LET ME ASK YOU A QUESTION

Do you know what you are? Professionally I mean. I thought I knew. I knew what I did and where I did it. I knew what kind of patients I took care of and how the little corner of the healthcare world in which I lived was created. I thought I was a trauma nurse[horizontal ellipsis]now I'm not so sure. The world of trauma care that you and I know today evolved in the early 1970s. The military lessons learned in Korea and Vietnam had found their way into civilian healthcare. Emergency Medical Services (EMS) care was being developed, trauma centers emerged, and the key concepts of the trauma care we provide today began to coalesce. The Highway Safety Act of 19661 and the Emergency Medical Services Systems Act of 19732 signaled the beginning of the federal governments' interest in fostering the development of EMS and trauma systems. The Trauma Systems Planning and Development Act of 19903 set the stage for the development of a critical document, the Model Trauma Care System Plan.4 Much of what we recognize in the structure and substance of our trauma systems today was articulated in that document. Now, in 2006, more than a decade and half later, that document has made a quantum leap forward.

In February 2006, the Trauma-EMS program in the Health Services and Resources Administration unveiled the next evolution of the Model Trauma System Planning and Evaluation document.5 This should be required reading for any nurse involved in trauma care. This document details the future of what our trauma systems will become and what they must become. What makes this publication so important, what makes it so different from the first version? Is it basically the same stuff rehashed with a new cover and updated bibliography? Hardly! The genius of this document is its vision of how trauma system development will survive, and thrive, over the next few decades. Listen closely and you will hear hundreds of forehead smacking, "duh, why we didn't think of this 10 years ago!" exclamations.

The key to understanding the heart of the Model Trauma System Planning can be summed up with 2 words: public health. The new Model Trauma System Planning places the development of trauma systems directly in the realm of the public health model. Clearly, trauma is recognized as a critical public health problem, and we have known it for decades. In 1966 it was appropriately labeled as "the neglected disease of modern society," sadly, a label that still applies 40 years later. The US Department of Health and Human Services acknowledged this when prevention of injury was reflected as one of the national health objectives described in Healthy People 2010.6

Consider the goals of a trauma system. We expect that trauma systems will lead to a decrease in the incidence and severity of trauma, that it will ensure optimal, equitable, and accessible care for all injured victims. The trauma system should prevent unnecessary deaths and disabilities while containing costs and promoting efficiency. We insist that a well-designed trauma system will implement quality and performance improvement processes and strive to make certain that designated facilities have the appropriate resources. Lastly, we expect trauma systems to foster and support the research needed to improve trauma care.

Now, consider the 10 core functions of public health. We expect public health officials to monitor health status and to identify community health problems. We insist that it diagnose and investigate health problems and health hazards in the community. The public health system should inform, educate, and empower people on health issues. We want it to mobilize community partnerships to identify and solve health problems while developing policies and plans that support individual and community health efforts. It should enforce laws and regulations that protect health and ensure safety and link people to needed personal health services and ensure the provision of healthcare when otherwise unavailable. Our public health system should ensure a competent public health and personal healthcare workforce. Lastly, we require our public health system to evaluate the effectiveness, accessibility, and quality of personal and population-based health services and conduct research to attain new insights and innovative solutions to health problems.

Do you see any similarities? Hear any foreheads being smacked yet?

Hence, what does the public health approach espoused in the Model Trauma System Planning bring to the table for trauma? It gives trauma much more credibility as a public health problem while following a reasonable, methodical approach, one recommended by the Institute of Medicine. It grounds trauma in a well-documented and proven theoretical base and will permit trauma to be competitive with other healthcare concerns for funding. This model will improve the dialogue among trauma, public health, and policy makers and will assure consistency in future documents such as the Trauma Vision and EMS Agenda for the Future. Finally, it begins looking at outcomes along with structure and process while integrating trauma systems into public health, disaster planning, and terrorism responses. "A natural affinity exists between public health professionals and trauma care professionals in their similar approaches to problem solving."5^(p18) If you haven't already done so, please pause a moment now, smack your forehead, and utter an exclamation of revelation.

So let me ask that question again, do you know what you are? Are you a trauma nurse or a public health nurse? The answer should be yes. The future of trauma system development in the United States is inextricably tied to public health, and it is about time.

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