In the event of a major trauma, resulting in potentially severe injuries to a child, it is important to ensure that that child receives the best care possible in the most appropriate place, so as to create the best chance that they will have the best outcome possible. Much work has been done to show that an organized trauma system, that is, a systematic approach to the management of major injuries, based on geography and predetermined guidelines of “who goes where”, and encompassing care from pre-hospital to acute in-hospital to rehabilitation, can improve the outcome of major injury events among adults. In Canada, several jurisdictions have developed such systems, centered around regional trauma centers represented by the major hospitals in each province.
For children sustaining major traumatic injuries, the value of such a system, generally geographically-centered around a pediatric trauma center, that enables them to receive pediatric-specific trauma care is no less. Studies have shown that for many different types of injuries, children who received dedicated pediatric care have better outcomes than those cares for in a primarily adult-based center. In Canada, the paucity of and geographically widely-dispersed nature of pediatric specific care creates a need for well thought out and evidence-informed pediatric trauma systems that aim to achieve the following in order to get the right child to the right place in a timely fashion:
- Ensure that children with major traumatic injuries that fare best with pediatric-specific care reach such care
- Ensure that processes and protocols are in place to ensure rapid stabilization of life-threatening conditions in children and rapid and safe transport to care appropriate to the severity and type of trauma sustained
- Reduce the burden of potentially overwhelming the regional pediatric trauma center by caring for children with less severe injuries in other centers still capable of providing appropriate care.
- Reduce the burden of injury on families by keeping the child as close to their home community as possible, while still ensuring the best outcome possible.
- Build within in all levels of care to maximize outcomes from acute care, to rehabilitation to identification of injury prevention priorities within the region.
- Identify and address within it barriers to appropriate care that may be based on vulnerabilities, such as geographic remoteness, high-risk injury mechanisms and/or immediate life-threatening injury patterns requiring highly emergent transport and definitive care, and socioeconomic deprivation.
- Be fiscally responsible