After three decades of evolution,
the need for consensus regarding trauma system development has never
been more evident. Over the past 20 years, a number of multidisciplinary
groups have described the essential components and influenced the design
of these systems. Focus has shifted from trauma centers to trauma systems,
with an emphasis on inclusiveness. A research agenda has been established
to strengthen medical evidence and draw conclusions regarding trauma
care effectiveness. An international study recently has been undertaken
to evaluate the cost-effectiveness of trauma care. And national experts
in trauma care have gathered in a series of forums to analyze system
needs and recommend strategies for improvement.
At one such meeting held in Skamania, Washington in July 1998, approximately
100 of the nation's leading trauma authorities convened to provide recommendations
for improved trauma system performance and evaluation. One recommendation
was that leaders from key stakeholder groups be gathered to create a
trauma system agenda for the future.
Between 1999 and 2002, the National Highway Traffic Safety Administration
(NHTSA), Health Resources and Services Administration (HRSA), and the
American Trauma Society (ATS) coordinated development of this vision
for a trauma system of the future. The process began in April 1999, when
leaders representing hospital and trauma system administrators, state
elected officials, EMS system managers, trauma surgeons, emergency physicians,
trauma nurses, and public health professionals were convened as a steering
committee. The committee met four times over two and a half years to
deliberate the many issues surrounding trauma care and develop thoughtful
recommendations to guide the future of trauma system development. The
American Trauma Society (ATS) launched a complementary Rapid Design® process
during their 2000 and 2001 Annual Meetings, during which more than 150
participants drafted a vision of trauma care in 2010.
This input was subsequently combined with that of the steering committee
to produce this Trauma System Agenda for the Future, a powerful vision
statement representing the perspectives and priorities of the full range
of professionals involved in the prevention, treatment, and rehabilitation
of trauma victims.
The design of high quality, cost efficient trauma systems for the United
States in the 21 st century is an iterative process that will involve
many organizations and individuals. This report has been prepared as
an important first step. Together, the groups convened in this vision
process represent a comprehensive range of trauma stakeholders. Their
findings complement and strengthen one another, presenting a persuasive
analysis of the needs, opportunities, and direction of trauma systems.
The report is organized around a framework that includes all components
of a comprehensive trauma care system. It begins with a discussion of
the fundamental components (injury prevention, prehospital
care, acute care facilities, and post-hospital care) that are at the
heart of the trauma care system. The report then examines the key
infrastructure elements that are integrated
across the continuum of care: leadership, professional resources, education
and advocacy, information management, finances, research, technology
and disaster preparedness and response.