Position paper on acute care treatment

F. R. Lewis, T. A. Gennarelli, D. A. Pollock, D. Johnson, R. H. Demling, F. Ehrlich, M. R. Eichelberger, A. W. Fleming, J. H. Ferguson, Kenneth W Kizer, R. K. Narayan, G. Rozycki, G. T. Shires, P. G. Trafton, D. D. Trunkey, J. Weigelt, N. Burton

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Traumatic injury is epidemic in the United States, and it is the largest killer of people from 1 through 44 years of age, which includes those in their most productive years. It continues to be a significant threat among older people and is among the four leading causes of death. Traumatic injury takes an economic toll greater than heart disease and cancer combined; even when it does not result in death, it is the cause of an extraordinary amount of disability, the human cost of which is impossible to quantify. Trauma, which has been called the number one public health problem in the United States today, particularly affects people in industrialized societies, where heavy tolls are taken by occupational and household injuries and even heavier tolls by motor vehicle trauma. The United States, however, has an additional cause of trauma-interpersonal violence-which causes a toll of death and disability not seen in other industrialized countries. Every year, 150,000 people in the United States die as a result of trauma, and more than 2 million people are hospitalized as a result of injuries. The yearly economic losses, including direct medical costs, disability costs, and lost wages and taxes, amount to over $100 billion. Despite this appalling toll in human and economic costs, we have done little as a nation to address this problem. Since 1967, it has been highlighted periodically in national white papers, but the public and legislative response can best be characterized as apathetic. Annual federal research expenditures related to trauma care are approximately 5% of those cancer, heart disease, or AIDS. The legislative response in mandating the development of trauma systems and trauma centers has occurred entirely at the state level and has been quite variable, with fewer than five states having any kind of complete system in place. The treatment phase of acute care begins before the patient reaches the hospital and extends through the hospital phase, including treatment in the emergency department, operating room, intensive care unit, and hospital ward. Rehabilitation should begin while the patients is in the hospital phase of treatment. Although the medical care of traumatized patients is generally well defined, improved care is needed in many areas if we are to reduce the toll of death and disability. In the broadest sense, the goal of the treatment phase is to minimize the effects of the injury. In this chapter, we identify and discuss those areas of acute care treatment that we believe need further study and improvement.

Original languageEnglish (US)
Pages (from-to)130-132
Number of pages3
JournalJournal of Trauma
Issue number2
StatePublished - 1992

ASJC Scopus subject areas

  • Surgery


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