What strategies can be implemented to strengthen trauma and acute care medicine?

Strategies to Strengthen Trauma and Acute Care Medicine

Implementing inclusive trauma systems with a tiered approach to trauma care is the most effective strategy for strengthening trauma and acute care medicine, as this has been shown to reduce mortality by 15-20% among seriously injured patients. 1

Developing Comprehensive Trauma Systems

System Organization

• Establish inclusive rather than exclusive trauma systems, which integrate all acute healthcare facilities in a tiered approach (Levels I-V) to trauma care, allowing appropriate distribution of patients based on injury severity 1
• Designate a national lead agency responsible for trauma system development, implementation, data collection, and research to facilitate policy-making and resource allocation 1
• Create regionalized trauma systems with formal protocols for prehospital and hospital care, which have demonstrated improved patient outcomes 1
• Develop evidence-based clinical protocols for managing traumatically injured patients at every institution to ensure a uniform and high standard of care 1

Training and Education

• Establish national trauma training hubs centered on regional academic centers to facilitate advanced trauma training for surgeons and residents 1
• Implement widespread stakeholder training using locally curated, low-cost training models that adhere to international core principles 1
• Provide standardized training for emergency medical service providers at all certification levels (EMT-Basic, EMT-Paramedic) to ensure proper field triage and initial management 1
• Incorporate trauma-informed care principles into emergency medicine education to address the psychological aspects of trauma care 2, 3

Field Triage and Prehospital Care

Triage Protocols

• Implement structured field triage decision schemes to identify patients requiring immediate life-saving interventions 4
• Categorize patients into four priority levels (red/immediate, yellow/delayed, green/minimal, black/expectant) based on vital signs and level of consciousness 4
• Prioritize patients with anatomical injuries indicating severe trauma, such as penetrating injuries to head, neck, torso, and proximal extremities 4
• Avoid undertriage and overtriage, as missing severely injured patients or sending too many non-critical patients to critical care areas can result in preventable deaths or overwhelm limited resources 4

Mass Casualty Management

• Develop protocols for mass casualty incidents guided by the principle of helping the greatest number of people survive 4
• Prepare to shift from conventional to contingency or crisis standards based on available resources during mass casualty events 4
• Establish hospital incident command systems with designated leaders who do not have direct patient care responsibilities 4

Acute Hospital Care

Bleeding Management

• Implement evidence-based protocols for management of bleeding and coagulopathy following major trauma 1
• Consider tranexamic acid administration for patients with significant hemorrhage, with careful attention to proper dosing (10 mg/kg) and administration route (intravenous only) 5
• Be aware of contraindications for tranexamic acid, including subarachnoid hemorrhage, active intravascular clotting, and hypersensitivity reactions 5

Post-Resuscitation Care

• Develop comprehensive packages of post-resuscitation care that include therapeutic hypothermia and percutaneous coronary intervention when appropriate 1
• Establish protocols for rehabilitation services as part of the continuum of trauma care 6

System Monitoring and Improvement

Data Collection and Analysis

• Establish trauma registries to collect standardized data on trauma cases, treatments, and outcomes 1
• Monitor outcomes and address factors contributing to preventable deaths through systematic quality improvement processes 7
• Publish annual reports from trauma registries to facilitate policy-making and resource allocation 1

Resource Allocation

• Secure stable funding under a dedicated lead agency to support trauma system development and maintenance 1
• Advocate for trauma critical care as a specialty to fuel trauma system policy development and implementation 1
• Allocate resources based on evidence of effectiveness in reducing morbidity and mortality 1

Special Considerations

Bioterrorism and Chemical Incidents

• Develop protocols for managing victims of bioterrorism or chemical incidents who may have combined physical trauma and toxic exposure 1
• Train emergency personnel in decontamination procedures and the use of personal protective equipment 1
• Understand the interdependence between toxic and traumatic occurrences and the drugs used to treat them 1

Low-Resource Settings

• Implement task sharing and task shifting where there is scarcity of trained specialized human resources 1
• Strengthen existing, basic formal emergency medical services or explore novel ways to enhance informal systems of prehospital care when formal EMS would be unfeasible 7
• Define and promote core essential trauma care services that every injured person realistically can and should receive, as outlined in the Essential Trauma Care Project 7

Common Pitfalls to Avoid

• Developing exclusive rather than inclusive trauma systems, which may limit access to appropriate care 1
• Neglecting to establish clear protocols for field triage, resulting in inappropriate patient distribution 4
• Failing to provide adequate training for all levels of providers involved in trauma care 1, 3
• Overlooking the importance of data collection and quality improvement processes 1
• Neglecting rehabilitation services as part of the continuum of trauma care 6

By implementing these strategies, healthcare systems can significantly improve trauma and acute care medicine, ultimately reducing morbidity and mortality among injured patients.