Specialty coverage at non-tertiary care centers.

The fundamental tenet of a trauma system is to get the right patient to the right hospital at the right time. Although most injuries are minor or moderate and can be managed at local community hospitals, a significant minority of injured patients require extensive and expensive care to survive or minimize injury. Most prehospital trauma triage criteria address a combination of factors to consider, but this approach sometimes fails to identify patients with severe injuries and often burdens trauma centers with patients suffering minor injuries. It is critical to utilize a method to differentiate those injury victims who need the specialized expertise and resources available in trauma centers from those who can be adequately cared for locally. Although trauma centers assume the leadership role, in a truly inclusive system, all health care providers (prehospital, community hospitals, and trauma centers) have a defined role in providing care to patients with trauma. All these institutions should establish and maintain transfer agreements for the transfer of patients meeting system trauma triage criteria. Because prehospital triage criteria are not 100% sensitive, there should be a mechanism in place for the secondary triage of patients. Initial management of patients should continue while efforts are made to transfer the patient.