More About Trauma

Trauma ranks as the leading cause of death for persons up to 40 and third for all age groups. Since the mid-1980s, anesthesiologists, surgeons, emergency physicians, intensivists and other health care providers have shown a dramatically increased interest in the perioperative anesthetic and critical care management of trauma. Trauma care has been a "growth industry" for several reasons, among them: The level of trauma in developed countries continues to mount; the number of seriously injured patients reaching the hospital alive, and thus requiring subsequent care, also is increasing as a by -product of improved EMS services. Today more hospitals are looking to trauma as a way to sustain revenues in this era of health care reform (e.g., trauma is one of the few conditions that does not offer the option of an elective, "preapproved" approach).

The incidence of trauma is projected to increase and, because medical practice in the field is improving dramatically, the number of trauma patients reaching the hospital alive will continue to grow. Thus, trauma management will become an increasingly large part of hospital-based practice. As trauma does not discriminate, a wide range of patients and injury types is encountered: cardiac, orthopedic, maxillofacial, thoracoabdominal, neurologic, obstetric, pediatric, etc. Also, the number of elective follow-up procedures and ambulatory cases is increasing. Both general and regional anesthesia, as well as various postoperative pain management techniques, are employed.

Currently, very few health care providers actually specialize in trauma, yet most are involved in the care of trauma patients by sheer necessity. Until recently, the knowledge and skills necessary to perform this function have been obtained empirically; however, this emergency on-the-job training should no longer suffice.

The field of trauma anesthesia and critical care addresses a wide range of topics from the pre-hospital arena (e.g., helicopter transport) to intrahospital functions (i.e., ER, OR, ICU). First and foremost, the trauma care provider functions in the clinical sphere as an important member of the trauma team. As surgical care expands to encompass more complex and challenging procedures, the traumatologist must also grow to cope with the inherent new demands, not only in the operating room, but also in the perioperative arena. Second, as the role of the traumatologist expands within the hospital, it also starts to encompass areas outside the facility environs, for example, in the development and management of EMS systems.

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