What is Trauma?
Trauma can be defined as a physical injury that requires surgical specialists to consult, observe, or perform surgery in order to optimize recovery. Trauma is a national and international public-health epidemic. It is the third leading cause of death overall, and the leading cause of death under the age of 45 in the United States. Annually in the US, there are 150,000 deaths and 400,000 persons disabled per year as a result of trauma. Additionally, there are 3.6 million hospital admissions greater than a week and nearly $12 billion (or 7%) of healthcare dollars spent annually to treat the trauma patient. In San Francisco alone, there were over 3,200 trauma patients taken to SFGH, half of which required hospital admission. Approximately 50% of these patients had a single body system injury, 20% had a two body system injury, and 30% had a critical life-threatening injury.
Photo by Ed Kashi, Photographer, courtesy of SFGH Foundation
Trauma System Development
The City of San Francisco developed the first complete trauma system in the United States, centering its program around SFGH. This system was designed to provide care 24 hours a day, seven days a week, and 365 days a year for the injured. The program required the organization of pre-hospital, hospital and post-hospital care. Since that time, SFGH has developed an international reputation as one of the world leaders in trauma care. Trauma systems were initially designed to decrease deaths and morbidity following trauma and return patients to their pre-injured state. Trauma centers also were designed to provide for optimal cost-effective care throughout the entire range of treatment. Over the past 30 years, studies have shown that trauma centers succeed in accomplishing all of these goals.
Levels of Trauma Care
Trauma centers are traditionally designated (Levels I through IV) based on existing resources and expertise in treating injuries of different type and severity. Many states have the authority to designate levels of care. The American College of Surgeons (ACS) has a verification process to evaluate centers for level designation. In general, Level I Trauma Centers are capable of providing the highest level of care across the spectrum for trauma patients, including pre-hospital, hospital, and post-hospital care, through patient care, education, and research. Level II facilities are often community hospitals that take a lead in regional trauma care, and have many of the same resources that Level 1 centers have for patient care. Level III centers are capable of initially stabilizing the patient and transferring the more complex injuries to higher level centers. Finally, Level IV centers are capable of administering advanced trauma life support and have transfer agreements with other trauma centers. In northern California, San Francisco General Hospital is only one of four Level I Trauma Centers.
Why is Orthopaedics Important for a Trauma Center?
In 2003, there were over 1.6 million fractures treated in US hospitals. Nearly half of these patients will not return to work within the first 6 months and 10% of the fractures will have a delay in healing or will not heal. Overall, 15% of permanent disabilities are the result of an extremity injury. In San Francisco alone, there were over 1,500 trauma admissions; approximately 2/3 of which had a musculoskeletal injury. Maintaining a group with the abilities to treat these complex injuries is paramount for any trauma center, including SFGH.