Americans See Access to Trauma Centers Decline

Approximately 25 percent of Americans had to travel farther in 2007 than in 2001 to access their nearest trauma center, published in Health Affairs.

In the 15 years between 1990 and 2005, nearly 339 or 30 percent of trauma centers closed, compared with just 66 closures between 1981 and 1991.  The majority of the centers closed because of financial problems resulting from treating too many uninsured patients and the cost of making life-saving resources available 24/7.  The study determined that the average increase in travel time to a trauma center was about 10 minutes, but that about 16 million people saw travel times increase by more than one-half hour.  Researchers found that residents of rural areas and communities with large minority populations, low-income and uninsured residents were most likely to be impacted.

“We’re not saying that we should build a trauma center on every street corner. But we do have evidence that access for certain populations is already pretty bad, and it’s getting worse,” Renee Hsia, lead researcher and emergency department doctor at San Francisco General Hospital.

When looked at in a different way, the study determined that 69 million Americans now have a longer trip to their closes trauma center than they did just 10 years ago.

The researchers studied longitude and latitude coordinates for every trauma center in the United States.  Next, they measured driving distances and times between trauma centers and area ZIP codes, factoring in population data.  They compared the results for 2001 and 2007, the most recent year for which data was available.  Hsia said the results surprised the researchers.

Designed to handle complex injuries, trauma centers are different from emergency rooms.  Someone with a broken leg should go to the emergency room; a person with multiple fractures should go to a trauma center.  A patient with a concussion can be treated in the emergency room, while someone with a brain injury should be taken to a trauma center.  Time is all important.  Medical experts agree that a severely injured victim’s chances of survival and returning to a normal life are optimal if they can get the right treatment within an hour.  It’s called the “golden hour,” derived from military medicine during the Vietnam War and still guiding medical units in Afghanistan and Iraq.  “A 30-minute increase means half that time is wasted on driving,” Hsia said.  “A quarter of the population is significant.”

“We’re not saying that we should build a trauma center on every street corner. That would not be cost-effective,” Hsia said.  “But we do have evidence that access for certain populations is already pretty bad, and it’s getting worse.”

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