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Looking at contemporary pre-hospital trauma care systems

01 August 2013
Volume 3 · Issue 3

Abstract

Care for patients suffering from major trauma varies greatly throughout the world. This may range from no response at all, to advanced systems comprising multiple levels of response. Much of the understanding of the management of civilian trauma has been drawn from military experience in times of war. Holistic, integrated trauma systems are well-established in many parts of the developed world. These contemporary trauma systems are complex, can be costly, and are a significant undertaking to establish.

Controversy surrounds the level of pre-hospital response, and the in-field skills required to improve patient outcomes. The ideal resourcing for pre-hospital response to trauma is not agreed upon, and requires further investigation. However, significant reductions in morbidity, mortality, suffering and societal burden can be expected following the establishment of an integrated trauma care system. A tiered response, encompassing basic and advanced level providers, who ultimately deliver patients to Major Trauma Centres, appears to be current best practice.

Pre-hospital trauma care varies greatly throughout the world. Developing countries may have no structured pre-hospital trauma services, whereas more affluent first-world economies may have advanced systems comprising multiple levels of response. This article will investigate these systems as a part of holistic and integrated trauma care, the role of paramedical staff within them, and discuss an ideal model of pre-hospital response to trauma that balances responsible health service delivery with improvements in morbidity and mortality.

Trauma is a common cause of death in underdeveloped, developing and developed nations. In developed nations such as Australia, injury from suicide, transport accidents and unintentional falls represents the majority of trauma-related hospital presentations (Henley and Harrison, 2009). Typically, young adult males are overrepresented in all trauma-related deaths.

Whilst foremost acknowledging the significant emotional cost of traumatic injury to the patient and their support network, traumatic injury also comes at a significant financial cost to society. Disability secondary to traumatic injury can incur a lifetime of financial burden on families, the healthcare system, support services and society as a whole. Connelly and Supangan (2006) estimated that the total cost (including healthcare and support services, emergency response and vehicle-related costs) of road trauma to Australia was $17 billion each year—2.3% of the nation's gross domestic product. Improvements in trauma care delivery are aimed at not only limiting human suffering, but reducing the financial burden on society.

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