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Appendix GEmergency and Trauma Care in Texas: Assessment,Challenges, and OptionsPrepared by Charles Begley, i Sharron Cox, ii Arlo Weltge, I Cindy Gunn, iiiand Munseok Seo ii Center for Health Services ResearchSchool of Public HealthThe University of Texas Health Science Center – Houstonii Houston- Galveston Area Counciliii Memorial Hermann Healthcare SystemI. IntroductionOctober 2005Trauma is the leading cause of death for Texans under the age of 45 and the thirdleading cause of death and disability for all Texans. Every day there are an average of 32trauma deaths in Texas with motor vehicle crashes, suicide and homicide topping the list ofcauses. a Emergency and trauma care systems have been shown to increase survival ofseverely injured patients by providing pre-hospital emergency (EMS) and specialized hospitalcare (trauma care). b State and regional efforts to develop regionalized trauma systems havebeen ongoing in Texas for about 30 years. This paper provides a historical overview of thefactors contributing to the development of these systems, describes their characteristics,discusses current issues and challenges, and suggests options to enhance their developmentand performance.II.Historical OverviewThe historical development of trauma systems in Texas can be understood in relation tothe history of emergency medicine in the military, the realization of injury as a public healthproblem in the United States in the 1960s, and the subsequent federal and state governmentfunding of systems and services.The earliest historical evidence of emergency transport and treatment of woundedsoldiers in military campaigns dates back to the Roman Empire. Emergency medical practicesemployed by France in the Napoleonic Wars by Baron Dominique-Jean Larrey remain guidingprinciples still in use today. Baron Larrey developed battlefield protocols that included a rapidmode of transport, known as an ambulance volante, where trained personnel could reach thewounded quickly and provide stabilization and minor treatment before quickly evacuating themto aide stations or a medical facility for more definitive care. Efforts to replicate Larrey’s preceptsof rapid transport, immediate treatment, and triage were made in the United States during theCivil War. cIn the 20 th century, medical knowledge, technology and practice in treatment of woundedsoldiers advanced in the two world wars leading to progressively higher survival rates.Motorized transport provided quicker access to the wounded and to the various levels of care.G-1