Trauma is the leading cause of lost years of life and productivity in young adults (Celso et al. 2006). Numerous studies including meta-analysis have confirmed a significant reduction in mortality when care is provided at a Level 1 Trauma Centre (MacKenzie et al. 2008 & Celso et al. 2006). Trauma centres employ a multitude of patient assessment techniques, management systems, human resources and infrastructure; each contributing to improving trauma patient care. With reducing mortality rates, the measurement of trauma centre success has shifted to non-fatal measures such as morbidity and improvement in functional outcomes (MacKenzie et al. 2008). It is estimated that for every trauma fatality, there are between three and four survivors who are permanently impaired (Halcomb et al. 2005) and so therapies that selectively improve the quality of life in survivors could be as valuable as therapies that decrease mortality. To date, there is no process measure that correlates with reducing disability.
Many studies of medical procedures have revealed that improved results occur in centres that perform large numbers of procedures versus centres that perform smaller numbers. The same concept is true for trauma (Markovchick & Moore 2007). Physicians, nurses and ancillary staff who care for trauma patients on a regular basis acquire and maintain valuable skills. Optimal human resources for a Level 1 Trauma Centre have been described as physicians, surgeons and other paramedical specialists all involved in the care of trauma patients on a continual basis (American College of Surgeons Committee on Trauma 2006). Specific literature and support for Allied Health in Trauma management is improving. In 2007, Pendleton, Cannada & Guerrero-Bejarano identified that Physiotherapy availability within 24 hours of surgery was an important factor in decreasing length of stay in isolated femur fractures after trauma. Furthermore, Dutton et al (2003) demonstrated that daily multi-disciplinary “discharge rounds” including Allied Health team members (physiotherapy, occupational therapy and speech therapy) provided a forum for clear communication and streamlined care, allowed a 36% increase in patient volume and 15% decrease in length of stay. More recently, advances in knowledge around the effects of immobility, intensive care unit acquired weakness and early / acute rehabilitation have helped to shape the role of specialised trauma allied health clinicians who contribute to the recovery and rehabilitation of trauma patients.
From acute inpatient phases through to community reintegration; allied health clinicians work to improve physical, cognitive and quality of life status post injury. Outcome after trauma should be considered as the sum of all residual deficits and not just organ specific. Contributions of social, economic and personal factors have to be considered as well as functional and psychological outcomes. Allied Health is a broad, encompassing term for a wide variety of clinical disciplines that are responsible for the recovery and rehabilitation of trauma patients from the acute care setting through to definitive discharge destinations. They possess a diverse range of skills and knowledge and due to the multi faceted sequale of trauma injuries, the dedication of specialist trauma clinicians in allied health disciplines should be an important factor for trauma centres to consider.
Trauma patient profile and care is changing. There is increasing pressure from organisations to maintain capacity by reducing length of stay, while still improving patient outcomes and ensuring consistency of care. With complex injuries, multi system morbidity and recovery needs, trauma management provides the perfect environment for dedicated allied health clinicians to demonstrate their role and utility. The ATS can assist in this vision, providing an important platform for Allied Health clinicians of all disciplines to work towards a strong voice and presence in trauma patient care and management.
American College of Surgeons Committee on Trauma 2006, Resources for optimal care of the injured patient, American College of Surgeons, Chicago.
Celso, B, Tepas, J, Langland-Orban, B, Pracht, E, Papa, L, Lottenberg, L & Flint, L 2006, ‘A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centres following the establishment of trauma systems’, Journal of Trauma, vol. 60, pp. 371 – 378.
Dutton, RP, Cooper, C, Jones, A, Leone, S, Kramer, ME & Scalea, TM 2003, ‘Daily multidisciplinary rounds shorten length of stay for trauma patients’, J Trauma, vol. 55, p. 913 – 919.
Halcomb, E, Daly, J, Elliott, D & Griffiths, R 2005, ‘Life beyond severe traumatic injury: an integrative review of the literature’, Australian Critical Care, vol. 18, pp. 17 – 24.
MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, Nathens, AB, Egleston, BL, Salkever, DS, Frey, KP & Scharfstein, DO 2008, ‘The impact of trauma-center care on functional outcomes following major lower limb trauma’, Journal of Bone and Joint Surgery (America), vol. 90, pp. 101 – 109.
Markovchick, VJ & Moore, EE 2007, ‘Optimal trauma outcome: trauma system design and the trauma team’, Emergency Medicine Clinics of North America, vol. 25, pp. 643 – 654.
Pendleton, AM, Cannada, LK & Guerrero-Bejarano, M 2007, ‘Factors affecting length of stay after isolated femoral shaft fractures’, J Trauma, vol 62, p. 697 – 700.