Updates from Sierra Nevada Memorial Hospital and Hospital Foundation
The first of this two-part series (part two will appear Saturday) explores the definition of trauma, the history of trauma care and the evolution of trauma centers. Part two will answer one of the most common questions asked about Dignity Health Sierra Nevada Memorial Hospital (SNMH): “Why doesn’t SNMH go after national accreditation as a trauma center?”
The word trauma can be confusing because there are two definitions. Trauma as a result of a distressing or disturbing psychological experience can be caused by one-time events such as an accident, injury, or a violent attack. Constant, persistent stress such as threats in a crime-ridden neighborhood, battling a life-threatening illness, or witnessing a painful event can cause trauma.
Physical injuries of sudden onset and severity, which require a higher level of medical attention are referred to as traumatic injury. Traumatic injury is caused by various forces from outside of the body, which can be blunt or penetrating. Blunt trauma includes falls, road traffic crashes, crush injuries and assaults and burns. Penetrating trauma involves shooting, stabbing or falling onto a sharp object (known as impalement).
Trauma incidents often cause systemic shock and may require immediate resuscitation and interventions to save life and limb. Traumatic injuries include motor vehicle collisions, sports injuries, falls, natural disasters and a multitude of other injuries that require intensive immediate care. People that experience a physical trauma may also experience psychological difficulty due to the shock of the unexpected injury.
Born on the battlefield, trauma care came of age during the 1960s with lessons learned in the Korean and Vietnam wars, which were brought back to the United States. Hospital emergency rooms existed long before that time, but while every trauma is an emergency, but not every emergency involves trauma. Indeed, trauma is a complex event requiring an on-site team of physicians, nurses, and technicians specially trained to do the right thing at top speed.
Modeled after these mobile army surgical hospital (M.A.S.H.) units, the nation’s first hospital-based civilian trauma units were established in 1966 at San Francisco General Hospital and Chicago’s Cook County Hospital. Although these two trauma units served as models in the sixties, it was a decade later that formal guidelines were established for the systematic delivery of trauma care. A 1976 report from the American College of Surgeons Committee on Trauma (ACSCOT), Optimal Hospital Resources for Care of the Seriously Injured, specified the requirements for effective trauma systems. Out of that report came the now-familiar trauma center levels, as well as the organization of multidisciplinary trauma teams and the trauma center verification process.
Emergency and trauma care differ in that trauma centers have availability of immediate resources to provide an entire spectrum of critical and intensive care any time of the day or night to address the needs of all types of injured patients, where an emergency department is not able to have the specific personnel or resources on-site 24/7 to provide certain types of critical intervention in the moment.
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