Trauma systems and early management of severe injuries in Scandinavia: review of the current state.
BACKGROUND
Scandinavian countries face common challenges in trauma care. It has been suggested that Scandinavian trauma system development is immature compared to that of other regions. We wanted to assess the current status of Scandinavian trauma management and system development.


METHODS
An extensive search of the Medline/Pubmed, EMBASE and SweMed+ databases was conducted. Wide coverage was prioritized over systematic search strategies. Scandinavian publications from the last decade pertaining to trauma epidemiology, trauma systems and early trauma management were included.


RESULTS
The incidence of severe injury ranged from 30 to 52 per 100,000 inhabitants annually, with about 90% due to blunt trauma. Parts of Scandinavia are sparsely populated with long pre-hospital distances. In accordance with other European countries, pre-hospital physicians are widely employed and studies indicate that this practice imparts a survival benefit to trauma patients. More than 200 Scandinavian hospitals receive injured patients, increasingly via multidisciplinary trauma teams. Challenges remain concerning pre-hospital identification of the severely injured. Improved triage allows for a better match between patient needs and the level of resources available. Trauma management is threatened by the increasing sub-specialisation of professions and institutions. Scandinavian research is leading the development of team- and simulation-based trauma training. Several pan-Scandinavian efforts have facilitated research and provided guidelines for clinical management.


CONCLUSIONS
Scandinavian trauma research is characterised by an active collaboration across countries. The current challenges require a focus on the role of traumatology within an increasingly fragmented health care system. Regional networks of predictable and accountable pre- and in-hospital resources are needed for efficient trauma systems. Successful development requires both novel research and scientific assessment of imported principles of trauma care.
Kristiansen
Thomas
T
Norwegian Air Ambulance Foundation, Department of Research, Drøbak, Norway. thomas.kristiansen@snla.no
Søreide
Kjetil
K
Ringdal
Kjetil G
KG
Rehn
Marius
M
Krüger
Andreas J
AJ
Reite
Andreas
A
Meling
Terje
T
Naess
Pål Aksel
PA
Lossius
Hans Morten
HM
D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007391:International Cooperation; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer / Q000458:organization & administration; D010819:Physician's Role; D011247:Pregnancy; D012042:Registries; D019035:Rural Health Services / Q000458:organization & administration*; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D013997:Time Factors; D014187:Transportation of Patients / Q000458:organization & administration; D014194:Traumatology / Q000193:education / Q000458:organization & administration* / Q000639:trends; D014218:Triage / Q000458:organization & administration; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000453:epidemiology