Failing Report Card for US Trauma Care: “fragmented, overwhelmed and under-funded”

This post was authored by Sharon Stabile and posted to The Eye Opener on November 4th, 2010.

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From one of the country’s power trauma centers in San Diego California, Dr. Brent Eastman, Chief Medical Officer, Senior Vice President and Chair of Trauma at Scripps Memorial Hospital, as well as, Chairman of the Board of Regents for the American College of Surgeons (ACS) has sounded the warning alarms loud and clear.

Trauma Care in the US is fragmented, overwhelmed, and under-funded. High death rates in rural areas and a disconnect between existing trauma systems and regional preparedness adds to a bleak picture of the state of trauma care in the US.

Coordinated, regionalized, and accountable trauma systems are proven to get the right patients to the right hospitals at the right time. For victims of major trauma, access to timely,optimal care during the first golden hour has been proven to saves lives, restore function, and prevent disability.

Dr. Eastman is a national and international leader in the development of trauma centers in the US, England, Australia, Brazil, Argentina, Canada, Mexico, South Africa, India, and Pakistan. He has served as chairman on the CDC research steering committee, and the ACS Committee on Trauma Systems. He was a distinguished visiting surgeon in 2007 to the Combat Casualty Program at Landstuhl Medical Center in Germany. In 2009, he delivered the signature speech on trauma care the the annual ACS Clinical Congress. Dr. Eastman is a powerhouse with a powerful message.

  • US TRAUMA IS  FAILING.
  • THERE IS A SHORTAGE OF TRAUMA SURGEONS.
  • NEARLY 40% OF THE US POPULATION IS NOT COVERED BY STATE TRAUMA SYSTEMS. RURAL AND POOR AREAS ARE IN THE GREATEST NEED.
  • 38% OF STATES HAVE NO TRAUMA SYSTEM.
  • 62% OF STATES REPORT STATE FUNDING IS IN JEAPARDY; PROGRAMS ARE UNSUSTAINABLE.

The ACS has made 2 important databases available to the public. Their Committee on Trauma has published the listing of verified US trauma centers, and the National Trauma Databank Annual Report for 2010. Everyone should be familiar with their state’s data. If your state does not have a functional trauma care system during the best of times, then it surely will not function during more difficult times as in the event of a terrorist attack, earthquake, tornado, hurricane, serious fire with casualties, major multi-vehicle traffic accident, or other widespread disaster.

The ACS Committee on Trauma specifically verifies the presence of resources that are defined in Resources for Optimal Care of the Injured Patient. Trauma centers across the country voluntarily participate in the verification process. States where no trauma centers participated or where the resources were not sufficient to sustain even one verified center were Georgia, Florida, Maryland, Arkansas,  Hawaii, New York, Mississippi, Pennsylvania, South Carolina, Tennessee, and Washington.

If trauma centers in these states refused to participate, one must wonder why? Were they afraid of public disclosure of their shortfalls and/or financial troubles? Were they competitively afraid of not measuring up to other states? Perhaps it is poor coordination and communication within the state trauma systems as reported by Dr. Eastman? Or were they simply woefully underfunded and embarrassed?

In the NTDB Annual Report you will find 6 states had only 34% to 66% of the trauma centers submit outcome data. And 8 States had only 0% to 33% of the trauma centers submit outcome data. I have to wonder why there was not 100% participation. New York, Florida, Illinois, and Texas were among the under submitters. Other states included New Hampshire, West Virginia, Iowa, Oklahoma, Colorado, Washington, and Oregon.

It is surprising to me that New York, Florida, and Mississippi, where serious disasters have taken place and are at high risk for recurrence, have the least participation? I would think national trend data on trauma performance and needs would be critical to state and federal funding analysis and support?

As you scan the listing, you will see each state verified resources for Level I, II, and III trauma centers. The levels are determined by the ACS and defined as:

  • Level I – Treats a minimally required number of trauma patients each year. Offers 24 hour emergency treatment 7 days a week by a complete set of specialists including anesthesiologists, emergency and critical care, neurosurgeons, orthopedic surgeons, plastic surgeons, and other specialists. Offers full critical care services in addition to research, preventative, and outreach programs. Must be superior in injury prevention solutions, trauma education, and trauma recovery. Must be a major referral center for the neighboring regions.
  • Level II – Works in collaboration with the Level I center. May not have 24 hour availability of all needed specialists and professionals, but can provide the same trauma care and management as a Level I center. Does not have research or surgical residency programs.
  • Level III – Does not have 24 hour availability of specialists but can provide a comprehensive trauma care with emergency resuscitation, surgery, critical care required by most trauma patients.  Has transfer agreements with Level I and II centers for back-up of severely injured patients.

As you will see, Illinois has only 1 verified Level I trauma center. Alaska, Idaho, North and South Dakota, and Wyoming have no verified Level I trauma centers.

There was a Boston TV news expose in 2008 that revealed a state with some of the country’s finest medical facilities but who could not deliver the proper level of care.  There was a 2007 statewide survey where 62% of the state’s trauma patients didn’t get transported to a trauma center.  83% of patients who needed a helicopter transport didn’t have one called. In 1992 the National highway Traffic Safety Administration recommended Massachusetts set-up a state trauma registry. Data collection began in 2008, 16 years later and one month before the Boston news story broke.

Just do a search in your favorite search engine for trauma center in jeopardy and see all the articles that come up! Astounding.

Kudos to Georgia. I commend to you an article entitled, “The Quest for Sustainable Trauma Funding: The Georgia Story”, by Dennis W. Ashley, MD, FACS, FCCM in the October 2010 Bulletin of the American College of Surgeons. A fascinating read on how the state’s Trauma Services Study Committee responded to dismal 2006 performance and financial data. The Georgia trauma death rate was 20% below the national average; rural area death rates were much higher than the metropolitan rates; only 305 of trauma victims were treated in designated trauma centers; and the state was delivering $250 million in uncompensated trauma care annually. The death rate translated to 700 lives lost that could and should have been saved.

Dr. Ashley concluded, “It is imperative trauma surgeons do not try to develop a system or obtain funding on their own.” In Georgia the surgeons joined forces with the EMS, the Georgia Hospital Association, the Medical Association of Georgia, nursing associations, the Georgia Chamber of Commerce, state and local governments. With a unified directive, a statewide media campaign was begun to first educate the public on the issues, problems, and needs. Next,  the media and surveys were used to determine what Georgians were willing to pay for improved regional and statewide trauma care. These initiatives led to support for 2009 and 2010 legislative bills to fund improved trauma care.  Despite a terrible economy, adequate and sustainable trauma care in Georgia is finally becoming a reality.

It is a call to action in every community to be aware of your local community and region’s healthcare trauma needs and problems. Get involved, get the data!  It’s out there.


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