History and development of trauma care in the United States

Until recently the development of systems for trauma care in the United Sta tes has been inextricably linked to wars. During the Revolutionary War trau ma care was based on European trauma principles particularly those espoused by the Hunter brothers. Surgical procedures were limited mostly to soft ti ssue injuries and amputations. The American Civil War was remarkable becaus e of the contributions that were made to the development of systems for tra uma care. The shear magnitude of casualties required extensive infrastructu re to support the surgeons at the battlefield and to care for the wounded. For the first time in an armed conflict, anaesthetics were used on a routin e basis, Despite these major contributions, hospital gangrene was a terribl e problem and was the cause of many mortalities. World War I and World War II were noteworthy because of the contributions made by surgeons in the use of blood. One of the major lessons of World War II was the reemphasis of h ow frequently lessons have to be relearned regarding the treatment and care of wounds. Between the Korean Conflict and the Vietnam War the discovery was made of t he tremendous fluid shifts into the cell after severe hemorrhagic shock. As a consequence, the treatment of patients with shock was altered during the Vietnam Conflict, which resulted in better outcomes and less renal failure . The first trauma centers for civilians were started in the United States in 1966. Since 1988 the number of states with mature trauma systems has expan ded front two to 35, During the same period, many studies have documented t he efficacy of trauma systems in reducing unnecessary mortality and disabil ity.