Care Continuum


Trauma Care Continuum (TCC)

What is it?

The Trauma Services Continuum (TSC) is the organizational model for trauma care and services in Québec. It consists of 14 components that cover all types of prevention, that is, primary, secondary and tertiary prevention. The TSC is a cross-sectoral system in which government, parapublic, university and community agencies work together.

The TSC is centred on a framework based on the Haddon matrix, which includes three types of prevention. Primary prevention, which consists of preventing accidents, and secondary prevention, aimed at preventing injury, are respectively the first and second components of the Trauma Services Continuum. Tertiary prevention, which targets reduction of mortality and morbidity associated with injury sustained in an accident, is also a prominent issue of concern among partners of the continuum.

The mission

The mission of the Institut national d’excellence en santé et en services sociaux (INESSS) is to promote clinical excellence and the efficient use of health and social service resources. For this reason, INESSS has an active role in the Trauma Care Continuum (TCC). Quebec studies have shown that primary and secondary prevention, being the first links of the TCC chain, has contributed to a 55% drop in the number of road deaths. In addition, the mortality rate for trauma victims who benefited from the TCC went from 51.8% in 1992 to 8.6% in 2002. The INESSS Trauma Services Continuum Team’s mandate is to consolidate the trauma network and monitor the assessment functions of 14 TCC components to continuously improve the quality of care available to trauma victims.

A computerized assessment tool has been developed to continuously document and evaluate the level of achievement of performance indicators identified for each of the links. This tool is hosted on this website, which has a secure section that is accessible only to trauma network partners. This section contains the indicators as well as the levels of achievement. A general section that is accessible to the public includes information on trauma and the stakeholders in the TCC.

The goals

The TCC is an integrated services network offering trauma victims all the personalized services necessary depending on the complexity and severity of their condition. The main goals of the TCC are accessibility, performance, quality and continuity.

  • Accessibility: the network must provide immediate comprehensive care through the health system to any victim of severe or potentially severe trauma. This implies an integration of services, from pre-hospital emergency services to hospital services to post-hospital services.
  • Performance: an essential priority in traumatology is reducing wait times to ensure the best chances for patient survival. Several tools have been developed at the international level to facilitate triage at the pre-hospital emergency services stage. Procedures and protocols have been developed to enable better organization and coordination of activities and resources.
  • Quality: all actions in the chain of interventions for the post-collision phase are defined by the procedures and protocols shared and recognized by all the stakeholders in the network. Local committees also play a key role in continuously improving quality, for example, by implementing a case review for certain files. Consultation mechanisms between the different levels (local, regional, national) have been established to ensure cohesion in achieving goals.
  • Continuity: the TCC must allow every patient to have access to specialized and sub-specialized care, regardless of their geographical situation or the severity or complexity of their trauma. To this end, bidirectional service corridors and administrative agreements have been established to facilitate patient transfers and the abolition of the right to refuse for institutions.
Pre-collision Collision Post-collision