History and Background
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Trauma is a disease of epidemic proportions. Each year, more than 118,000 American's lives are ended – suddenly, unexpectedly, brutally – by this killer. It has been aptly called the last major plague of the young, for trauma kills more Americans between the ages of one and 34 than all other diseases combined. But trauma is more than a plague of the young: trauma is the leading cause of death for all people under age 44, and the leading cause of disability for all people under 65.
Washington State has been a leader in confronting this epidemic. In 1990, far-reaching legislation was adopted which called for the development of a comprehensive statewide trauma care system. This legislation was the culmination of a series of initiatives which began in the late 1960s with the University of Washington pioneering the development of paramedic training programs; continued through the 1970s with the establishment of legislatively mandated minimum standards for prehospital providers and services, and certification for paramedics and other advance life support personnel; and concluded in the late 1980s with the completion of the "Washington State Trauma Patient Tracking Study," and the development of the 1990 Washington State Trauma Project: A Report to the State Legislature.
The key components of this 1990 legislation, the Trauma Care Systems Act, include:
- Clear lines of authority and responsibility;
- Designation of Trauma Care and Trauma Rehabilitation services;
- Trauma Care services;
- Verification of Prehospital Trauma services;
- Field triage criteria development;
- Regional planning and implementation;
- Cost containment considerations;
- Integration of trauma/injury prevention;
- Trauma registry development;
- Establishment of regional quality assurance/improvement programs;
- Integration of trauma rehabilitation services; and,
- Evaluation of system effectiveness.
Washington's EMS and trauma care system aims to assure that the required resources are available and the necessary infrastructure is in place to deliver the “right” patient to the “right” facility in the “right” amount of time. The system is built upon broad consensus and cooperation among diverse groups and around complex logistical, political,financial, legal and medical issues. It's a comprehensive system that includes a strong injury prevention component as well as the designation of rehabilitation services for post-acute care.
State authority and responsibilities
The Washington EMS and Trauma Act of 1990 created three major groups of participants: the Department of Health's Office of Emergency Medical Services and Trauma System, the EMS and Trauma Care Steering Committee and the eight EMS and Trauma Care Regions.
State responsibilities include coordination of injury prevention programs, regulation of EMS providers, standards for education of EMS personnel and training programs, standards and designation of trauma and rehabilitation services, management of a trauma registry and quality improvement programs, establishment of trauma triage criteria, patient care protocols, destination guidelines and administration of the Trauma Care Fund.