Veterinary trauma centers.

In this issueof the Journal,Abelsonet al1 report the results of a prospective single-centered investigation on the incidence of coagulopathy following severe acute trauma in dogs. The mere fact that the study was a prospective investigation of trauma in dogs already puts the study in a select category and serves as a reminder that focused investigations related to veterinary trauma are needed. Much of the existing studies relating to veterinary trauma are retrospective in nature. Evidence based protocols for the approach to treating animals sustaining severe trauma are lacking and some commonly employed practices are directly extrapolated from the human literature on trauma despite the recognition that key differences exist in the types of trauma sustained, the availability of pre-hospital care, and in the medical and surgical approaches to certain types of injuries. The ability to conduct large scale studies of animals sustaining severe trauma could lead to evidence based treatment recommendations and the development of protocols that that would greatly impact the outcome of this population of patients. A multi-institutional collaborative approach to gathering data on a large number of veterinary trauma patients would provide a foundation for veterinary trauma research. Such an undertaking requires organization, structure and funding in order to ensure that the information is adequately collected and managed. This undertaking was fortunately achieved in people with the formation of a Committee on Trauma, and we are happy to report that a similar effort in veterinary medicine is underway. Veterinary trauma patients account for 11–13% of admissions to small animal veterinary tertiary centers.2,3 Although the reported survival to discharge rate in dogs with traumatic injury is very good (85–91%),3–5 trauma is the second leading cause of death behind infectious disease for dogs under 1 year of age and neoplasia for dogs >1 year of age.6 A multidisciplinary, multiinstitutional group (Spontaneous Trauma in Animals Team [STAT]) was created in 2009 with a vision to improve trauma patient outcome through comparative and translational medicine. The team’s ultimate goal is to establish naturally occurring trauma in dogs as a pre-clinical model to improve human and veterinary trauma patient care, much in the same way veterinary oncologists and neurologists have done.7,8 During the ACVECC Multidisciplinary/Post Graduate Review meeting in January 2010, representatives from the STAT teamgathered todiscuss the idea of creating a network of veterinary trauma centers (VTC) that would collaborate to provide exceptional patient care as well as develop a method to enhance multi-institutional clinical research and education. As a result of this discussion and early efforts by the group, the American College of Veterinary Emergency and Critical Care (ACVECC) established the Veterinary Committee on Trauma (VetCOT) as an ad hoc committee in 2011. In people, trauma is the leading cause of death in people <34 years of age.9 In an effort to improve trauma patient care, theAmericanCollegeof Surgeons (ACS) established the Committee on Trauma (ACS-COT) in 1922.10 The first trauma centers were established in Chicago (Cook County Hospital) and San Francisco (General Hospital) in 1966.11 Ten years later (1976) the first “Resource” document was published regarding resource requirements for trauma centers. The goal of creating requirements for trauma centers is to ensure that all of the specialties required for definitive treatment of trauma patients are available with minimal delay, and to avoid the need to transfer patients with multi-system injuries to other facilities. It was hoped that “by virtue of the expertise contained within, training and research will be facilitated and there will be reciprocal improvements in trauma related services.”11 In 1987, theACS-COT formalized their Consultation and Verification process. Trauma centers then seeded the development of trauma systems which allowed for coordinated trauma care within communities, ensuring patients received the right resources for the right care at the right time. There is extensive literature documenting the improvement in trauma patient outcome in people cared at established trauma centers.9 The newly established VetCOT is striving to adapt the successes and modify the struggles encountered during the creation of human trauma networks in order to achieve measurable improvements in veterinary trauma patient care. The VetCOT is composed of 5 subcommittees populated by representatives from across the United States, Canada, and Australia. Drs. Kelly Hall and Claire Sharp spearheaded the effort to create the first document (“Guidelines”) outlining proposed resources required for Level I, II and III VTCs. The Guidelines and Verification subcommittee, led by Drs. Claire Sharp and Armelle deLaforcade, worked to modify the document and generate a consensus on requirements for VTCs (https://sites.google.com/a/umn.edu/vetcot/). This committee also generated an electronic survey distributed to all Diplomates of the ACVECC to ascertain interest in trauma center participation and identify, in a blinded fashion, the first wave of provisional VTCs based on likelihood that they would be able to verify