A National Trauma Care System

Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

“…Together, these data suggest that in some states, improving pre-hospital care and access to definitive trauma care will be critical in order to achieve the "Zero Preventable Deaths after Injury" mandate. 3 Dedicated efforts in the last few decades have profoundly improved the care of the injured patient. 4,24,25 Since the 1970s, multiple legislative efforts have resulted in the funding, development, and evolution of the modern trauma system.…”

“…Sciences, Engineering and Medicine (NASEM) have outlined a number of recommendations to achieve "Zero Preventable Deaths after Injury," with an emphasis on improving the quality of pre-hospital care and timely access to definitive trauma center care. 3 Over the last few decades, the establishment of trauma centers and data-centric performance improvement has resulted in a significant reduction of in-hospital trauma mortality. [4][5][6] However, it is unclear if similar progress has been made in the pre-hospital setting, given variations in state-level emergency medical services (EMS) systems and lack of standardized data collection to inform process improvement.…”

“…[4][5][6] However, it is unclear if similar progress has been made in the pre-hospital setting, given variations in state-level emergency medical services (EMS) systems and lack of standardized data collection to inform process improvement. 3,7 Additionally, large areas of the country remain without timely access to definitive care due to geographic misalignment of US trauma centers with population densities. [8][9][10] Although these factors are known to contribute to significant geographic disparities in overall and in-hospital injury mortality, the impact of timely access to trauma center care on the burden of pre-hospital deaths has not been elucidated.…”

Translating Battlefield Practices to Disaster Health

“…n June 2016 the National Academies of Sciences, Engineering, and Medicine (NAS) released a seminal report entitled A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. 1 The report's focus is to systematically capture and share knowledge and practice to save lives following traumatic injury. Several points from the report, particularly the discussion of focused empiricism and a learning health system, are worth the consideration of the disaster health community.…”

“…These ideas appear ripe for translation to the disaster medicine world. 1 The military health system has documented tremendous advances in battlefield trauma care by employing focused empiricism. 2,3 The NAS report defines focused empiricism as follows: 1 An approach to process improvement under circumstances in which: (1) high-quality data are not available to inform clinical practice changes, (2) there is extreme urgency to improve outcomes because of high morbidity and mortality rates, and (3) data collection is possible.…”