Systems of Care in the Management of Vascular Injury

In North America and Australia, systems of trauma care have been shown to reduce mortality and morbidity in injured patient populations. These systems rely on a health infrastructure that can rapidly match the patient's needs to the appropriate level of care, is able to ensure expeditious transport to the right health facility, and can ensure that treatment is rendered seamlessly across the whole of the patient's pathway. To function properly and to assure progressive improvement in standards, trauma systems are dependent on continuous analysis of outcome and process data allied to feedback mechanisms whose improvement actions are underwritten by an agreed authority. Proven in civilian circumstances, this concept was deployed in Afghanistan and Iraq to remarkable effect. The "ownership" of the vascular-injured trauma patient, whether treated within an overarching system of care or not, varies according to national and local circumstances. Vascular-trained surgeons have a stake in making sure that the same principles that increasingly govern their systems of care for patients with degenerative and chronic vascular disease are applied to patients with vascular injury. Trauma-trained surgeons have responsibilities to ensure that the domain knowledge and endovascular expertise of the vascular surgical community is continuously leveraged. By developing this dialogue, surgeons can safeguard the progressive systemization of care for patients with vascular injury and can set the conditions for continued improvement in outcome.