[Multiple trauma and the management structure].

The implementation of Quality Management Procedures is necessary in evaluating the treatment of multiple trauma-patients. The development of standards in structures of the trauma management system is the first step to insure quality (appraisal of structure). But the amount of investment in the trauma system structure is limited by 1. The resources available, 2. The efficacy of the applied resources, i.e. the principle of diminishing returns of investment. Centralization of care in Level I Trauma Centers is not realistic in every situation. Transport time can be too long and exceed the critical "golden hour". Review of current data indicates that in approximately 50% of the time, helicopter transport is not possible due to weather, geography, or other limiting factors. This leads to a fragmented transport system, often necessitating extensive transport times, resulting in less than optimal patient outcomes. In order to optimize quality, the following needs to be done: Assessment of process: 1. Realistic algorithms or protocols for primary transport must be developed. 2. Agreements must be reached between designated regional hospitals. 3. Treatment algorithms or protocols which address the different care levels, must be developed by a committee of clinical experts. 4. Quality management procedures must be implemented to monitor the quality of care delivered. Assessments of outcomes: 1. Outcome data must be reviewed on an ongoing basis to determine if changes must be made in the system design or the transportation & clinical algorithms/protocols. 2. Such outcome data should be gathered by means of a Trauma Registry.