Comprehensive regional trauma/Emergency Medical Services (EMS) delivery systems: The United States experience

Abstract

The early 1970's, as an outgrowth of the American military experience, several pioneer regional trauma/EMS programs showed the way for better planning, organization, and resource deployment for trauma/EMS systems in the civilian community. The experience of the mid and late 1970's has brought an even wider implementation and modeling of trauma/EMS care systems with identification of specific patient problems, designation of trauma service centers, development of protocols, and professional teams on a regionwide basis. Currently, the acceptance of regionalized systems of care for trauma makes it a potentially manageable disease with greater prospect for developing even better systems of trauma care and control in the 1980's. The progressive impact on improving trauma care for this nation will in large part be due to the continued planning and development of regional trauma/EMS systems which have as a key focus the designation of an appropriate limited number of trauma service centers for geographic regions and the nation. There should be little question today that hospitals having extensive experience with injured patients offer better care to these patients than hospitals receiving only an occasional trauma patient. Mortality and morbidity rates are lower in more experienced hospitals where interdisciplinary teams provide coordinated resuscitation, evaluation, and definitive operative management. The skills and teamwork employed in this complex task are improved by practice and repetition, which come only with a large volume of injured patients.

The influence of prehospital time on trauma patients outcome: A systematic review

“…Tien et al [34] likewise report on TBI patients and show a strong trend suggesting that patients arriving within 60 min of injury have a decreased mortality. Osterwalder et al [32] report no difference in mortality between patients arriving within 1 h or after 1 h. This is in concordance with some of the literature found [4,5,7,8,10]. Though we are under the impression time is best to be analysed as a continuous variable or at best grouped in intervals.…”

“…Petri et al [12] also report that mean TPT was significantly lower among decedents than survivors. Contradicting, Feero et al [4] report that TPT was significantly shorter for unexpected survivors than for unexpected death. Three studies report on patients suffering penetrating trauma.…”

“…Historically, time is considered to be an essential determinant on the outcome of trauma patients. A fundamental tenet of trauma care is the 'golden hour', the immediate time after injury when resuscitation, stabilization and rapid transport are perceived to be most beneficial to the patient [4]. It is thought that when advanced emergency medical care is provided in this brief window of time and this time interval is kept to a minimum, mortality and morbidity of the trauma patients will be reduced [5][6][7][8].…”

Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services

“…3 Helicopter emergency medical services (HEMS) were created and encouraged as a strategy to decrease this interval. 4 The first formal helicopter ambulance program was initiated by the U.S. military during the Korean conflict (1950)(1951)(1952)(1953), in which a small group of 12 helicopters conducted 20,000 transports. The majority of these reached Mobile Army Surgical Hospitals (MASH units) in less than 60 minutes after injury, which compared very favorably with the previous average of four to six hours for treatment for the wounded.…”

Has the Gold Lost Its Luster?

“…These physicians believed there was a window of opportunity, or a "golden period," during which resuscitation and stabilization would be most beneficial to the patient. 1 They defined this period as 60 minutes-the golden hour between life and death. Is there, however, opportunity to interpret the aphorism of a golden hour?…”