Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T18:55:09.205Z Has data issue: false hasContentIssue false
  • English
  • Français

An inventory of Canadian trauma systems: opportunities for improving access to trauma care

Published online by Cambridge University Press:  04 March 2015

Christopher C.D. Evans ,
J.M. Tallon ,
Jennifer Bridge  and
Avery B. Nathens
Christopher C.D. Evans*
Affiliation:
Department of Emergency Medicine, Kingston General Hospital and Hotel Dieu Hospital, Kingston, ON
J.M. Tallon
Affiliation:
Departments of Emergency Medicine, Anesthesia, Surgery, and Community Health and Epidemiology, Dalhousie University, Halifax, NS
Jennifer Bridge
Affiliation:
Department of Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital and Sunnybrook Research Institute, University of Toronto, Toronto, ON
Avery B. Nathens
Affiliation:
Department of Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital and Sunnybrook Research Institute, University of Toronto, Toronto, ON
*
Department of Emergency Medicine, Kingston General Hospital and Hotel Dieu Hospital, c/o 76 Stuart Street, Kingston, ON K7L 2V7; c.evans@queensu.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care.

Methods:

We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A “snowball” approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region.

Results:

The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system.

Conclusion:

There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.

Keywords

emergency medical serviceshealth care surveyspublic healthtrauma centreswounds and injuries
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 207 - 213
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Canadian Institute for Health Information. National Trauma Registry 2011 report: hospitalizations for major injury in Canada, 2008-2009 data. Ottawa: Canadian Institute for Health Information; 2011.Google Scholar
2. Peden, M, McGee, K, Krug, EG. Injury: a leading cause of the global burden of disease. Geneva: World Health Organization; 2000.Google Scholar
3. Peden, M, McGee, K, Sharma, G. The injury chart book: a graphical overview of the global burden of injuries. Geneva: World Health Organization; 2002.Google Scholar
4. Trauma Association of Canada. Trauma system accreditation guidelines: 4th edition, 2011. Available at: (accessed July 26, 2012).Google Scholar
5. Nathens, AB, Jurkovich, GJ, Cummings, P, et al. The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA 2000;283:1990–4.CrossRefGoogle ScholarPubMed
6. Nathens, AB, Jurkovich, GJ, Rivara, FP, et al. Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma 2000;48:25–30.CrossRefGoogle ScholarPubMed
7. Gabbe, BJ, Biostat, GD, Simpson, PM, et al. Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system. Ann Surg 2012;255:1009–15.CrossRefGoogle Scholar
8. World Health Assembly. Health systems: emergency care systems - report by the Secretariat, 2012. Available at: (accessed July 26, 2012).Google Scholar
9. Statistics Canada. Canada at a glance 2012-population, 2012. Available at: (accessed July 26, 2012).Google Scholar
10. Statistics Canada. Human activity and the environment: annual statistics: section 2: annual statistics: Canada’s physical environment, 2012. Available at: (accessed July 26, 2012).Google Scholar
11. Hameed, SM, Schuurman, N, Razek, T, et al. Access to trauma systems in Canada. J Trauma 2010;69:1350–61.Google ScholarPubMed
12. Ball, J, Burton, RA, Channarayapatn, S, et al. Regional trauma systems: optimal elements, integration, and assessment-American College of Surgeons Committee on Trauma: systems consultation guide. Chicago: American College of Surgeons; 2008.Google Scholar
13. Health Resources Service Administration. Model trauma system planning and evaluation. Washington (DC): Department of Health and Human Services; 2006.Google Scholar
14. Centers for Disease Control and Prevention. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage. MMWR Morb Mortal Wkly Rep, 2008;57(No. RR-1);1–35.Google Scholar
15. Graham, ID, Logan, J, O’Connor, A, et al. A qualitative study of physicians’ perceptions of three decision aids. Patient Educ Couns 2003;50:279–83.CrossRefGoogle ScholarPubMed
16. Tallon, JM, Fell, DB, Karim, SA, et al. Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation. Can J Surg 2012;55:8–14.CrossRefGoogle ScholarPubMed
17. MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366–78.CrossRefGoogle ScholarPubMed
18. Utter, GH, Maier, RV, Rivara, FP, et al. Inclusive trauma systems: do they improve triage or outcomes of the severely injured? J Trauma 2006;60:529–35.CrossRefGoogle ScholarPubMed
19. Sasser, SM, Hunt, RC, Sullivent, EE, et al. Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep 2009;23:1–35.Google Scholar
20. Pasquale, MD, Peitzman, AB, Bednarski, J, et al. Outcome analysis of Pennsylvania trauma centers: factors predictive of nonsurvival in seriously injured patients. J Trauma 2001;50:465–72.CrossRefGoogle ScholarPubMed
21. Simons, R, Kasic, S, Kirkpatrick, A, et al. Relative importance of designation and accreditation of trauma centers during evolution of a regional trauma system. J Trauma 2002;52:827–33.Google ScholarPubMed
22. Haas, B, Stukel, TA, Gomez, D, et al. The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis. J Trauma Acute Care Surg 2012; 72:1510–7.CrossRefGoogle Scholar
23. Grava-Gubins, I, Scott, S. Survey response rates among Canadian physicians and physicians-in-training. Can Fam Physician 2008;54:1424–30.Google ScholarPubMed