Our intention was to compare the effectiveness of the two systems; however, we found that a valid comparison of effectiveness was not possible with existing data. A thorough search of the MEDLINE database (January, 1966, to December, 2003) for reports with the medical subject headings or keywords “American,” “French”, “United States”, “France”, “trauma”, “wounds and injuries”, in various combinations and in concert with a manual search of references cited in published original and review
SeriesDevelopment of trauma systems and effect on outcomes after injury
Section snippets
History
The American experience during the war in Korea laid the earliest foundation for the current system of trauma care in the USA. Evacuation of the wounded along the traditional chain from the front lines to surgical care, as had been possible during the world wars of 1914–18 and 1939–45, was made difficult by challenging terrain.2 A further difference was the availability of helicopters, which were used to move the wounded rapidly from combat zones to mobile army surgical hospitals. Additional
History
Until World War II, the French and American experience of trauma care was derived from combat. The concept of haemorrhagic shock was described in the 19th century, with the observation that the longer the delay between the wounding of a soldier and his receiving definitive surgical care to stop bleeding, the greater his chances of dying. The importance of blood loss in the evolution of shock was not recognised until later. The convergence of these two notions—to limit blood loss rapidly while
Can we compare outcomes between countries?
The ambivalence towards advanced prehospital care in the USA contrasts strikingly with the emphasis on the value of physician-directed prehospital care in France. These two countries represent diametrically opposing views of the importance of prehospital care to the outcome for the patient. The extent of regionalisation of trauma care also differs, with the French only recently deciding not to increase the number of centres devoted to trauma care.
To compare outcomes between different systems of
Conclusion
The delivery of effective trauma care requires a complex system needing trained practitioners with specific expertise and skills, availability of diagnostic and therapeutic resources, and readily available specialty care. The trauma system of a given region or country represents a local solution to a complex organisational problem involving coordination of resources and services provided by many players, and is largely dependent on tradition rather than outcome-driven data. In the absence of
Search strategy
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