Basic rescue and resuscitation. Trauma system concept in the United States.

Trauma has become the most expensive health care problem in the United States. It is the leading cause of death in persons younger than 44 years old. In 1990, there were approximately 92,000 deaths from trauma, 50% of which were caused by automobile accidents. Before 1976, there was no systemized approach for care of the traumatized patient. The American College of Surgeons Committee on Trauma has developed guidelines covering the spectrum of care of the trauma patient from access and prehospital care to hospital treatment and rehabilitation. The effectiveness of trauma systems has been proven in many studies that show a significant decrease in the preventable death rate in traumatized patients receiving care at a trauma center. The implementation of a national trauma system has proven difficult because of expense, commitment, and effective legislation. Small strides continue to be made, but many hurdles remain.