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.