History

The concept of the trauma care continuum (TCC) dates back to 1984, when a study funded by the SAAQ (Québec’s automobile insurance corporation) advocated an integrated approach to care for victims of head trauma. In 1987, with the approval of the MSSS (Québec’s ministry of health and social services), the SAAQ signed agreements with a number of rehabilitation care facilities, fostering emergence of highly specialized care in some of these facilities. In 1991, these agreements were extended to the early rehabilitation services available in some centres specializing in neurotrauma. The agreements were broadened again in 1997 to include services for spinal cord injury victims and once again in 2000 to include services to victims of severe orthopedic injuries. Four years later, services for victims of severe burns were included as well.

In addition to these specific agreements, the MSSS asked the SAAQ in the early 1990s to come up with an overall blueprint for Québec’s trauma care network. The network took shape in stages:

• 1992: The SAAQ creates a trauma services advisory group. Using a matrix approach, the advisory group conducts the first assessment (an external audit) of the health care facilities network and recommends designation of certain institutions to create a trauma centre network.
• 1995: The trauma services advisory group examines whether the preliminary designations based on the matrix approach used in 1992 should be maintained.
• 1997: The trauma services advisory group evaluates two expert care centres for patients with spinal cord injuries as well as the rehabilitation component in the matrix used (quality standards and components of the service programs). A rehabilitation/reintegration support arm is added to the trauma services advisory group’s existing physical health arm.
• 1998-1999: The physical health arm of the trauma services advisory group carries out a third external audit, the goal to strengthen the trauma network by mandatory implementation, at each designated institution in the network, of a specific trauma care and services program, a standardized set of required trauma care procedures applicable to all centres and a continuous quality improvement program.
• 1999: The MSSS commissions the rehabilitation/reintegration support arm of the trauma services advisory group to evaluate facilities providing rehabilitation services for those who have sustained moderate-to-severe traumatic brain injuries (TBI).
• 2002: The rehabilitation/reintegration support arm of the trauma services advisory group launches the second phase of the mandate, designating consortiums of facilities (acute care and rehabilitation facilities) to provide services for those with moderate-to-severe TBIs.
• 2004: The trauma services advisory group (physical arm and rehabilitation/reintegration support arm) evaluates and designates two expert care centres for severe burn victims.
• Spring of 2004, the trauma services advisory group begins designing and engineering assessment functions for the entire TCC, the goal to centralize all TCC assessment-related data on a single computer platform so network performance can be monitored in real time.
• 2005: An advisory committee is formed to determine services to be provided to victims of mild TBI. The 2005-2010 ministerial guidelines for mild TBI are released in early 2006. The MSSS starts preparing a new version of these guidelines.
• 2006: The rehabilitation/reintegration support arm of the trauma services advisory group undertakes a second assessment cycle, the objective to consolidate the consortiums of facilities providing services to patients with a moderate-to-severe TBI.
• 2008: the team responsible for TCC assessment joins the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS), consolidating its assessment expertise.
• January 2011: The Act respecting the Institut national d’excellence en santé et en services sociaux (INESSS) enters into effect. INESS is created under this act by merging the Conseil du Médicament and AETMIS. The team responsible for continuous assessment of the TCC is incorporated in INESSS so it can continue to pursue and develop its trauma care mission. In 2017, this unit adds a critical care component to its program of scientific and assessment activities.
• In 2018, the trauma care services computer platform (FECST) is incorporated in the INESSS website.

For more information:

• The characteristics, history and implementation of Québec’s trauma care continuum (1991-2012)