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Policy Points In order to achieve successful operationalization of trauma‐informed care (TIC), TIC policies must include conceptual clarity regarding the definition of both trauma and TIC. Furthermore, TIC requires clear and cohesive policies that address operational factors such as clearly delineated roles of service providers, protocol for positive trauma screens, necessary financial infrastructure, and mechanisms of intersectoral collaboration. Additionally, policy procedures need to be considered for how TIC is provided at the program and service level as well as what TIC means at the organizational, system, and intersectoral level. Context Increased recognition of the epidemiology of trauma and its impact on individuals within and across human service delivery systems has contributed to the development of trauma‐informed care (TIC). How TIC can be conceptualized and implemented, however, remains unclear. This study seeks to review and analyze the TIC literature from within and across systems of care and to generate a conceptual framework regarding TIC. Methods Our study followed a critical interpretive synthesis methodology. We searched multiple databases (Campbell Collaboration, Econlit, Health Systems Evidence, Embase, ERIC, HealthSTAR, IPSA, JSTOR, Medline, PsychINFO, Social Sciences s, Sociological s and Web of Science),as well as relevant gray literature and information‐rich websites. We used a coding tool, adapted to the TIC literature, for data extraction. Findings Electronic database searches yielded 2,439 results and after inclusion/exclusion criteria were applied, a purposive sample of 98 information‐rich articles was generated. Conceptual clarity and definitional understanding of TIC is lacking in the literature, which has led to poor operationalization of TIC. Additionally, infrastructural and ideological barriers, such as insufficient funding and service provider “buy‐in,” have hindered TIC implementation. The resulting conceptual framework defines trauma and depicts critical elements of vertical TIC, including the bidirectional relationship between the trauma‐affected individual and the system, and horizontal TIC, which requires intersectoral collaboration, an established referral network, and standardized TIC language. Conclusions Successful operationalization of TIC requires policies that address current gaps in systems arrangements, such as the lack of funding structures for TIC, and political factors, such as the role of policy legacies. The emergent conceptual framework acknowledges critical factors affecting operationalization.

Introduction Trauma burden is one of the leading causes of young human life and economic loss in low- and middle-income countries. Improved emergency and trauma care systems may save up to 2 million lives in these countries. Method This is a comprehensive expert opinion participated by 4 experts analyzing 6 Asian countries compiling the most pressing trauma care issues in Asia as well as goal directed solutions for uplifting of trauma care in these countries. Result Lack of legislation, stable funding under a dedicated lead agency is a major deterrent to development and sustainment of trauma systems in most Asian countries. While advocating trauma, critical care as a specialty is a key event in the system establishment, Trauma specialized training is challenging in low resource settings and can be circumvented by regional cooperation in creating trauma specialized academic centers of excellence. Trauma quality improvement process is integral to the system maturity but acquisition and analysis of quality data through trauma specific registries is the least developed in the Asian setting.

\"The Korean War (1950-53), was a ferocious and brutal conflict that produced over four million casualties in the span of three short years. Despite this, it remains relatively absent from most accounts of mental health and war trauma. Invisible Scars provides the first extended exploration of Commonwealth Division psychiatry during the Korean War and examines the psychiatric care systems in place for the thousands of soldiers who fought in that conflict. Fitzpatrick demonstrates that although Commonwealth forces were generally successful in returning psychologically traumatized servicemen to duty and fostering good morale, they failed to compensate or support in a meaningful way veterans returning to civilian life. Moreover, ignorance at home contributed to widespread misunderstanding of their condition, and veterans were often deprived of public space in which to grieve. This book offers an intimate look into the history of psychological trauma and assesses the impact of the Korean War on the development of military psychiatry. In addition, it engages with current disability, pensions and compensation issues that remain hotly contested and reflects on the power of commemoration in the healing process.\"-- Provided by publisher.

