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Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (US) acute care hospital staff's ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers.

Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5,000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities.

US acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, US emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staff's ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state‐of‐the‐art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement.

This research uses the AHA annual surveys, which represent self‐reported data by individual hospital staff. However, the AHA expends significant resources to validate reported information and the annual survey data are widely used for hospital research.

The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure.

This article has important information on US emergency service availability in the hospital industry.

This study aims to examine trauma room staff’s perception of factors that influence workflow in trauma care from a physical environment standpoint.

A semi-structured focus group method was used. Trauma team members, representative of various roles within a team, were recruited from five Level I trauma centers in the USA, through a convenience sampling method. A total of 53 participants were recruited to participate in online focus groups. The Systems Engineering Initiative for Patient Safety model was used to analyze the findings.

In addition to factors directly related to the physical environment, aspects of people and technology, such as crowding and access to technology, were found to be related to the physical environment. Examples of factors that improve or hinder workflow are layout design, appropriate room size, doors, sink locations, access to resources such as X-ray or blood and access to technology. Seamless and uninterrupted workflow is crucial in achieving efficient and safe care in the time-pressured environments of trauma rooms. To support workflow, the physical environment can offer solutions through effective layout design, thoughtful location of resources and technology and room size.

Trauma rooms are time-pressured and complex environments where seconds matter to save a patient’s life. Ensuring safe and efficient care requires seamless workflow. However, the literature on workflow in trauma rooms is limited.

The purpose of this paper is to describe an American healthcare organization's experience creating the first multi-facility trauma system managed by a private, nonprofit organization.

A leadership structure was established to initiate the first steps of system development, followed by needs assessments that identified key components essential to creating the interconnected system. The key components were applied as a result of evidence-based system development. After system implementation, early benefits were explored.

Data collection and research, prehospital support, system-wide quality improvement, rural outreach, communication, and system evaluation were identified as key components essential to creating an interconnected trauma system. The system currently connects 12 trauma centers throughout the state of Colorado while working within the parameters of an established statewide system. Early benefits included improved designation review results, the utilization of system-wide best practice protocols, a rich trauma registry, and closer relations with rural, out-of-network facilities.

This study describes the process undertaken to implement a unique medical system that provides regionalized care and complements an existing statewide trauma system. The authors hope their experience may serve as a roadmap for healthcare professionals wishing to develop an integrated, patient-centered model of care.

The development of this multi-facility trauma system within a private, not-for-profit healthcare organization is the first of its kind.

This integrative literature review aims to explore themes within higher education that may be applicable to leadership education including: descriptions of trauma, trauma-informed practices and trauma-informed practitioners.

Integrative, systematic literature review.

The results suggest that trauma and trauma-informed practices may have a place in leadership education pedagogy.

There is no work being done in trauma informed practice in leadership education. This study provides future direction for both research and practice.

This study aims to discover how leadership emerges in a hospital’s trauma team in a simulated trauma care situation. Instead of investigating leadership from a leader-centric perspective, or using a metrics-based approach to reach generalizable results, the study aims to draw from post-heroic theories by applying leadership-as-practice and sociomaterial perspectives that emphasize the cultural-historical context and emergent nature of leadership.

The study was conducted in a Finnish central hospital through ethnographic observations of 14 in situ trauma simulation trainings over a period of 13 months. The data consist of vignettes developed and written from field notes. The analysis was informed by the cultural-historical activity theory.

Leadership in a trauma team during an in situ simulation training emerges from a complex system of agencies taking place simultaneously. Contextual elements contributed to the goal. Clarity of roles and task division, strong execution of leadership at critical points, active communication and maintenance of disciplined communication helped to overcome difficulties. The team developed coordination of the process in conjunction with the care.

The study considers trauma leadership to be a practical phenomenon emerging from the trauma team’s sociomaterial context. The results can be used to develop non-technical skills training within the field of simulation-based medical training.

The research is an administrative case study based on an extensive review of Hawaii government documents and interviews with key personnel of the Hawaii Emergency Preparedness Committee, civil defense and other relevant officials. Describes the interagency coordination at the federal, state, county, and community level to improve capability. Also described and critically evaluated are the roles of interagency emergency preparedness training, disaster drills, and coordination and partnership with the private sector, such as medical centers and the Federal Emergency Management Agency’s designated “disaster resistant communities” in Maui and Hawaii County. Recommends that more frequent interagency drills, increased funding for family emergency preparedness and local community response teams, and continuous training by emergency response coordinators could improve state and county disaster preparedness and concludes that, overall, Hawaii is adequately prepared in emergency response capability, particularly in the areas of medical services and interagency coordination.

