Redefining Ladd's path Journal of Pediatric Surgery Mary E. Fallat  Journal of Pediatric Surgery  Volume 52, Issue 1, Pages 3-15 (January 2017) DOI: 10.1016/j.jpedsurg.2016.10.012 Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 1 Many noteworthy achievements in trauma care that resulted in enhanced survival were lessons learned from military experience. Abbreviations: M.A.S.H. (mobile Army surgical hospital); CSH (combat surgical hospitals); FST (forward surgical teams) Figure created by Krista Walker. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 2 A Pediatric Trauma System is an organized, coordinated effort in a defined geographic area that delivers the full range of care to all injured patients. Trauma system integration with the public health system includes prevention, acute care of injured patients including processes of care and outcomes, and integration of these services with emergency management and disaster planning. Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Courtesy of the Childress Institute for Pediatric Trauma Summit II, Winston-Salem, NC, held May 18–20, 2015. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 3 The continuum of care model recognizes that trauma care is a “team effort” that includes all aspects of care starting at the scene of the injury, the entire emergency care system including emergency medical service providers and emergency transportation, the emergency department, acute care hospitals and critical care units, rehabilitation, and re-entry into society. The continuum includes research as well as injury prevention, not represented here but depicted separately in Fig. 4. Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Courtesy of the Childress Institute for Pediatric Trauma Summit II, Winston-Salem, NC, held May 18–20, 2015. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 4 Most injuries are unintentional and preventable, making Injury Prevention key to the continuum of care model. Injuries can be lessened by using appropriate safety devices, including car and booster seats, seat belts, and helmets. Essential components of injury prevention include communication, education, data that shows the success of interventions, and legislation to ensure compliance with strategies that are lifesaving. Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Courtesy of the Childress Institute for Pediatric Trauma Summit II, Winston-Salem, NC, held May 18–20, 2015. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 5 A paradigm shift in how we view training of young surgeons who will devote all or part of their careers to caring for children of any age in any type of center could include an alignment with the new Optimal Resources for Children's Surgical Care Verification Program of the American College of Surgeons as well as Trauma Center Verification. Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 6 A Level I Center is generally a full service children's hospital that is also a trauma center in an urban location providing the expertise needed for the care of patients with complex conditions, who may require multidisciplinary involvement and services that are only available in a regional center. Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 7 A Level II Center may be a general hospital with a large children's unit, which may or may not also be a trauma center that takes care of children as well as adults. The number of complex or index cases will be less than in a Level I center and the hospital will generally transfer cases for which specialty care is unavailable to a Level I center using pre-established transfer protocols and guidelines. Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 8 A Level III Center may be a smaller urban or rural hospital, a Level III Trauma Center, or both. The hospital will take care of children with much lower acuity single system surgical problems and will have transfer protocols and guidelines for cases that require specialty care, which is unavailable or outside of the scope of practice of the surgeons who are on staff. Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 9 Pediatric surgeons have formed many critical relationships that inform our practice, where we practice, and training new pediatric surgeons. Many of these relationships were a direct result of the leadership of the American Pediatric Surgical Association (APSA). These include: the American Board of Surgery (ABS), the Association of Pediatric Surgery Training Program Directors (APSTPD), the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC), the National Resident Matching Program (NRMP), the American College of Surgeons and its Verification Programs for Trauma and Optimal Resources for Children's Surgical Care and companion quality programs (Pediatric National Surgical Quality Improvement Program (Pediatric NSQIP) and Trauma Quality Improvement Program (Pediatric TQIP), the American Academy of Pediatrics (AAP), the Emergency Medical Services for Children Program (EMSC), and the Children's Hospital Association (CHA). Figure developed by Tanya Gerber, Graphic Recorder, The Tremendousness Collective. Journal of Pediatric Surgery 2017 52, 3-15DOI: (10.1016/j.jpedsurg.2016.10.012) Copyright © 2017 Elsevier Inc. Terms and Conditions

Journal of Pediatric Surgery 2017 52, 3-15DOI: (10. 1016/j. jpedsurg Copyright © 2017 Elsevier Inc. Terms and Conditions