Table 1 Standards of adequacy in trauma care. Pre-hospital time is considered from dispatch to hospital arrival; LOC: loss of consciousness; DPL: diagnostic peritoneal lavage; US: ultrasound; ET: emergency department thoracotomy; RH: retroperitoneal hematoma

1. pre-hospital time > 30 minutes

2. admission – OR time > 2 hours in patient requiring laparotomy or thoracotomy

3. admission-OR time > 4 hours in patient requiring craniotomy for epidural or subdural hematoma

4. transfer to a higher level hospital > 6 hours after initial hospital arrival

1. management not appropriate to ATLS guidelines during resuscitation (pre & in-hospital) and therapeutic or diagnostic decision contrary to available data

2. lack of airway control in LOC patient

3. lack of intravenous fluids in exsanguinating patient

4. lack of external bleeding control

5. lack of immobilization

6. lack of pleural decompression when requested

7. lack of thoracostomy tube in hemo-pneumothorax

8. lack of DPL or US or laparotomy in hemoperitoneum with unstable hemodynamics

9. median sternotomy in patient requiring ET

10. laparotomy in RH from closed pelvic fracture without associated abdominal injury

11. lack of CT-scan in GCS < 13 within 2 hours

an injury important in patient demise missed because of misinterpretation or inadequacy of physical examination or diagnostic procedures.