A historical perspective of trauma system development in the United States.

The concept of a trauma system as public health policy has developed substantially during the 30 years since publication of Accidental Death and Disability: The Neglected Disease of Modern Society. The military experience with casualties established the public expectation that grievously injured citizens should be expected to survive if a system enables a team of experts to work smoothly together. The federal government has invested hundreds of millions of dollars in support of development of an infrastructure of emergency medical systems throughout the country, and trauma systems have benefited from timely prehospital care provided by trained professionals. State or regional metropolitan governments have initiated establishment of trauma systems as fusions of health care and the politics of health care policy. Trauma systems can be considered an experiment in health care policy because they have characteristics uncommon with other areas of medical practice. Hospitals have been categorized by means of outside review based on their capabilities to provide trauma care, which has led to designation, whereby individuals are transported to trauma centers after serious injury rather than the hospitals they might normally choose. The performance of hospitals and health providers in a trauma system is subjected to outside review and some form of public accountability. All of the effort, money, and work committed to trauma systems requires careful scrutiny to determine whether trauma systems are indeed beneficial. Have trauma systems reduced death, ameliorated disability, and successfully prevented the problems these public health policies intend to manage?