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The care of victims of trauma is among the most gratifying sources of satisfaction for emergency physicians and nurses. In many ways, trauma care was one of the first examples of evidence-based medicine, through the development of standardized care in the Advanced Trauma Life Support (ATLS) and Trauma Nurse Core Curriculum courses.1,2 However, trauma patients require the highest level of resources and their care can be substantially disruptive to emergency department (ED) operations. Whether practicing in a designated or verified trauma center or not, virtually all emergency nurses and physicians participate in the care of injured patients. Only 10% to 20% of trauma patients require the focused and intense resources of trauma centers. The rest are cared for in nondesignated community hospitals.3

The decision to pursue formal trauma center designation or verification is one which involves the entire hospital, including its nursing, medical, and administrative staffs. (Trauma center verification is a noncompetitive process by which either the state or the American College of Surgeons [ACS] performs a site survey and verifies that the facility is in compliance with ACS guidelines for trauma centers. Trauma center designation is a competitive process in which 2 or more facilities in a geographic area compete for the right to be designated as the receiving trauma center for that area.)

Injuries—including unintentional injuries, homicide, and suicide—are the leading cause of death for those aged 1 to 44.3-5 The consequences of injuries can be extensive and wide ranging. Injuries have physical, emotional, and financial consequences that can affect the lives of individuals, their families, and society. Injuries place an enormous burden on hospital EDs and trauma care systems, accounting for approximately one-third of all emergency department visits and 8% of all hospital stays.6

Every year 50 million people are injured severely enough to require medical treatment. Most injuries requiring medical care are preventable. In 2000, injuries resulted in lifetime costs of $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Full 40% of the lifetime medical and lost productivity costs of injury are attributed solely to motor vehicle crashes and falls.7

CDC-supported research shows a 25% reduction in deaths for severely injured patients who receive care at a Level I trauma center rather than at a nontrauma center.7 First described in 1982, the tri-modal distribution of deaths implies that death due to injury occurs in 1 of 3 periods (Table 43-1).

Table 43-1 Trimodal Distribution of Trauma Deaths

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