Table 1

Trauma system components and benchmarking activities in Quebec and the English National Health Service*

Trauma system component
Trauma centres10 MTCs (5 level I [3 adult centres and 2 pediatric centres], 5 level II, 21 level III, 28 level IV)27 MTCs, 154 trauma units
No. of MTCs per 100 000 population0.1250.05
No. of MTCs per 1000 km20.0060.111
Designation/accreditationInstitut national d’excellence en santé et services sociaux; mandatoryStrategic Health Authorities; mandatory
Prehospital triageUniform, validated tool (adapted from American College of Surgeons Committee on Trauma)Varies across regions
Bypass to MTC60 min60 min
Highest level of prehospital careLevel II. Basic Life SupportLevel IV. Advanced Life Support On-Scene, Physician Field Care
Prehospital intubationNoneTracheal intubation
Surgical airway
Nontracheal intubation intervention: pharyngeal tube, supraglottic airway device, airway positioning
Prehospital transportationGround; fixed-wing aircraftGround; fixed-wing aircraft; helicopter
Trauma team leaderIn 1 level I hospitalAll MTCs
Benchmarking activities
Process indicators13Tranexamic acid, rapid sequence intubation, rehabilitation prescription
Risk-adjusted outcomesDeath, readmission, complications, hospital length of stayDeath
FeedbackConfidential audit and feedback reportsPublicly available reports, dashboards, best practice tariffs, alerts (2 SDs), alarms (3 SDs)
AccountabilityMandatory quality-improvement report; linked to accreditationPay-for-performance indicators
FrequencyAccreditation cycles (about 3 yr)4 mo (reports), 3 mo (dashboard)
  • MTC = major trauma centre; NHS = English National Health Service; SD = standard deviation.

  • * Sources: The Trauma Audit & Research Network ( and the Trauma Care Continuum, Institut national d’excellence en santé et services sociaux (https://www.inesss.