Hemorrhagic shock remains the leading cause of mortality in trauma patients and prehospital whole blood transfusion (PHWBT) improves outcomes in patients with significant shock burden. This study evaluates the impact of PHWBT on the probability of survival (PS) in trauma patients. We compared PS determined via the Trauma and Injury Severity Score (TRISS) equation, for patients receiving PHWB and WB within 1 ​h of arrival to our Level 1 academic trauma center (EDWB). 419 patients (241 PHWB, 178 EDWB) were identified. 54.4 ​% vs 35.4 ​% of patients had an improvement in PS (prehospital to on-arrival) and 34.3 ​% vs 16.6 ​% (PHWB vs. EDWB, respectively) demonstrated a shock index decline from >1 to <1, p ​< ​0.001. PHWB group had more unexpected survivors, 24 vs. 7 (p ​= ​0.02), corresponding to an estimated $15,725 to produce one additional unexpected survivor through PHWBT. PHWBT enhances shock physiology, improves survival probability, and offers a potentially cost-effective investment towards optimizing outcomes in trauma patients with hemorrhagic shock. •Patients receiving prehospital whole blood have improved probability of survival.•Prehospital whole blood increases the odds of unexpected survivorship from trauma.•About every $15,725 spent saves one additional life through prehospital transfusion.•Every $5550 spent on prehospital whole blood significantly improves shock burden.•Nationwide adoption of prehospital whole blood could improve trauma outcomes. [Display omitted]

Background Trauma is a leading cause of mortality and disability in low- and middle-income countries (LMICs). Among African nations, Ethiopia has one of the highest trauma fatality rates at 26.7% per 100,000 population, significantly exceeding rates in many other LMICs. Most trauma cases occur in the capital, Addis Ababa. Despite this significant burden, the effectiveness and quality of trauma care in Addis Ababa vary widely across hospitals, driven by disparities in available resources and the knowledge levels of trauma team members. Objective This qualitative study aimed to explore trauma team members’ perceptions of the effectiveness of the current trauma care system in Addis Ababa, Ethiopia. Methods This study used a qualitative phenomenological design to analyze trauma care team members’ perceptions of the current trauma care system in Addis Ababa, Ethiopia. The population included trauma team members, healthcare personnel, hospital leaders and coordinators from nine hospitals. The data were collected through semi-structured interviews and focus group discussions. The study used the Colaizzi approach and ATLAS.ti 23 software for data analysis. An inductive-deductive strategy, alternating between data analysis and emergent concepts and theories to identify patterns. Memos and display matrices were generated for in-depth analysis. Results This study identified several challenges with the trauma care system in Addis Ababa, Ethiopia, including a lack of effective leadership, coordination, and teamwork spirit; insufficient referral connections in the trauma care system; knowledge gaps among health-care professionals; and poor organization of the emergency room and trauma center. In addition, participants perceived that factors such as insufficient pharmaceutical and medical equipment and ineffective ambulance services may have contributed to the increased number of deaths and disabilities among trauma patients in the country. Conclusion The qualitative report highlights the gaps in Ethiopia's emergency trauma care system and recommends strategies for improvement, including clear leadership, policies, resources, communication, and continuous training.

Introduction Fluid resuscitation has long been a cornerstone of pre-hospital trauma care, yet its optimal approach remains undetermined. Although a liberal approach to fluid resuscitation has been linked with increased complications, the potential survival benefits of a restrictive approach in blunt trauma patients have not been definitively established. Consequently, equipoise persists regarding the optimal fluid resuscitation strategy in this population. Methods We analysed data from the two largest European trauma registries, the UK Trauma Audit and Research Network (TARN) and the German TraumaRegister DGU® (TR-DGU), between 2004 and 2018. All adult blunt trauma patients with an Injury Severity Score > 15 were included. We examined annual trends in pre-hospital fluid resuscitation, admission coagulation function, and mortality rates. Results Over the 15-year study period, data from 68,510 patients in the TARN cohort and 82,551 patients in the TR-DGU cohort were analysed. In the TARN cohort, 3.4% patients received pre-hospital crystalloid fluids, with a median volume of 25 ml (20–36 ml) administered. Conversely, in the TR-DGU cohort, 91.1% patients received pre-hospital crystalloid fluids, with a median volume of 756 ml (750–912 ml) administered. Notably, both cohorts demonstrated a consistent year-on-year decrease in the volume of pre-hospital fluid administered, accompanied by improvements in admission coagulation function and reduced mortality rates. Conclusion Considerable variability exists in pre-hospital fluid resuscitation strategies for blunt trauma patients. Our data suggest a trend towards reduced pre-hospital fluid administration over time. This trend appears to be associated with improved coagulation function and decreased mortality rates. However, we acknowledge that these outcomes are influenced by multiple factors, including other improvements in pre-hospital care over time. Future research should aim to identify which trauma populations may benefit, be harmed, or remain unaffected by different pre-hospital fluid resuscitation strategies.

