June 1, 2005
Many Americans Can’t Get Quick Injury Treatment
Almost 47 million Americans don't have rapid access to specialized trauma treatment centers should they get hurt in a serious accident, a national survey finds.
The problem is worst in thinly populated rural areas, but a lack of coordinated planning means access is also limited in some urban areas, according to a report in the June 1 Journal of the American Medical Association.Trauma centers, which differ from emergency rooms because they specialize in treatment of injuries, are listed in three classes, with Class I centers having the largest number of specialists available to patients in the shortest time.
An estimated 69 percent of Americans can be taken to a Class I center within 45 minutes, the survey found, and 84 percent can reach such a center within 60 minutes. "The 46.7 million Americans who had no access within an hour lived mostly in rural areas," the report said. The researchers based their findings on information from two national databases.
The issue of quick access to trauma care is also of great concern to many city-dwellers, stressed study lead researcher Charles C. Branas, an assistant professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia. While the American College of Surgeons has guidelines for establishment of trauma centers, "states pick and choose and have their own versions of those criteria," he said.
Inevitably, Branas said, "you won't get access for everyone in rural areas, but we can certainly do better with good planning."
The study was partially financed by the American Trauma Society, a private organization. "We are very interested in making sure that the country is well-covered in terms of access to trauma centers," said Harry M. Teter, executive director of the society.
One major issue, especially for rural patients, is the organization of helicopter ambulance services, Branas said. "Good geographic placement of these programs can increase access for rural residents," he said. But planning for helicopter services also differs widely from state to state, Branas said.
"Some states have government-run medical helicopter centers," he said. "Most states have private consortiums, or just leave it open to private enterprise. One of our recommendations is that there should be changes in such helicopter programs."
Another recommendation calls for closer cooperation between states in handling trauma patients who live near state borders. "If you are injured in Pennsylvania and want to get to a trauma center in Buffalo, there should be a seamless protocol that allows you to do this," Branas said. "States need to sit down and hash out these transfer agreements."
Many states do have such transfer agreements, but they cover only major disasters that require treatment of hundreds of patients, he said.
There has been talk about the need for centralized, national planning of trauma centers, Branas said, "which might be helpful for a number of reasons, not only for care in rural areas but also for national security."
A graphic illustration of the lack of national oversight arose when Branas was asked just how many Americans each year require treatment at trauma centers, and how many lives might be saved by a better organized system.
"We don't have centralized information on that," he said.
A detailed description of trauma centers is provided by the South Carolina Department of Health and Environmental Control.