Trauma represents a particular kind of medical
emergency. It is typically defined as having a physical wound caused by force
or impact, such as a fall or automobile accident; burns and other severe wounds
are also deemed a form of trauma. Other life-threatening medical conditions
caused by preexisting conditions are generally not considered trauma. Trauma
care is distinguished from care received in a general ED by the specialized
diagnostic and treatment procedures necessary to care for the traumatically
injured patient. Trauma centers are designed to meet the complex surgical
demands of critically ill patients immediately. To qualify as a trauma center,
a hospital must have a number of capabilities, including a resource-intensive
ED, a high-quality intensive care ward, and an operating room that is
functional at all times. Ideally, traumatically injured children are cared for
in a pediatric trauma center, a facility with the personnel, equipment, space,
and other resources required to provide the necessary care 24 hours a day, 7
days a week (Ramenofsky, 2006). The American College of Surgeons’ (ACS)
Committee on Trauma has defined the term “pediatric trauma center” in its
categorization of trauma centers into levels based on their capabilities. A
level I pediatric trauma center, the highest level, is a children’s hospital or
an adult center with pediatric expertise (Ramenofsky, 2006).
emergency. It is typically defined as having a physical wound caused by force
or impact, such as a fall or automobile accident; burns and other severe wounds
are also deemed a form of trauma. Other life-threatening medical conditions
caused by preexisting conditions are generally not considered trauma. Trauma
care is distinguished from care received in a general ED by the specialized
diagnostic and treatment procedures necessary to care for the traumatically
injured patient. Trauma centers are designed to meet the complex surgical
demands of critically ill patients immediately. To qualify as a trauma center,
a hospital must have a number of capabilities, including a resource-intensive
ED, a high-quality intensive care ward, and an operating room that is
functional at all times. Ideally, traumatically injured children are cared for
in a pediatric trauma center, a facility with the personnel, equipment, space,
and other resources required to provide the necessary care 24 hours a day, 7
days a week (Ramenofsky, 2006). The American College of Surgeons’ (ACS)
Committee on Trauma has defined the term “pediatric trauma center” in its
categorization of trauma centers into levels based on their capabilities. A
level I pediatric trauma center, the highest level, is a children’s hospital or
an adult center with pediatric expertise (Ramenofsky, 2006).
Given that the development of pediatric emergency
care has lagged behind that of adult emergency care, it is surprising that the
first pediatric trauma center was established in 1962—5 years before the first
adult trauma center was established (Ramenofsky, 2006). In 1970, the American
Pediatric Surgical Association (APSA) was founded; 2 years later, one of the
members requested greater emphasis on trauma, and the association established a
Committee on Trauma, which continues today. Also in 1972, the APSA joined the
American Medical Association, the ACS, the American Academy of Orthopedic
Surgeons, and the American Association for the Surgery of Trauma in sponsoring
the American Trauma Society (ATS) (Personal communication, M. Stanton, March
12, 2006). The ATS, established in the late 1960s, was an advocate for the EMSS
Act of 1973. Today it works to promote trauma care and prevention, serving as
an advocate for trauma victims and their families and for optimal care for all
trauma victims (ATS, 2006).
care has lagged behind that of adult emergency care, it is surprising that the
first pediatric trauma center was established in 1962—5 years before the first
adult trauma center was established (Ramenofsky, 2006). In 1970, the American
Pediatric Surgical Association (APSA) was founded; 2 years later, one of the
members requested greater emphasis on trauma, and the association established a
Committee on Trauma, which continues today. Also in 1972, the APSA joined the
American Medical Association, the ACS, the American Academy of Orthopedic
Surgeons, and the American Association for the Surgery of Trauma in sponsoring
the American Trauma Society (ATS) (Personal communication, M. Stanton, March
12, 2006). The ATS, established in the late 1960s, was an advocate for the EMSS
Act of 1973. Today it works to promote trauma care and prevention, serving as
an advocate for trauma victims and their families and for optimal care for all
trauma victims (ATS, 2006).
However, advanced
resources for the care of pediatric trauma patients were largely unavailable
until the 1980s. In 1982, the Journal of Trauma published the first description
of resources necessary to treat the injured child. Others followed. In 1984,
the ACS Committee on Trauma included an appendix on pediatric trauma care in
its standards manual, which was the first document to define the standards of
care necessary to treat trauma patients. A chapter on pediatric trauma appeared
in the ACS resource manual in 1987 (Ramenofsky, 2006).
resources for the care of pediatric trauma patients were largely unavailable
until the 1980s. In 1982, the Journal of Trauma published the first description
of resources necessary to treat the injured child. Others followed. In 1984,
the ACS Committee on Trauma included an appendix on pediatric trauma care in
its standards manual, which was the first document to define the standards of
care necessary to treat trauma patients. A chapter on pediatric trauma appeared
in the ACS resource manual in 1987 (Ramenofsky, 2006).
Today, most regions have dedicated trauma
facilities, board-certified surgeons have training and experience in trauma
care and pediatric surgery, and most states have organized trauma systems.
Injuries are no longer viewed as “accidents” but as predictable events that can
be prevented through the application of harm reduction strategies (Cooper,
2006). As detailed later in the chapter, however, unintentional injury
continues to be the leading cause of death in children over age 1 and an
important source of ED visits. While this report is focused on the emergency
care system and the pediatric component of that system, the committee
emphasizes that greater effort is needed to build a comprehensive injury
control strategy or system to reduce injuries among both children and adults.
facilities, board-certified surgeons have training and experience in trauma
care and pediatric surgery, and most states have organized trauma systems.
Injuries are no longer viewed as “accidents” but as predictable events that can
be prevented through the application of harm reduction strategies (Cooper,
2006). As detailed later in the chapter, however, unintentional injury
continues to be the leading cause of death in children over age 1 and an
important source of ED visits. While this report is focused on the emergency
care system and the pediatric component of that system, the committee
emphasizes that greater effort is needed to build a comprehensive injury
control strategy or system to reduce injuries among both children and adults.