TABLE 6.2 Essential Criteria to Identify Regional Trauma Systems

Legal authority to designate trauma centers

Formal process to designate trauma centers

Use of ACS criteria for classifying trauma centers

Out-of-area survey team for trauma center designation

Number of trauma systems limited by need (i.e., volume of patients or population of the area)

Written triage criteria

Ongoing monitoring system

Statewide trauma center coverage


SOURCE: West et al. (1988).

Although the surveys cited above provide insight into trauma systems development, they do not identify the actual growth in the number of trauma centers, as opposed to systems, nationwide. In an effort to identify hospitals either formally designated or self-designated as trauma centers between 1980 and 1991, Bazzoli and MacKenzie (1995) found 471 trauma centers. More recent figures from the ACS Committee on Trauma, which began a program to verify centers in 1987, reveal that, from 1987 to 1997, 285 hospitals were verified by the ACS as trauma centers (G. Strauch, American College of Surgeons, personal communication, 1998).

Rehabilitation is among the fastest-growing provinces of health care, with the number of freestanding rehabilitation hospitals and inpatient units increasing by more than 100 percent between 1985 and 1994 (IOM, 1997a). Even though injury patients account for a minority of all rehabilitation patients, their use of rehabilitation services is likely to increase for two key reasons: (1) the increased survival of more injured patients (HRSA, 1992) and (2) reduced lengths of stay in acute care services or hospitals, instituted in response to cost containment policies (IOM, 1997a). Nevertheless, there is anecdotal information about the lack of coordination between rehabilitation and acute care providers. The committee endorses full-fledged coordination between rehabilitation and acute care providers in an inclusive trauma system (for a complete discussion of rehabilitation research and the effectiveness of acute care interventions, see IOM [1997a]).


Does the establishment of trauma systems increase trauma patients' survival? This is a seminal question governing trauma systems research since the 1970s. Many outcome studies have focused on ''preventable mortality" (i.e., the percentage of deaths retrospectively judged to have been preventable had optimal care been available from a trauma system). Although estimates vary, some studies have found preventable deaths to range as high as 20–40 percent of

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