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Dr.Sanjay Shah DNB Trauma Surgeon,

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What is a Trauma Center?
Trauma centers are hospitals with resources immediately available to provide efficient surgical intervention to reduce the likelihood of death or permanent disability to injured patients. Accredited trauma centers must be continuously prepared to treat the most serious life threatening and disabling injuries. They are not intended to replace the traditional hospital and its emergency department for minor injuries.

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How do trauma centers differ from regular hospitals?
The major component that differentiates a regular hospital from one that is a trauma center is the requirement for 24 hour availability of a team of specially trained health care providers who have expertise in the care of severely injured patients. These providers include trauma surgeons, neurosurgeons, orthopedic surgeons, cardiac surgeons, radiologists and nurses. From a facility standpoint, there also needs to be 24 hour availability of a trauma resuscitation area in the Emergency Department, an operating room, laboratory testing, diagnostic testing, blood bank and pharmacy.

The most common causes of injury that bring patients to a trauma center are falls and motor vehicle crashes. These events cause life-threatening trauma in multiple areas of the body. Other common causes of injury include burns, gunshot wounds, and assaults.

Research shows that in states where there is a trauma system in place, the death rate is drastically reduced. A trauma system unlike a trauma center involves the use of many services including Emergency Medical Services (EMS), Rehabilitation facilities, and trauma prevention organizations. From an EMS standpoint it is the job of Emergency Medical personnel to care for the patient at the scene of the injury and transport them quickly to a trauma center. After trauma center care is delivered, rehabilitation facilities provide care that allows the injured individual to return to work and family. Preventing traumatic injuries from occurring is the best prevention education anyone can provide. Moreover, research is needed to assure that the outcomes of care delivery are reducing death and disability among the people of the state.

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What process is required for being a trauma center?
A hospital interested in becoming a trauma center is required to inform the Pennsylvania Trauma Systems Foundation (PTSF) of their intent to pursue trauma accreditation a minimum of 2 years prior to the time of a site survey visit. At that time written materials are given to explain the many standards that need to be met. Over the next year, PTSF staff conducts educational visits with the interested center. Often the hospital will partner with another trauma center or an outside consultant to assist them in developing their trauma program to gain an understanding of what is needed to be a trauma center before PTSF is notified.

The formal application process involves submitting a document called an Application for Survey. Questions are asked regarding whether the hospital complies with the thirty-eight standards needed for trauma accreditation. These standards include commitment, physician and nursing education, personnel availability, presence of fully equipped and staffed departments including the ER, Radiology, OR, ICU, lab, and x-ray. Social services are needed to support the family’s emotional needs and an aggressive trauma care review process is required to assure trauma care is being delivered according to established standards of care.

PTSF also requires that a trauma center submit data on all trauma patients who are cared for at that facility to the PTSF statewide trauma database. This data provides a source of information that guides PTSF accreditation review activities and allows trauma research to be conducted.

Following submission of an Application for Survey, a Site Survey is conducted at the institution comprised of a team of experts who review care delivery. Factual information collected during this survey coupled with information from the application is then presented to the PTSF Board of Directors in a blinded fashion. If the Board votes that the institution complies with standards of accreditation the facility is accredited for one year and another survey is conducted the following year to assure that trauma care delivery has been optimal since the official accreditation and opening of the trauma center.

The site survey process is currently conducted every 3 years for those centers in good standing. If issues develop surveys can be conducted more frequently; this is determined on a case-by-case basis.

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What are the types of traumatic events?

Type I trauma includes single, one-time events such as rape, accidents, natural disasters, or witnessing the death of a loved one (Terr, 1991).
Type II trauma involves multiple, prolonged, or chronic events, such as child abuse or captivity (Terr, 1991). There are several types of events that can be traumatic.
Natural disasters, so-called “acts of God,” that typically affect entire groups of people, e.g., hurricanes, earthquakes, tsunamis, fires.
Stressful events that do not typically lead to trauma-related disorders in most people, but may do so in some individuals, e.g., childbirth, death of a loved one.
Unintentional accidents caused by human error, e.g., many car accidents, building collapse, fire, a child playing with a gun and accidentally shooting a playmate.
Acts of gross negligence, e.g., accidents caused by drunk drivers; collapse of building due to inferior construction; neglect of a child leading to a serious accident.
Intentional interpersonal violence, e.g., arson, assault, domestic violence, child abuse, rape, war, genocide, torture.

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What is Acute Stress Disorder?

Acute Stress Disorder (ASD) is only one of two disorders (along with PTSD) that are defined by DSM-IV as being directly related to a traumatic event. ASD begins no more than four weeks after a stressful event and lasts from two days to four weeks. When the symptoms persist beyond four weeks, the diagnosis becomes PTSD. ASD is strongly predictive of subsequent PTSD (Brewin, Andrews, Rose, & Kirk, 1999; Classen, Koopman, Hales, & Spiegel, 1998; Grieger et al., 2000; Harvey & Bryant, 1998). Thus, some authors argue have suggested that ASD be subsumed under PTSD (e.g., Marshall, Spitzer, & Liebowitz, 1998). Even though ASD is listed as an anxiety disorder, its diagnosis is partly made on the basis of having three or more so-called dissociative symptoms, and like PTSD, many consider it to be a dissociative disorder. Additional criteria include persistent reexperiences, marked avoidance of trauma-related stimuli, and marked hyperarousal or anxiety.

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What is Posttraumatic Stress Disorder?
PTSD began to be recognized formally as a serious psychological problem in combat veterans of World War I. At that time it was called “shell shock.” In World War II it was referred to as “combat neurosis.” Only after the Vietnam War did the name “posttraumatic stress disorder” evolve, and eventually it was recognized that PTSD was not unique to male soldiers, but affected survivors of other kinds of traumatic events. Although PTSD is currently listed in DSM-IV as an anxiety disorder, many have proposed that it is a dissociative disorder (Brett, 1996; Chu, 1998; van der Hart et al., 2004, 2006).

PTSD is acute when the duration of symptoms is less than three months, is chronic when the symptoms last three months or longer, and has a delayed onset when at least six months have passed between the traumatizing event and the onset of symptoms. In addition to exposure to a potentially traumatizing event, PTSD requires persistent reexperiences (Criterion B), persistent avoidance (Criterion C), persistent hyperarousal (Criterion D), and duration of symptoms for more than one month (Criterion E) (APA, 1994).

Trauma survivors with PTSD feel chronically afraid that the event is happening or is going to happen, and are unable to fully realize the traumatic event is over. Sometimes they involuntarily relive the event to such a degree that they are unable to maintain contact with present reality; these experiences are called “flashbacks”. At the same time, they avoid remembering as much as possible, and as stimuli in daily life trigger memories, they begin to avoid more and more of life. They may feel intense shame and guilt, thinking that they are somehow responsible for what happened, or guilty for what he or she did in order to survive. With chronic hyperarousal, they feel exhausted, have sleep problems, have difficulty concentrating, and are irritable and jumpy. They may purposefully avoid sleep because of terrifying nightmares. Due to emotional numbing they lose feeling a sense of being connected to others, withdraw from loved ones, and may lash out due to irritability, causing whatever support they have to slowly disappear. They may begin to drink, use drugs, work too much, or engage in other self-destructive behaviors to avoid the feelings and memories of what happened.

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Dr. Sanjay Shah M.B.B.S, M.S, DNB General Surgery, DNB Trauma Surgeon Profile Schedule

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