美国创伤中心的发展(3)

NumberMay2004

422withaseverelydeformedleftfemurandobviousopenleftanklefracture.Thepatientisintubatedimmediately,intra-venousaccessisobtained,andfluidsareadministered.Recognizingthelimitedresourcesavailableathishospital,theemergencyphysiciancontactstheclosesttraumacenterandarrangementsaremadetotransportthepatientbyhelicopterwhileactiveresuscitationproceeds.Atthetraumacenter,themanreceivesdefinitivetreatmentforhisneuro-logicandorthopaedicinjuries,fromwhichherecoverswith-outcomplication.Hesubsequentlyistransferredtoaninpa-tientrehabilitationfacilityandsubsequentlyreturnedhomewitharrangementsforfollowupwithanorthopaedicsurgeoninhiscommunity.

In1990,theTraumaCareSystemsPlanningandDe-velopmentActmandatedthedevelopmentofaglobaltraumaplan.Asaresult,theBureauofHealthResourcesDevelopmentconvenedagroupofconsultantstowritetheModelTraumaCareSystemsPlan,whichremainsthees-sentialtextontraumasystems.23Theplanwasthefirstiterationoftheessentialcomponentsofaninclusivetraumasystem.Beforethisinnovation,traumasystems,basedontheguidelinessetforthbytheACS-COT,con-sistedofhospitalsthatchosetoberecognizedfortheircommitmenttocaringforpatientswithtrauma.Thesefa-cilitiesweredesignatedastraumacenters(exclusivetraumasystem).

Inaninclusivetraumasystem,thecontributionsofallhealthcarefacilitiestothecareofpatientswithtraumaandproviderswithinageographicareaarerecognizedregard-lessofdesignationasatraumacenter.ThemajorityofpatientswithtraumahaveinjurieswhichareclassifiedasminorormoderateanddonotrequiretheresourcesofaLevelIorIItraumacenter(Fig1).Therefore,theabilityofallacutecarehospitalstotreatinjuredpatientsmustbeconsideredwiththecaveatthatallfacilitieshavesomelinkagetoaLevelIorIItraumacenter.3Theultimategoalistomatchtheresourcesofthefacilityorprovidertotheneedsoftheinjuredpatient.

TheessentialcomponentsofthemoderntraumasystemareshowninFigure2.Activitiesshownontheringfacili-tateandsupportthecentralcomponentsofthesystem.Trainingforalllevelsofprovidersensuresoptimalclinicalcareforpatients.Populationandinjury-specificpreventionandoutreachactivitiesareintendedtoreducetheoverallincidenceandseverityoftrauma.Finally,thetraumasys-temmusthavesomeprovisionforcontinuousperformanceimprovementandevaluation.Tomaintainsuccessfulac-creditation,individualtraumacentersmustshowactiveperformanceimprovementprograms.Fromasystem-wideperspective,regularsitevisitsdonebyteamsofoutsidesurveyorsensurethatindividualtraumacenterscontinuetomeetestablishedstandards.

TraumaSystemDevelopmentinNorthAmerica19

Fig1.ThegraphshowstheInclusiveTraumaCareSystem.(ReprintedwithpermissionfromtheU.S.DepartmentofHealthandHumanServices,Washington,DC.)

Thecentralcoreconsistsoftheclinicalcomponentsrequiredforpatientcare.Prehospitalcarerequireseffec-tivecommunicationandreliablemedicalcommand.Ap-propriatematchingofpatientstoresourcesentailstriagecriteriathatmaybeappliedeasilyinthefield.A

discus-

Fig2.ThegraphshowstheessentialcomponentsofanIn-clusiveTraumaCareSystem.(ReprintedwithpermissionfromtheU.S.DepartmentofHealthandHumanServices,Wash-ington,

DC.)

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