Improving access to trauma care in the United States

A study led by University of Pennsylvania School of Medicine researchers has, for the first time, determined access to trauma centers at the national level.

The study found that about 70 percent and 84 percent of all US residents had access to a Level I or Level II Trauma Center within 45 and 60 minutes, respectively. Most of the roughly 46.7 million Americans who had no access within an hour live in rural areas. The study's results are reported in the June 1 issue of the Journal of the American Medical Association.

"Quickly getting to a trauma center will very likely save your life if you are seriously injured, and we need to get more people basic access to these important hospitals," says the study's lead author, Charles Branas, PhD, an Assistant Professor of Epidemiology at Penn.

According to the study, a prime way to increase access to life-saving trauma care was through medical helicopters, which provided access to about 81.4 million Americans who otherwise would not have been able to reach a trauma center within an hour. The authors concluded that more, well-placed medical helicopter bases would be a practical way to extend trauma-center access to suburban and rural residents who currently have none.

The debate over just how many Americans have access to trauma centers, and how quickly, has been unsolved since trauma centers were created in the 1970s. Researchers and policymakers were thus eager to know the effect of location and how they might geographically reorganize trauma centers, ambulances, and medical helicopters to improve access. The researchers used two new national databases, one based on the location of trauma centers and another on the location of helipads to ascertain their figures.

To improve access to trauma care in the United States, the researchers offer three recommendations – select trauma centers based on the geographic need of the surrounding population, appropriately locate medical helicopter bases to provide outlying communities with access to trauma centers, and establish more agreements that allow residents injured in one state to use the trauma centers and ambulances in another.

"A concerted effort between hospitals, the air medical industry, and state policymakers is needed if we're going to expand rapid access to life-saving trauma care for Americans who have none," says Branas.

The study was funded by the Agency for Healthcare Research and Quality, the American Trauma Society, and the CDC National Center for Injury Prevention and Control. Study co-author C. William Schwab is from Penn. Other study co-authors are Ellen J. MacKenzie, Justin C. Williams, and Charles S. ReVelle with Johns Hopkins University; Harry M. Teter of the American Trauma Society; and Marie C. Flanigan and Alan J. Blatt with Calspan-University at Buffalo Research Center.

http://www.med.upenn.edu/