Trauma

The word trauma originated from the Greek word τραεµα, which means wound. There are references to trauma in the ancient Greek, Egyptian, and Indian literature. Injuries result from acute exposure to physical agents. The physical agents could be varied, such as heat, mechanical force, chemicals, electricity, and radiation. When the magnitude of force of the physical agent exceeds the normal human tolerance, injury results.

Injuries are classified by various methods. They are categorized based on mechanism of injury, for example: a motor vehicle crashes, pedestrian struck. The type of injury caused by blunt forces are called blunt trauma and the injuries caused by sharp objects that penetrate the skin before causing internal damage are called penetrating trauma. Examples of blunt trauma are motor vehicle crashes, falls, and so on; examples penetrating trauma are stab wounds and gunshot wounds. Another way to classify traumatic wounds is as “intentional” and “unintentional” depending on the intent of the perpetuator. The intentional injuries are further classified as homicide and suicide.

The impact of trauma on American society is devastating. It is the leading cause of death in the first four decades of life. Trauma causes devastation to the young and potentially more productive members of society. With the advancing age of the American population, geriatric trauma is becoming an increasing social issue. No subset of the population is immune from trauma. Trauma ranks third, behind cancer and arteriosclerosis, as a leading cause of death in all decades of life.

Two people are killed, approximately 350 sustain a disabling injury, and $7.8 million is spent every 10 minutes in this country as a result of trauma. Approximately 60 million injuries occur in this country every year. Of these injuries, 50% require medical treatment. Every year 3.6 million trauma hospital admissions occur. Approximately 9 million of these injuries are disabling, 300,000 permanently and 8.7 million temporarily. The trauma-related costs exceed $400 billion annually. It is ironic that despite such an amount of financial loss to the economy of this country, only four cents of every federal research dollar are spent in trauma research.

Death from trauma follows what is known in trauma circles as the trimodal death distribution. The first peak of deaths occurs in the field and occurs within the first few seconds or minutes of injury. This peak of deaths is beyond control of the medical profession. Only legislation and law enforcement can make a significant impact on this peak of death. Enforcement of laws against drunken driving, helmet laws, and safety belt laws would significantly reduce this peak of trauma death. Public education about trauma prevention would significantly help to reduce trauma death. The American Trauma Society and National Safe Kids Coalition have spearheaded trauma prevention education. Public awareness of battered spouse syndrome, battered child syndrome, and elder abuse would help prevent trauma in those vulnerable subsets of society. The second peak of deaths occurs within a few minutes to several hours of the injury. Dr. Adam Cowley therefore popularized the Golden Hour concept. The concept is that if the trauma patient is taken to a specialized trauma care center within an hour of injury, then the trauma victim has a better chance to survive the injury. Based on that concept, specialized centers to treat trauma were created all around the country. These are called trauma centers. There are various levels of trauma centers depending on the resources of the trauma centers. They are classified as level I, II, or III trauma centers. To use the Golden Hour concept effectively, the prehospital trauma care (the care provided by emergency medical service at the scene) has been streamlined and integrated into trauma care. [Page 568]The prehospital care is to stabilize and rapidly transport the trauma victim to the nearest trauma center for the definitive care. Standardization of trauma care across the board has a major impact in improving the morbidity and mortality of the trauma victims in this country. Multiple studies in the past decade have confirmed the notion that trauma victims do have a better chance of survival if they are brought to a trauma center. The third peak of deaths occurs in several days to several weeks after the initial injury. The mode of death is sepsis and multiple organ failure, and such mortality can be decreased by better ICU care.

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