the proportion of deaths to population

off-line medical direction - the establishment and monitoring of all medical components of an EMS system, including protocols, standing orders, education programs, and the quality and delivery of on-line control

on-line medical direction - immediate medical direction to prehospital personnel in remote locations (also know as direct medical control) provided by a physician or an authorized communications resource person under the direction of a physician

overtriage - directing patients to trauma centers when they do not need such specialized care. Overtriage occurs because of incorrect identification of patients as having severe injuries when retrospective analysis indicates minor injuries.

protocols - standards for EMS practice in a variety of situations within the EMS system

quality improvement - a method of evaluating and improving processes of patient care which emphasizes a multidisciplinary approach to problem solving, and focuses not on individuals, but systems of patient care which might be the cause of variations

quality management - a broad term which encompasses both quality assurance and quality improvement, describing a program of evaluating the quality of care using a variety of methodologies and techniques

regionalization - the identification of available resources within a given geographic area, and coordination of services to meet the needs of a specific group of patients

rehabilitation - services that seek to return a trauma patent to the fullest physical, psychological, social, vocational, and educational level of functioning of which he or she is capable, consistent with physiological or anatomical impairments and environmental limitations

response time - the time lapse between when an emergency response unit is dispatched and arrives at the scene of the emergency

risk factor - a characteristic that has been statistically demonstrated to be associated with (although not necessarily the direct cause of) a particular injury. Risk factors can be used for targeting preventative efforts at groups who may be particularly in danger of injury.

rural - those areas not designated as metropolitan statistical areas (MSAs)

service area (catchment area) - that geographic area defined by the local EMS agency in its trauma care system plan as the area served by a designated trauma center

specialty care facility - an acute care facility that provides specialized services and specially trained personnel to care for a specific portion of the injured population, such as pediatric, burn injury, or spinal cord injury patients

surveillance - the ongoing and systematic collection, analysis, and interpretation of health data in the process of describing and monitoring a health event

trauma - a term derived from the Greek for "wound"; it refers to any bodily injury (see injury)

trauma care system - an organized approach to treating patients with acute injuries; it provides dedicated (available 24 hours a day) personnel, facilities, and equipment for effective and coordinated trauma care in an appropriate geographical region

Trauma Care Systems Planning and Development Act of 1990 - The law that amended the Public Health Service Act to add Title XII - Trauma Programs. The purpose of the legislation is to assist State governments in developing, implementing and improving regional systems of trauma care, and to fund research and demonstration projects to improve rural EMS and trauma

trauma center - a specialized hospital facility distinguished by the immediate availability of specialized surgeons, physician specialists, anesthesiologists, nurses, and resuscitation and life support equipment on a 24 hour basis to care for severely injured patients or those at risk for severe injury

trauma registry - a collection of data on patients who receive hospital care for certain types of injuries. Such data are primarily designed to ensure quality trauma care and outcomes in individual institutions and trauma systems, but have the secondary purpose of providing useful data for the surveillance of injury morbidity and mortality

trauma team - the multidisciplinary group of professionals who have been designated to collectively render care for trauma patients in a particular trauma care system

triage - the process of sorting injured patients on the basis of the actual or perceived degree of injury and assigning them to the most effective and efficient regional care resources, in order to insure optimal care and the best chance of survival

triage criteria - measures or methods of assessing the severity of a person's injuries that are used for patient evaluation, especially in the prehospital setting, and that use anatomic and physiologic considerations-and mechanism of injury

uncompensated care - care for which no reimbursement is made

undertriage - directing fewer patients to trauma centers than is warranted because of incorrect identification of patients as having minor injuries when retrospective analysis indicates severe injuries

9-1-1 - a three-digit telephone number to facilitate the reporting of an incident or situation requiring response by a public safety agency

enhanced 9-1-1 - a telephone system that includes automatic number identification, automatic location identification, and (optimally) selective routing, to facilitate appropriate public safety response