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In traumatology, what is the trauma care continuum (TBI)?

Quebec has developed its own organizational model for all services provided directly or indirectly to brain-injured persons. In addition to improving chances of survival, efficient coordination between care delivery levels fosters better social integration of brain-injured persons. [1]

The trauma care continuum includes prevention, acute care and rehabilitation. Consisting of 14 links, it involves governmental and para-governmental agencies, universities and community organizations. The links in the trauma care continuum are grouped into 5 main stages.

Continuum’s main stages [2]

Prior to the accident: accident prevention

Examples of road accident prevention include road transportation controls and rules as well as police controls. Occupational safety and health legislation and the Civil Code also foster occupational accident as well as other kinds of prevention. Awareness campaigns (advertisements) have been developed to reach a large segment of the public.

At the time of the accident: injury prevention

Safety rules have been implemented to reduce the risks of injury in the event of an accident. They include wearing a safety belt in a car or a helmet on a bicycle and using children’s car seats. Helmets and harnesses are used by construction workers for occupational safety.

After the accident: prior to arriving at the hospital

Many services play a key role in the case of accidents with injuries:

  • Calls are received at 911 call centres,
  • Health communication centres identify needs, send necessary resources to the accident site and refer people to the proper health care establishments.
  • The police, firefighters and ambulance attendants may also be involved.

At the hospital: stabilization

Brain-injured persons are first sent to a hospital, where their condition is stabilized within 10 minutes (if there are no trauma centres within 30 minutes). Then the patient may be transferred to another hospital where specialized trauma services are offered and where they can receive critical and acute care. Rehabilitation begins with the help of an interdisciplinary team.

After discharge from hospital: rehabilitation

Rehabilitation takes place in different settings:

  • In a rehabilitation centre that provides inpatient services,
  • In other establishments that provide outpatient services,
  • There are also community-based reintegration services.

[1] Lavoie, A., N. Lesage, and J.S. Sampalis. Continuity of Care for Major Trauma Victims in an Integrated and Regionalized System. Research Report, Ottawa: Canadian Health Services Research Foundation, 2002.

[2] Information concerning the TCC has come from a [Quebec government pamphlet on the subject->