As winter’s winds whirl and water turns to ice, the health care system braces for the seasonably predictable rash of weather-related traumatic injuries. Snow, ice, and freezing temperatures lead inevitably to car crashes, falls, and thermal injuries. Trauma care has evolved into a distinct field of medicine ever since pioneering doctors in the 1950’s and ’60’s started a system from the first responders to the definitive care centers.
Most of modern trauma care arose directly from wartime military experience, especially Vietnam and Korea. There we learned that the first hour after a serious injury, the so-called Golden Hour, will determine the likelihood of survival. So today the prehospital rescuers, not unlike field medics in combat, are expected to quickly carry out a list of actions and assessments which maximize the first part of the golden hour. They are expected to evaluate the ABCDEs of resuscitation. They will protect the spine from movement, they will stanch any active bleeding, and closely monitor the vital signs. And importantly, they must triage correctly.
Triage is a way of matching resources to needs. When managing an accident scene, the EMT must quickly go through the abc’s with each victim, initiate spinal immobilizations, and then determine if the injuries should be managed by the closest available site, the most appropriately qualified hospital, or the most convenient. The rapid, confident performance of the EMT, including triage decisions, results daily in hundreds of trauma victims getting the most appropriate treatment of their injuries. Though a nearby average ER may save a trauma victim’s life by being the quickest option, seriously traumatized persons who can be safely delivered to a trauma center will be well served by the comprehensive care such centers represent. For a hospital to be designated as a trauma center, it must meet the stringent requirements of the American College of Surgeons, including the requirement of having immediately available at all times doctors in anesthesia, neurosurgery, orthopedics, etc., and certain services such as CT scan and ultrasound.
So should a slip on the ice result in a slide followed by a snap and a crack, rest assured that your 911 call will result in a magical mystery tour of the trauma system. Somehow the system works; from the EMT’s putting you in a splint and on a board, to the morphine for the pain, to the ER for x-rays, to the operating room for the orthopedist to pin the broken bone back together, to physical therapy and rehabilitation.