scholarly journals Trauma Specialist Centres

2007 ◽  
Vol 89 (7) ◽  
pp. 252-253 ◽  
Author(s):  
Karim Brohi
Keyword(s):  
Trauma Care ◽  
Trauma System ◽  
England And Wales ◽  
National Trauma ◽  
Trauma Service ◽  
Specialist Centre ◽  
Injured Patients ◽  
First Time

In 2011 it will be 50 years since the Osmond-Clarke report first proposed a network of specialist units to care for injured patients across England and Wales. Since that time there have been multiple aborted attempts to implement regionalisation of trauma care. For the first time in half a century the clinical imperative now appears to be supported by a political recognition of the importance of a national trauma system to UK citizens. With this in mind, this paper aims to describe the role of a trauma specialist centre within its regional trauma system; the capabilities, resources and infrastructure required; and the functions of a specialist trauma service.

scholarly journals Models of care for traumatically injured patients at trauma centres in British Columbia: variability and sustainability

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 200-206 ◽  
Author(s):  
Benjamin Tuyp ◽  
Kasra Hassani ◽  
Lisa Constable ◽  
Joseph Haegert
Keyword(s):  
Trauma Care ◽  
Trauma System ◽  
Models Of Care ◽  
Short Stay ◽  
Trauma Centres ◽  
Trauma Unit ◽  
Trauma Service ◽  
Level Ii ◽  
Level I ◽  
Injured Patients

AbstractBackgroundSuccessful trauma systems employ a network of variably-resourced hospitals, staffed by experienced providers, to deliver optimal care for injured patients. The “model of care”—the manner by which inpatients are admitted and overseen, is an important determinant of patient outcomes.ObjectivesTo describe the models of inpatient trauma care at British Columbia’s (BC’s) ten adult trauma centres, their sustainability, and their compatibility with accreditation guidelines.MethodsQuestionnaires were distributed to the trauma medical directors at BC’s ten Level I-III adult trauma centres. Follow-up semi-structured interviews clarified responses.ResultsThree different models of inpatient trauma care exist within BC. The “admitting trauma service” was a multidisciplinary team providing exclusive care for injured patients. The “on-call consultant” assisted with Emergency Department (ED) resuscitation before transferring patients to a non-trauma admitting service. The single “short-stay trauma unit” employed on-call consultants who also oversaw a 48-hour short-stay ward.Both level I trauma centres utilized the admitting trauma service model (2/2). All Level II sites employed an on-call consultant model (3/3), deviating from Level II trauma centre accreditation standards. Level III sites employed all three models in similar proportions. None of the on-call consultant sites believed their current care model was sustainable. Inadequate compensation, insufficient resources, and difficulty recruiting physicians were cited barriers to sustainability and accreditation compliance.ConclusionsThree distinct models of care are distributed inconsistently across BC’s Level I-III trauma hospitals. Greater use of admitting trauma service and short-stay trauma unit models may improve the sustainability and accreditation compliance of our trauma system.

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

scholarly journals The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

A Decade Evaluation of a State Trauma System: Has Access to Inpatient Trauma Care at Designated Trauma Centers Improved?

2017 ◽  
Vol 83 (7) ◽  
pp. 769-777 ◽  
Author(s):  
◽  
Dennis W. Ashley ◽  
Etienne E. Pracht ◽  
Regina S. Medeiros ◽  
Elizabeth V. Atkins ◽  
...  
Keyword(s):  
Trauma Care ◽  
Injury Severity ◽  
Trauma System ◽  
Age Groups ◽  
Trauma Centers ◽  
Access To Treatment ◽  
Score Method ◽  
Severity Levels ◽  
Injured Patients ◽  
Discharge Database

Recently, the trauma center component of the Georgia trauma system was evaluated demonstrating a 10 per cent probability of increased survival for severely injured patients treated at designated trauma centers (DTCs) versus nontrauma centers. The purpose of this study was to determine the effectiveness of a state trauma system to provide access to inpatient trauma care at DTCs for its residents. We reviewed 371,786 patients from the state's discharge database and identified 255,657 treated at either a DTC or a nontrauma center between 2003 and 2012. Injury severity was assigned using the International Classification Injury Severity Score method. Injury was categorized as mild, moderate, or severe. Patients were also categorized by age and injury type. Access improved over time in all severity levels, age groups, and injury types. Although elderly had the largest improvement in access, still only 70 per cent were treated at a DTC. During the study period, increases were noted for all age groups, injury severity levels, and types of injury. A closer examination of the injured elderly population is needed to determine the cause of lower utilization by this age group. Overall, the state's trauma system continues to mature by providing patients with increased access to treatment at DTCs.

scholarly journals National Trauma System Establishment Based on Implementation of Regional Trauma Centers Improves Outcomes of Trauma Care; A Follow-up Observational Study in South Korea

