Quality in Trauma Care Systems

In the industrialized world, trauma remains the leading cause of death in those aged 1 to 40 years. If current trends continue, traffic injuries will become the second leading cause of death worldwide1. Therefore, even a small improvement in survival rate or reduction of morbidity can result in large benefits for society2,3. The average trauma patient is treated by a large number of providers of care. To evaluate any progress made in the care for the injured it is required to take all of these elements into account. The different phases of trauma care form a chain. This chain (a very fitting metaphor, because the weakest link indicates the strength of the entire chain) starts with the initial phone call and first aid provided by bystanders. This initial call has to be transformed in an appropriate response by emergency care providers, who treat the victim on-scene and en route. The emergency room of the receiving hospital is the gateway to the in-hospital logistic chain, and should guarantee swift stabilization and basic diagnostics for an optimal in-hospital route. This route often contains additional shackles in the form of (radio)diagnostic modalities and therapeutic modalities such as emergency surgery and advanced life support in the Intensive Care Unit. After admission to the general ward, the initial plan for discharge and rehabilitation can be made, possibly with the aid of a revalidation clinic. In total, the average multi-trauma patient passes through 10 recognizable stages of this chain.