Complex clinical situations, involving multiple medical specialists, create potential for tension or lack of clarity over leadership roles and may result in miscommunication, errors and poor patient outcomes. Even though copresence has been shown to overcome some differences among team members, the coordination literature provides little guidance on the relationship between coordination and leadership in highly specialized health settings. The purpose of this paper is to determine how different specialties involved in critical medical situations perceive the role of a leader and its contribution to effective crisis management, to better define leadership and improve interdisciplinary leadership and education.

A qualitative study was conducted featuring purposively sampled, semi-structured interviews with 27 physicians, from three different specialties involved in crisis resource management in pediatric centers across Canada: Pediatric Emergency Medicine, Otolaryngology and Anesthesia. A total of three researchers independently organized participant responses into categories. The categories were further refined into conceptual themes through iterative negotiation among the researchers.

Relatively “structured” (predictable) cases were amenable to concrete distributed leadership – the performance by micro-teams of specialized tasks with relative independence from each other. In contrast, relatively “unstructured” (unpredictable) cases required higher-level coordinative leadership – the overall management of the context and allocations of priorities by a designated individual.

Crisis medicine relies on designated leadership over highly differentiated personnel and unpredictable events. This challenges the notion of organic coordination and upholds the validity of a concept of leadership for crisis medicine that is not reducible to simple coordination. The intersection of predictability of cases with types of leadership can be incorporated into medical simulation training to develop non-technical skills crisis management and adaptive leaderships skills.

The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran.

This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA.

In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA.

Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate.

To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs.

This paper aims to examine complex clinical decision‐making processes in trauma center units of hospitals in terms of the immediate impact of complexity on the medical team involved in the trauma event.

It is proposed to develop a model of decision‐making processes in trauma events that uses a Bayesian classifier model with convolution and deconvolution operators to study real‐time observed trauma data for the decision‐making process under tremendous stress. The objective is to explore and explain physicians' decision‐making processes under stress and time constraints during actual trauma events from the perspective of complexity.

Because physicians have blurred information and cues that are tainted by random environmental noise during injury‐related events, they must de‐blur (de‐convolute) the collected data to find a best approximation of the real data for decision‐making processes.

The data collection and analysis is innovative and the permission to access raw audio and video data from an active trauma center will differentiate this study from similar studies that rely on simulations, self report and case study approaches.

Clinical decision makers in trauma centers are placed in situations that are increasingly complex, making decision‐making and problem‐solving processes multifaceted.

The science of complex adaptive systems, together with human judgment theories, provide important concepts and tools for responding to the challenges of healthcare this century and beyond.

The purpose of this paper is to describe the use of group concept mapping (GCM) as a tool for developing a conceptual model of an episode of acute, unscheduled care from illness or injury to outcomes such as recovery, death and chronic illness.

After generating a literature review drafting an initial conceptual model, GCM software (CS Global MAX^TM) is used to organize and identify strengths and directionality between concepts generated through feedback about the model from several stakeholder groups: acute care and non-acute care providers, patients, payers and policymakers. Through online and in-person population-specific focus groups, the GCM approach seeks feedback, assigned relationships and articulated priorities from participants to produce an output map that described overarching concepts and relationships within and across subsamples.

A clustered concept map made up of relational data points that produced a taxonomy of feedback was used to update the model for use in soliciting additional feedback from two technical expert panels (TEPs), and finally, a public comment exercise was performed. The results were a stakeholder-informed improved model for an acute care episode, identified factors that influence process and outcomes, and policy recommendations, which were delivered to the Department of Health and Human Services’s (DHHS) Assistant Secretary for Preparedness and Response.

This study provides an example of the value of cross-population multi-stakeholder input to increase voice in shared problem health stakeholder groups.

This paper provides GCM results and a visual analysis of the relational characteristics both within and across sub-populations involved in the study. It also provides an assessment of observational key factors supporting how different stakeholder voices can be integrated to inform model development and policy recommendations.