Access to a Level I trauma center lowers the risk of death by 25% but not all trauma victims have immediate access to this highest level of trauma care. Nearly 45 million Americans are still not within an hour of a Level I or II trauma center. The lack of emergency care and trauma centers has a disparate impact on the poor, those in rural areas and those who are geographically distant from trauma centers.
These disturbing facts were confirmed most recently in the December 2016 issue of The Journal of the American College of Surgeons in an article entitled, "Geographic Distribution of Trauma Burden, Mortality, and Services in the United States: Does Availability Correspond to Patient Need? (Vol. 223, 764-773)." Unfortuately, the simple answer to this highly relevant question is "no." In the authors' analysis of over 1.3 million trauma admissions at 1,987 trauma centers spread across the country they found that there is no association between the density of trauma admissions and the location of Level I and Level II trauma centers. States with higher trauma burdens tend to have lower per-capita income and increased mortality rates. However, there is no association between trauma admissions and availablity of trauma centers.
This marked regional variation between clinical need and availability of trauma services across the United States is something we should all be concerned about no matter where we live because it could affect our friends and loved ones and even us if we find ourselves traveling into these underserved areas. What can be done about this life-threatening discrepancy in trauma services? The authors of this timely study admit that there is no easy solution although a centrally organized national trauma system, something that does not exist now, might have the insight and authority to help balance resources and urge a more equitable distribution. The authors also suggest that perhaps the trauma center verification process might be altered to include an assessment of local need.
This is one more issue that a National Insitute of Trauma Medicine would be able to address but there isn't one in the United States. Trauma, the fourth leading cause of death and the number one cause of death between the ages of 1 and 44 doesn't merit one . . . . yet.
More about trauma centers and how they save lives in Chapter 6 of my book Hurt: The Inspiring, Untold Story of Trauma Care.