[Polytrauma and the hospital structure]

Hospital standards for the care of multiple traumatized patients include certain clinical capabilities, special logistics (appraisal of structure), and--even more important--algorithms for simultaneous activities in diagnosis and therapy (assessment of process). The main goal in the trauma system should be definitive, specialized care for the injured in the shortest possible time. Economically there is no way of creating a tight network of highly developed trauma centers close to every patient. Also primary air-transport by helicopters over some distances in every case is not realistic (darkness, weather conditions). Therefore, an algorithm that is dependent on regional conditions is needed for primary care and stabilization of multiple trauma patients in smaller hospitals followed by early transfer to trauma centers. The effectivity of this stepwise approach must be compared with primary care in a trauma center. Trauma registers are necessary to plan for the future. Quality improvement programs (education, system evaluation) should be installed, especially for smaller hospitals bound into the trauma system. Financial support is essential for hospitals designated for care of multiple traumatized patients in rural areas.