Trauma systems in North America

Abstract

North American trauma systems are well developed yet vary widely in form across the continent. Comparatively, the Canadian trauma system is more unified, and approximately 80% of Canadians live within 1 hour of a level I or II center. In the United States, trauma centers are specifically verified by the individual states and thus there tends to be more variability across the country. Although many states use the criteria developed by the American College of Surgeons Committee on Trauma, the individual agencies are free to utilize their own verification standards. Both Canada and the United States utilize efficient prehospital care, and both countries recognize that postdischarge care is a financial challenge to the system. Population dense areas offer rapid admission to well-developed trauma centers, but injured patients in remote areas may have challenges regarding access. Trauma centers are classified according to their capabilities from level I (highest ability) to level IV. Although each trauma system has opportunities for improvement, they both provide effective access and quality care to the vast majority of injured patients.

Rehabilitation outcomes based on service provision and geographical location for patients with multiple trauma: A mixed-method systematic review

“…There were no RCTs identified describing rehabilitation location, provision or need. All studies originated from developed countries and were published well beyond the establishment of UK trauma networks in 2012 but owing to earlier introduction of North American trauma systems [44,45], two studies [33,34] were deemed appropriate for inclusion.…”

A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in NSW, Australia: a whole population record linkage study

“…Trauma service hospitals are designated as either MTS (equivalent to Level 1 Trauma Service, accredited) or RTS (equivalent to Level 3) 23 ; critically ill patients can be taken to one of six strategically located MTS or ten RTS. Approximately 200 additional non-trauma designated hospitals (district/regional/local hospitals) are situated across metropolitan and regional health districts around the state.…”

Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation

“…Most developed countries have trauma systems which triage patients to the appropriate level of care via evidence-based algorithms. [28][29][30][31] However, injuries which occur less frequently, such as mechanically unstable acetabulum fractures and thoracolumbar spine injuries, may be associated with hoarding by surgeons and/or trauma centres, rather than transferring patients to receive expeditious reduction and fixation of such injuries when prompt surgical care is not available within the initial facility. Influenced by personal and institutional financial reasons, these practices should be called out in the interest of optimizing patient outcomes.…”