2021 ◽  
Author(s):  
Kyoungwon Jung ◽  
Junsik Kwon ◽  
Yo Huh ◽  
Jonghwan Moon ◽  
Kyungjin Hwang ◽  
...  
Keyword(s):  
Trauma Care ◽  
Death Rate ◽  
Injury Severity ◽  
Trauma System ◽  
Trauma Centers ◽  
Middle Income ◽  
Death Rates ◽  
Middle Income Countries ◽  
National Trauma ◽  
Trauma Death

Abstract Background: Although Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates (> 30%). Since 2012, Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness.Methods: We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores.Results: The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53–0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47806) to 1.9% (1062/55057) (p = 0.041).Conclusions: Establishment of the national trauma system was associated with significant improvements in performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.

scholarly journals Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jing Zhou ◽  
Tianbing Wang ◽  
Igor Belenkiy ◽  
Timothy Craig Hardcastle ◽  
Jean-Jacques Rouby ◽  
...  
Keyword(s):  
South Africa ◽  
Trauma Care ◽  
Hospital Care ◽  
Life Support ◽  
Trauma Registry ◽  
Trauma System ◽  
Emerging Countries ◽  
Trauma Centers ◽  
Trauma Systems ◽  
National Trauma

AbstractAs emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.

scholarly journals The Role of Thrombelastography in Multiple Trauma

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Victor Jeger ◽  
Heinz Zimmermann ◽  
Aristomenis K. Exadaktylos
Keyword(s):  
Trauma Care ◽  
Early Death ◽  
Clinical Applications ◽  
Trauma Patients ◽  
Coagulation Test ◽  
Early Assessment ◽  
Acute Traumatic Coagulopathy ◽  
Injured Patients ◽  
Traumatic Coagulopathy

Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications.

scholarly journals College training supports trauma care

2008 ◽  
Vol 90 (2) ◽  
pp. 44-46
Author(s):  
Alex Barbour
Keyword(s):  
Trauma Care ◽  
Trauma System ◽  
Trauma Systems ◽  
Confidential Enquiry ◽  
Quality Of Trauma Care ◽  
College Training ◽  
The Uk ◽  
High Level ◽  
Injured Patients

Last year the quality of trauma care in the UK came under fire from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), in their report, Trauma: Who cares? The document restated the need for regional trauma systems that provide high-level trauma care. The College's view that care for injured patients must be organised on a networked basis to create a trauma system in each region certainly matches this recommendation.

scholarly journals Dressing the law

2018 ◽  
Vol 14 (4) ◽  
pp. 479-492
Author(s):  
Aoife Monks
Keyword(s):  
Common Law ◽  
Professional Culture ◽  
England And Wales ◽  
The Common ◽  
The Law ◽  
First Time ◽  
Point Of Departure

AbstractThe theatre shares many features with the law. One key commonality is the presence of dressers in both professions. In the law and the theatre, the dresser is a key intermediary in the transformation of bodies and the transmission of professional culture, while being relatively under-recognised in criticism and scholarship. The point of departure for this paper is that the dresser is a figure worthy of further scrutiny. As the Court and Ceremonial Manager at Ede and Ravenscroft, Christopher Allen is perhaps one of the common law's most important dressers. Allan is instrumental to the entry of the judiciary into their new roles by dressing them for the very first time in advance of their swearing-in ceremony. Established as a wig-making business in 1726 (later selling robes from 1871), Ede and Ravenscroft are the tailors and robe-makers of choice for the judiciary, not only in England and Wales, but in many common-law jurisdictions. This paper draws upon an interview with Allen about his work as the dresser of the judicial establishment of England and Wales in order to explore the role of dressing up in the production of images of the judiciary. Thinking about the role of the dresser in the production of the judicial image draws attention not simply to the function that dress plays in the law, but foregrounds the process of dressing up as a key aspect of the law's performance.

Performance improvement challenges for managing abdominal trauma at a New Major Trauma Centre

2014 ◽  
Vol 96 (10) ◽  
pp. e1-e4
Author(s):  
P Macgoey ◽  
C Lamb ◽  
NR Tai ◽  
BA Cotton ◽  
AJ Brooks
Keyword(s):  
Trauma Care ◽  
Major Trauma ◽  
Trauma Centre ◽  
Trauma Patients ◽  
England And Wales ◽  
Improved Outcomes ◽  
Major Trauma Centre ◽  
The Us ◽  
Trauma Networks ◽  
Injured Patients

A number of reports spanning more than two decades have highlighted significant deficiencies in UK trauma care. 1–4 data suggest that seriously injured patients in england and wales endure in-hospital mortality rates that are 20% higher than their counterparts in the us. 5 more than 30 years ago, improved outcomes for major trauma patients were demonstrated by provision of an organised system of trauma care that included the resources of a trauma centre. 6 Trauma care throughout england and wales has recently been reorganised into regional trauma networks. 7

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