UMEM Educational Pearls

In follow-up to last week’s pearl regarding the inequitable distribution of trauma care, there were a few more thoughts:

1.     A huge shout out to those ED physicians working in critical access facilities without surgical back up, access to specialists, and who are regularly struggling to get their patients transferred to trauma centers to receive the care they need.

2.     All centers, big and small, are struggling with crowding, staffing, and patient flow. It is critical to the entire system that these issues get addressed. They need to be addressed at a system level by all stake holders. Smaller EDs, critical access EDs, or Level 2 and 3 centers holding patients that need to be transferred has a deleterious effect not only on that individual patient, but the patients that can’t be seen while the most critically ill are being attended to.

3.     Hospital administrators, medical directors, national organizations, department leaders, and each of us in the trenches owe it to our communities and patients to get involved in fixing the problems. These issues are best addressed by a meeting of stake holders than by an overwhelmed ED provider at 2 am desperately trying to do the right thing for their patient.

4.     The best systems have:

a.     ongoing education for EMS providers, hospital providers, nurses and the general public,

b.     pre-hospital protocols regarding trauma patients,

c.      a timely means to get patients to the correct facility,

d.     injury prevention programs,

e.     post-acute care rehabilitation services, and

f.      family support services in place.

5.     Those with well-functioning systems, please publish your results and the steps you have taken to become well-functioning. We need leadership. We do not need to reinvent the wheel. Please take an active role in lifting the less functional systems to your level.

6.     Those that are struggling, ask for help! Also publish your efforts, your struggles, and your needs.


For those interested in a deeper dive into where we have come from and the concept of trauma systems, please read the attached reference. This is a call to all that care for the critically ill to work to improve our stressed system, publish your work so we ca all learn and to advocate and lobby for your patients.

This pearl's author is open to comments, criticism, concerns and questions. 

Back to clinical pearls next week.




The impact of trauma systems on patient outcomes

Jeff Choi, MD, MSc,1 Garrison Carlos, MD,1 Aussama K. Nassar, MD, MSc, FRCSC, FACS, Lisa M. Knowlton, MD, MPH, FRCSC, and David A. Spain, MD, FACS?


Curr Probl Surg. 2021 Jan; 58(1): 100849.

Published online 2020 Jun 10. doi: 10.1016/j.cpsurg.2020.100849 PMCID: PMC7286246 PMID: 33431134