Background In trauma systems, criteria for individualised and optimised administration of tranexamic acid (TXA), an antifibrinolytic, are yet to be established. This study used nationwide cohort data from Japan to evaluate the association between TXA and in-hospital mortality among all patients with blunt trauma based on clinical phenotypes (trauma phenotypes). Methods A retrospective analysis was conducted using data from the Japan Trauma Data Bank (JTDB) spanning 2019 to 2021. Results Of 80,463 patients with trauma registered in the JTDB, 53,703 met the inclusion criteria, and 8046 (15.0%) received TXA treatment. The patients were categorised into eight trauma phenotypes. After adjusting with inverse probability treatment weighting, in-hospital mortality of the following trauma phenotypes significantly reduced with TXA administration: trauma phenotype 1 (odds ratio [OR] 0.68 [95% confidence interval [CI] 0.57–0.81]), trauma phenotype 2 (OR 0.73 [0.66–0.81]), trauma phenotype 6 (OR 0.52 [0.39–0.70]), and trauma phenotype 8 (OR 0.67 [0.60–0.75]). Conversely, trauma phenotypes 3 (OR 2.62 [1.98–3.47]) and 4 (OR 1.39 [1.11–1.74]) exhibited a significant increase in in-hospital mortality. Conclusions This is the first study to evaluate the association between TXA administration and survival outcomes based on clinical phenotypes. We found an association between trauma phenotypes and in-hospital mortality, indicating that treatment with TXA could potentially influence this relationship. Further studies are needed to assess the usefulness of these phenotypes. Graphical abstract

Trauma team activation (TTA) is widely recognized to improve outcomes in trauma care; however, few studies have examined its long-term maturation and the effects of protocolized implementation. This study aimed to evaluate the impact of a comprehensive trauma team protocol introduced in 2012 in a single institution and to identify factors associated with patient outcomes. We conducted a retrospective cohort study of trauma patients who underwent TTA between 2006 and 2023 at a single medical center in Taiwan. The generalized protocol was implemented in 2012 for trauma patients who fulfilled the TTA criteria. Patients <18 years old, who were dead or had unknown vital signs on arrival at the emergency department (ED) or had been transferred from other institutions were excluded. The primary outcomes were the patient clinical outcomes; the time intervals to critical decision-making points after TTA were evaluated as secondary outcomes. Logistic regression was performed to identify independent risk factors. The study included 3002 patients. Compared with patients in the pre-protocolized stage (n = 518), patients in the protocolized stage (n = 2484) had a higher survival rate (90.5% vs. 79.7%, p < 0.001), lower morbidity (0.8% vs. 10.6%, p < 0.001), a higher success rate of nonoperative management (NOM) (39.0% vs. 27.2%, p < 0.001), and shorter ED-to-computed tomography (CT) times (39.0 vs. 52.6 min, p = 0.001). Multivariate analysis identified age, Trauma Score and Injury Severity Score (TRISS), Glasgow Coma Scale (GCS) score, and treatment stage as independent predictors of survival. In addition, timely ED-to-CT (≤60 min) was more frequent in the protocolized stage. Implementing a protocolized TTA system is feasible and can enhance the quality of trauma care, both in processes and outcomes. The treatment stage itself, independent of patient condition, serves as a determinant of clinical results. Tertiary trauma centers should consider adopting a standardized TTA protocol to improve patient outcomes. •Protocolized trauma care was associated with improved patient outcomes and better efficiency in terms of shorter emergency department -to-computed tomography times,