Organisation of a Trauma Service



Trauma, a major cause of death and disability, is underfunded

In Europe and the United States trauma is the leading cause of death and disability in those who are under 50 years of age. Below the age of 40 trauma causes more deaths than all other diseases combined. In the United States, trauma accounts for around 4 million life-years lost. Cancer and cardiovascular disease together amount to less, yet almost a billion dollars is spent on cancer research, over 500 million dollars on heart disease research, and under 20 million dollars on trauma research. (1)


Chest injuries may not need thoracic surgery but they do need a thoracic surgeon

Of all deaths from injury, 25% are due to chest injuries directly and are the significant factor in a further 25%. It is obvious that the management of chest trauma must be optimal and this may only be possible in organized trauma systems. At present in the United Kingdom there is no comprehensive system for managing trauma cases and patients who have suffered from chest trauma will be managed in a wide variety of ways. At one end of the scale there are regions where the vast majority of major chest injuries are managed by thoracic surgeons in large regional intensive care units with the support of experienced intensivists. Elsewhere, major chest injuries are managed in small intensive care units with little experience of major chest trauma and without the on-site support of cardiothoracic surgeons. There is, therefore, a wide disparity in management techniques. The assertion that the majority of thoracic injuries do not require operative intervention has led to a situation where it is assumed that virtually no chest injury needs operative intervention, and secondly that when chest injury does not require thoracotomy that the thoracic surgeon does not have a place in its immediate management.