Trauma care in the U.S. is fragmented, overwhelmed and underfunded: American College of Surgeons 2009 Clinical Congress

AMERICAN COLLEGE OF SURGEONS 2009 Clinical Congress, October 11-15, 2009 -- Trauma care in the United States is so fragmented, overwhelmed and underfunded that the survival and recovery of those who suffer major trauma often depends on where they happen to be when they are injured. That was the conclusion voiced today during a signature speech at the 2009 Clinical Congress of the American College of Surgeons in Chicago.

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 the state of trauma care in the U.S., said A. Brent Eastman, MD, FACS, vice-chair of the ACS Board of Regents and Chief Medical Officer and N. Paul Whittier Chair of Trauma of Scripps Health in San Diego. He delivered the organization's annual speech on trauma, the Scudder Oration on Trauma, "Wherever the Dart Lands: Toward the Ideal Trauma System."

"Coordinated, regionalized and accountable trauma systems are proven to get the right patients to the right hospital at the right time," said Dr. Eastman. "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."

But Dr. Eastman pointed out during his presentation that there are many areas of our country, especially rural areas, not served by such systems. Assembling for the first time maps of the U.S. that show death rates due to trauma per 100,000 population, travel times to the nearest trauma center and populations of surgeons, he showed that a combination of a shortage of surgeons and gaps in regional trauma systems has stymied access to timely, appropriate trauma care in many areas of the country. This has led to unnecessarily high death rates due to trauma in those areas, and has contributed to the fact that trauma is the leading cause of death for those under the age of 45 in this country and in developing countries around the world.

In addition, Dr. Eastman revealed that in a survey this year of trauma surgeons in each state, nearly 40 percent of the U.S. population may not be covered by a statewide trauma system.

"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," Dr. Eastman added. "That's the vision when I say that wherever the dart lands on a map of the U.S., there should be a system of care to take care of you if you suffer a traumatic injury."

Dr. Eastman also told the stories of several trauma victims who were fortunate enough to have access to a trauma system. Joining him at the presentation were Johan and Jenna Otter, a father and his daughter who survived being attacked by a grizzly bear in Glacier National Park in 2005 thanks to a trauma system that rescued and flew them to a hospital in Kalispell, Mont. then on to a trauma center in Seattle, Wash.

He also discussed the highly developed military trauma systems in Iraq and Afghanistan as an ideal trauma model, where the injured are rapidly transported from combat zones to sophisticated care, in field hospitals, combat support hospitals, the Landstuhl Regional Medical Center in Germany and eventually to the continental U.S. In addition, Marine CPL William Gadsby, who lost his right leg in Iraq, was present to be acknowledged and pay tribute to the military surgeons in the audience.

Eastman called on his fellow surgeons to advocate for trauma systems in states or regions where fully developed systems are still lacking. He also addressed the need to include advanced trauma systems into health care reform discussion and initiatives, and the need for more trauma surgeons.