Trauma is a major cause of disability and death for individuals in the United States. In fact, trauma from unintentional injuries, homicide, and suicide is the leading cause of death for Americans aged 1 to 44 years. Injuries associated with trauma account for approximately one third of all emergency department visits and 8% of all hospital stays in trauma care systems. The top four mechanisms of traumatic injuries involve falls, motor vehicle accidents (struck by or against another individual), and other transportation accidents. The mechanism of injury varies in different age groups. For those younger than 7 years or 75 and older, falls account for 40% of traumatic injuries; but in those aged 15–33 years, motor vehicle injuries account for 27% of the injuries, peaking around age 19.
Based on these numbers and the burden on the U.S. health care system, one can understand the need for integrated trauma care programs. In the U.S. civilian health care system, there has been and continues to be a growth of trauma care systems. A trauma center is a hospital that has the resources and equipment to help care for severely injured patients. The American College of Surgeons (ACS) Committee on Trauma classifies levels of trauma centers from 1 to 4, with a level 1 trauma center providing the highest level of trauma care. The designation of trauma facilities is a geopolitical process that only the government is empowered to delegate; however, the ACS verifies the presence of the resources listed in the Resources for Optimal Care of the Injured Patient. ACS certification is a voluntarily process undertaken by participating hospitals. Having access to specialized resources and equipment is critical for severely injured patients. Research supported by the Centers for Disease Control and Prevention shows that there is a 25% reduction in the death rate for severely injured patients who received care at a level 1 trauma center rather than a nontrauma center.
THE ROLE OF THE REHABILITATION PHYSICIAN IN TRAUMA CARE
With more people today surviving severe traumatic injuries, it is essential that rehabilitative services be made available throughout the acute and postacute hospital care system. The rehabilitation process for acute trauma patients should be initiated as early as possible in the hospital setting. Many of these patients have specific medical and rehabilitative needs that can benefit from the expertise of rehabilitation physicians in an acute care hospital setting.
The role of rehabilitation physicians in an acute care hospital can differ somewhat from their role in an inpatient rehabilitation facility. In the inpatient facility, the rehabilitation physician serves as the team leader; in the acute hospital setting, the rehabilitation physician is a valuable team member whose importance and input may vary based on the patient’s specific injury, time since injury, and clinical course. For patients with recent multitrauma injury who are being treated in an intensive care unit, the ...