Essential Trauma System Elements

Statutory authority to enable development and implementation of a trauma system should exist. A lead agency with sufficient authority to implement policy, maintain well-defined administrative rules, and allocate trauma system funds, should be established or identified. A multidisciplinary advisory group, consisting of stakeholders representing the full spectrum of trauma care, should guide the lead agency.

The lead agency should establish a sustained funding mechanism for trauma system infrastructure. Funding should include physical and staffing resources for program administration and oversight, data collection, data storage, data analysis, quality improvement activities, education, and support for disaster response and military integration.

A multidisciplinary advisory group, consisting of stakeholders representing the full spectrum of trauma care, should be established. The role of the advisory group should be to guide the lead agency regarding trauma system development and operations. Representation should be diverse, with respect to geography, population (rural/urban, adult/pediatric, burn), phases of care (prehospital and rehabilitative) and trauma center level designation.

An integrated trauma system plan should be created and implemented. This plan should be reviewed annually and updated every three years at a minimum, under the direction of the lead agency and the multidisciplinary advisory group.

The trauma system should address the full continuum of injury from prevention and pre-hospital/interfacility emergency medical services, to acute hospital care (referring and accepting facility) through rehabilitation. The system should address all injured patients with special attention to pediatric, geriatric, and other vulnerable populations.

The lead agency should develop and administer a trauma center designation process which is based upon population needs.

The lead agency should have the authority to establish and maintain a trauma system registry to collect, validate, and analyze injury surveillance data. Data collection should include the full continuum of care from point of injury through rehabilitation. These data should include all care facilities that treat injured patients. These data should be integrated with other data collection systems (i.e., vital records, medical examiner, law enforcement, and rehabilitation). Data definitions and patient inclusion criteria should be standardized to a national standard.  Data sharing should be inclusive of system stakeholders to support quality improvement, research efforts, and legislative outreach pertaining to trauma.

The lead agency should have systems and processes in place to regularly track and report on injury frequency, rates, and patterns across the entire jurisdictional population.  Analysis and reporting should be based on multiple pertinent data sources (e.g., vital statistics, hospital discharge data, EMS, ED data, and trauma registries), including information obtained through surveillance activities.   Data from these sources should be synthesized to provide a comprehensive description of injury and analyzed to identify trends and patterns to inform system development, injury prevention, and performance improvement efforts.

The lead agency should establish a system-wide trauma performance improvement (PI) process to evaluate all aspects of the trauma system.  The plan should define audit filters to monitor and track specific processes and outcomes, such as access to care, availability of services, and effectiveness of injury prevention initiatives.  In addition, the plan should define a process for tracking of the audit filters, addressing performance gaps, and determining loop closure.

The lead agency should establish a process to ensure confidentiality and provide statutory protection from discoverability to support trauma system performance improvement and research efforts.

A comprehensive emergency disaster preparedness and response plan should be established and reviewed annually. This plan should integrate all components of the trauma system and coordinate with all existing response entities including local, state, federal and particularly military partners. There should be a developed and operational network of Regional Medical Operations Centers (RMOCs) as a major component of the disaster preparedness plan. The plan should be exercised at least semiannually. One of these exercises should be operationally based (not tabletop) and test all components of the system.

The trauma system should actively support integration and cooperation with military personnel, medical treatment facilities, and transport capabilities. This should include patient care, education, data collection, performance improvement, research, training, disaster response, and clinical readiness.