Trauma centers save lives… unequally

Often the sites of harrowing injuries, trauma centers are a vital part of the U.S healthcare system. Trauma centers save lives. According to the New England Journal of Medicine, victims treated at trauma centers have a 25% higher survival rate when compared with treatment at non-trauma hospitals.

The simple assertion that trauma centers save lives opens an ongoing discussion about racial, economic, and geographic inequality that has plagued the U.S. Trauma center designations are currently determined state by state and verified by the American College of Surgeons.

Would a national system solve vast inequality and better serve Americans?

Trauma centers born from conflict

Trauma centers are at heart a direct result of military conflict, and medical knowledge gained from the battlefield impacts care provision in our centers today.

The first trauma center serving U.S. civilians opened in 1966. By 1988, 35 states had developed networks of trauma centers, and the nation currently has over 520 Level 1 and 2 trauma centers.

Level designation and verification

Trauma categories are determined at a state level. Of the common designations, Level 1 trauma centers are tertiary facilities that offer the highest level and comprehensive care, from injury prevention to rehabilitation.

Level 2 centers are equipped for definitive diagnosis and immediate treatment for all injured patients. Those designated Level 3 provide resuscitation, surgery and intensive care. Level 4 centers offer the lowest levels of trauma care and focus only on life support and stabilization prior to patient transfer.

The American College of Surgeons (ACS) verifies that facilities meet the qualifications for their level designation. ACS verification is voluntary and about 50% of facilities obtain it. According to ACS data, ACS-verified centers offer better-quality care.

Trauma centers save lives, but suffer from inequality

The truth is, trauma centers save lives, but the distribution of trauma centers across the U.S. is far from equal. Almost 50 million Americans are unable to reach a Level 1 or 2 center in 60 minutes or fewer. Inequality also transcends geography. Areas with high African American populations, poverty, and uninsured residents are more likely to experience deteriorating access to trauma centers. Additionally, in Chicago, a University of Chicago study found that Hispanic and Latino communities were more likely to be farther from trauma care than those living in white communities.

The role of finance

Trauma centers treat a great proportion of patients who are unable to pay for their care. And private hospitals have discontinued trauma care because of it. Meanwhile, government and private payers are increasingly funding more trauma care. Certain geographical areas are seeing rapid trauma facility expansion. Although trauma center facility expansion will result in a decreases inpatient mortality, changes in the insurance system are needed to allow these new centers to stay open. Trauma centers already endure high fixed costs. Thus, they need patients to pay for services.

A vision for a national network

Trauma centers are a relatively new service within medical care delivery. While they improve care and save lives, experts within the National Academies of Science, Engineering and Medicine and the American College of Surgeons are concerned that the current structure is not impacting as many people’s lives as it could be. Despite the current pandemic, metropolitan trauma centers are still experiencing a steady flow of penetrating trauma injuries (gunshot wounds or stabbings).

The current patchwork system is not equitable, surgeons argue. Rural areas continually lack ease of access while minorities in metropolitan areas frequently live in “trauma deserts.” As the current pandemic has proven, we as a nation are unprepared for large-scale catastrophic events within our borders.

This is sobering news, and also an important time to talk about how to best engage with stakeholders in trauma care.

Snowfish has been helping leading pharma, biotech and med device companies optimize their stakeholder networks for almost two decades. Reach out to Snowfish or, to learn about how our expertise can enable your team to partner with these important stakeholders.


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