The trauma care continuum (TCC) is structured in accordance with Haddon’s1 three levels of prevention and is subdivided into 14 coordinated components, beginning with accident prevention and ending with reintegration into the community.


The INESSS trauma and critical care evaluation unit focuses on tertiary prevention level activities, that is, the post-event phase of the trauma care continuum, which covers three types of services:

Pre-hospital services (components 3 to 6) – all interventions and activities in the continuum after the 911 call reporting the event:

  • 911 dispatchers and health communication centres
  • Police and first responders: rapid, standardized response to stabilize the injured and secure the accident scene until the arrival of the ambulance services
  • Ambulance services: transport of the injured to designated trauma care facilities

Hospital services (components 7 to 11) – provided by designated health facilities that offer services depending on their resources. Trauma care facilities are classified as follows:

  • Stabilization centres: facilities in remote, isolated areas whose task is basically to stabilize breathing. Trauma victims should remain in these facilities for no more than 10 minutes.
  • Primary trauma care centres: facilities more than 30 minutes from a secondary or tertiary trauma care centre that offer general surgery and anesthesia services.
  • Secondary trauma care centres: facilities offering general surgery, orthopedic care, critical care and early rehabilitation services.
  • Regional secondary or neurotrauma centres: facilities providing supplementary orthopedic, critical care and neurotrauma care services for their region or territory.
  • Tertiary trauma care and tertiary pediatric centres: facilities providing specialized and ultraspecialized trauma care and neurosurgery as well as specialized intensive care and interdisciplinary early rehabilitation services. As part of consortiums, some tertiary trauma care centres are responsible for subspecialized neurotramatology services for their regions. Some tertiary facilities are also part of a centre of expertise.
  • Centres of expertise: facilities offering subspecialized services for victims of spinal cord injuries and severe burns or those requiring emergency microsurgical replantations. These centres comprise a consortium of facilities working in partnership with rehabilitation facilities, the whole constituting the centre of expertise.

Post-hospital rehabilitation and social integration services (components 12 to 14) – services for trauma victims whose lifestyle is significantly jeopardized by one or more effects of their injuries. Specialized in-patient as well as out-patient rehabilitation services are provided depending on patient needs. Community support services are also provided to those with permanent disabilities so they and their families can enjoy a satisfactory quality of life and participate in society as fully as possible.

1 Haddon W. (1973). « Energy damage and the 10 countermeasure strategies ». Journal of Trauma. Vol.13:321-331.

For more information:
Ajouter liens vers:
•    The Trauma Care Continuum (brochure)
•    The characteristics, history and implementation of Québec’s trauma care continuum (1991-2012)

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