Overview
Trauma has been dubbed the forgotten epidemic and the neglected disease of modern society. Trauma annually impacts hundreds of thousands of individuals and costs billions of dollars in direct expenditures and indirect losses. Trauma care has improved over the past 20 years, largely from improvements in trauma systems, assessment, triage, resuscitation, and emergency care.
However, an Institute of Medicine report identified a US crisis in access and distribution to emergency care that may impact trauma system efficiency and effectiveness. Similarly, a predicted deficit in critical care practitioners may similarly degrade the post-emergency department care of the critically injured patient. The American College of Surgeons Committee on Trauma (ACS-COT) and the American Association for the Surgery of Trauma (AAST) acute care surgery initiative is designed to integrate trauma, emergency general surgery, and surgical critical care and to bolster new trainee interest in this field. Its sensitivity for identifying major trauma patients is lower and specificity higher than previously described, particularly among elders.
Work must still be done to continuously improve trauma care nationally, regionally, and institutionally, and the ACS-COT applies rigorous standards to performance improvement prior to verifying US trauma centers. For this improvement to occur, the ongoing application of the unique principles and practice of intensive care medicine is necessary.