Trauma Care Fragmented, Study Finds

Trauma care in the United States is so fragmented and underfunded that the survival of people who suffer major injuries often depends on where they are when they're hurt, says Brent Eastman, MD, chairman of the Board of Regents of the American College of Surgeons.

Writing in the current issue of the Journal of the American College of Surgeons, Eastman said high death rates in rural areas, a growing shortage of trauma surgeons and a disconnect between existing trauma systems and regional disaster preparedness plans add to a bleak picture of trauma care in the nation.

Eastman is a general, vascular and trauma surgeon and CMO of Scripps Health and N. Paul Whittier Chair of Trauma at Scripps Memorial Hospital La Jolla, CA. His article in the journal's August edition—Wherever the Dart Lands: Toward the Ideal Trauma System—is the first time his findings have been published for public review. Eastman initially voiced his findings during his "Scudder Oration on Trauma" at the 2009 Clinical Congress of the ACS in Chicago. 

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

Eastman is a co-founder of San Diego County's trauma system, which has reduced preventable deaths in San Diego from 22% when it was deployed in 1984 to approximately 2% today.

Eastman wrote that many parts of the country, especially rural areas, are not served by trauma systems.

He compiled a map of the United States showing death rates due to trauma per 100,000 population, travel times to the nearest trauma center and populations of surgeons. It shows a shortage of surgeons and gaps in regional trauma systems, which Eastman says has stymied access to timely, appropriate trauma care in many areas of the country.

As a result, Eastman wrote, death rates due to trauma are unnecessarily high in those areas, contributing to the fact that trauma is the leading cause of death for people 45 and younger in the United States and in developing countries.

His survey of trauma surgeons in each state shows that 38% of states reported having no statewide trauma system. Of the 62% of states that have a statewide trauma system, for most, funding to sustain these systems is in jeopardy.

"Everyone living or traveling in the U.S. should be able to expect prompt transport to the appropriate level of care proportionate with their injuries," Eastman wrote. "That's the vision when I say that wherever the dart lands on a map of the U.S., there should be a system to take care of your traumatic injury."

Eastman wrote that the sophisticated military trauma systems in Iraq and Afghanistan are an ideal trauma model, and he called on surgeons to advocate for trauma systems in states or regions where developed systems are still lacking.