Trauma Systems, Trauma Registries, and Prehospital Triage

Trauma systems are an integrated, hierarchical, and regionalized network of agencies, institutions, and resources aimed at full collaboration, trained, and dedicated to control, treat, and prevent deaths and permanent disability in a population, directly or indirectly related to trauma disease. The main objective of trauma systems is to maximize the effort and effectiveness of all human, material, and financial resources available. The main objective of trauma registries is to provide information for trauma systems, and that includes accurate and reliable information of the causes, circumstances, and type of injuries of the population. Access to trauma victims depends on various aspects. It will be defined by the existence of medical or paramedical services for emergency transport, type of transportation, hospital resources, and the number of victims. The flow plans and protocols will determine the referral of these patients to the definitive care. In multiple-casualty disasters, prehospital and field staff can use a simplified version of “simple triage and rapid treatment” (START). Using the “START,” patients will be classified into four groups of colors and priorities: red, yellow, green, and black. The great benefit of START is the accurate identification of severe patients who will benefit from efficient and expeditious transportation to the Specialized Trauma Centers, where victims would be assured of resources and better treatment care

Critical Care in Trauma

The goal of care in trauma patients is to reestablish homeostasis, treat morbidity, prevent complications and mortality, and functionally rehabilitate this subset of patients. To achieve this goal, the intensivist utilizes and coordinates a multidisciplinary, evidence-based approach to ensure that resources are effectively and efficiently allocated to the patients that need them. Airway management and breathing are the highest priority when evaluating a trauma patient. The goal is to protect the airway, improve gas exchange, and relieve respiratory distress. Sedation is a useful tool in the ICU setting and increases patient safety and comfort. Critical illness, anxiety, pain, and delirium can result in significant agitation, which may lead to an increased stress response. Trauma patients are at an increased risk of developing pneumonia because of the need for prolonged mechanical ventilation, increased risk of aspiration, lung injury, and/or pain. Positioning, oral hygiene, aiding the clearing of secretions, and pain control can drastically reduce the risk. In addition, for those patients requiring prolonged intubation and mechanical ventilation, the implementation of weaning trials is beneficial. Multiple factors increase the risk of developing a deep vein thrombosis (DVT), including hypoperfusion due to blood loss and inadequate resuscitation, tissue injury, immobilization, and inflammation. It is recommended that chemical DVT prophylaxis is started within 72 hours from the time of injury barring any contraindications