Trauma systems in Europe.

For prehospital care, Switzerland developed the first helicopter air rescue system but it has been surpassed by the Federal Republic of Germany, where a coordinated rescue system of physician-equipped air and terrestrial transport has been developed. With regard to hospital care of trauma victims, three systems have evolved. In Austria and the Federal Republic of Germany, the "general surgeon-traumatologist" is in charge. In these countries, the Workmen's Compensation Board restricts treatment privileges to trauma surgeons. In Switzerland and Holland, general surgeons in regional hospitals and to some extent also in university centers have largely remained responsible for trauma, including fractures. In Great Britain, as in other major European countries like France, Italy, and Spain, trauma of the locomotor system is the domain of orthopedic surgeons, with multiple trauma and body cavities remaining the responsibility of general surgeons. Overall, there is a general tendency to create integrated trauma care systems within large hospital settings. Although an experienced general surgeon can function as the leader of the trauma team, such implementation has, for the most part, not occurred.