Trauma centers: a pragmatic approach to need, cost, and staffing patterns.

Based on the recommendations of the Health Services Administration and the Committee on Trauma of the American College of Surgeons, optimal staffing patterns for a trauma center are unrealistic in cost and personnel needs for all but a few large, urban teaching hospitals. As an alternative, the staffing pattern for a trauma program for a nonuniversity community hospital consists of one general surgeon, an anesthesiologist and one emergency physician. In addition, surgical subspecialists in thoracic surgery, urology, obstetrics and gynecology, ophthalmology, otolaryngology and plastic surgery would be on call within 30 minutes. A paid, part-time program director and paid coordinator of nursing and allied health personnel would be on staff. Need for trauma centers versus trauma programs can be assessed by using 5% of the number of motor vehicle accidents in an area to forecast the number of traumatic injuries. This is done in California as an example.