Despite the growing number of trauma centers over the past decade, studies indicate that their geographic distribution varies widely across states, according to background information in the article. These studies suggest that residents in many parts of the country are without timely access to trauma centers that could save their lives. In other parts of the country, there are possibly too many trauma centers that may lead to inefficiencies, reduced quality of care, and lower patient volumes per center.
Charles C. Branas, Ph.D., from the University of Pennsylvania School of Medicine, Philadelphia, and colleagues used information from two national databases to estimate U.S. residents' access to level I, II, and III trauma centers by ground ambulance or helicopter within 45 and 60 minutes. "Level I and II trauma centers provide comprehensive care for the most critically injured patients and have immediate availability of trauma surgeons, anesthesiologists, and certain other physician specialists," the article states. "Level III centers provide prompt assessment, resuscitation, surgery, and stabilization, with transfer to a level I or II center when indicated."
The researchers found that an estimated 69.2 percent and 84.1 percent of U.S. residents had access to a level I or II trauma center within 45 and 60 minutes, respectively. Residents in the northeastern region of the U.S. had the greatest access to level I and II centers within 45 and 60 minutes, with accessibility at 85.8 percent and 96.9 percent, respectively. The 46.7 million people who did not have access within an hour of trauma care generally lived in rural areas, while the 42.8 million people who had access to 20 or more level I or II trauma centers within an hour lived mostly in urban areas. Only about ten percent and 25 percent of U.S. land area was located within 45 and 60 minutes, respectively, of a level I or II trauma center.
"Judiciously selecting trauma centers based on geographic need, appropriately locating medical helicopter bases, and establishing formal agreements for sharing trauma care resources across states should be considered to improve access to trauma care in the United States," the authors conclude.
(JAMA. 2005; 293: 2626 – 2633. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported in part by the American Trauma Society Trauma Information and Exchange Program, a grant from the Agency for Healthcare Research and Quality, and a grant from the Centers for Disease Control and Prevention's Center for Injury Prevention and Control.
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