Access to Trauma Centers in the United States

Abstract

Context Previous studies have reported that the number and distribution of trauma centers are uneven across states, suggesting large differences in access to trauma center care. Objective To estimate the proportion of US residents having access to trauma centers within 45 and 60 minutes. Design and Setting Cross-sectional study using data from 2 national databases as part of the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) project. Trauma centers, base helipads, and block group population were counted for all 50 states and the District of Columbia as of January 2005. Main Outcome Measures Percentages of national, regional, and state populations having access to all 703 level I, II, and III trauma centers in the United States by either ground ambulance or helicopter within 45 and 60 minutes. Results An estimated 69.2% and 84.1% of all US residents had access to a level I or II trauma center within 45 and 60 minutes, respectively. The 46.7 million Americans who had no access within an hour lived mostly in rural areas, whereas the 42.8 million Americans who had access to 20 or more level I or II trauma centers within an hour lived mostly in urban areas. Within 45 and 60 minutes, respectively, 26.7% and 27.7% of US residents had access to level I or II trauma centers by helicopter only and 1.9% and 3.1% of US residents had access to level I or II centers only from trauma centers or base helipads outside their home states. Conclusion Selecting trauma centers based on geographic need, appropriately locating medical helicopter bases, and establishing formal agreements for sharing trauma care resources across states should be considered to improve access to trauma care in the United States.

Rural risk: Geographic disparities in trauma mortality

“…23 This increased risk of death may result in part from differences in injury incidence, 13, 14 but our findings suggest that differences in injury response also contribute to injury mortality in rural populations, including documented barriers to trauma center access for the majority of rural residents. 5 Our findings are consistent with prior studies indicating that rural residents are more likely to die from injury that non-rural residents. 19,40 While our findings are not consistent with the overall findings of Lipsky et al, we do find variation in mortality across trauma designation levels, with no disparity found at Level III and IV trauma centers, which may support a similar conclusion that well organized EMS systems reduce mortality in populations with limited trauma center access.…”

“…While many rural residents in the both regions live more than an hour from a Level I or II trauma center, time to trauma center care is longer in the Midwest than in the South. 5 Treatment in the West region does not predict mortality, and we did not observe a disparity in mortality for rural residents in the West region. Again, this is likely due to travel times, which are longer in the West than in any other Census region.…”

“…Nearly all of Northeast region falls within a sixty minute drive of a Level I or II trauma center, while other regions have larger rural populations living more than an hour from trauma care. 5 Treatment in the Midwest region does not predict higher odds of death, but rural residents in the Midwest face a greater disparity in mortality than rural residents in the South. This may be due to variation in time to treatment for rural residents across regions.…”

“…Again, this is likely due to travel times, which are longer in the West than in any other Census region. 5 Travel times in the West region may be long enough that patients are dying in transit (and not included in the NEDS), while similar patients in other regions die in the ED. Differences in EMS system structure and pre-hospital care also likely contribute to regional variation in injury mortality, [37][38][39] including the presence of well-organized EMS systems in the West region, as noted by Lipsky, et al 18 Approximately 20% of the US population live in rural areas and face elevated risk of death from injury.…”

“…5 Geographic barriers to trauma care are more likely to impact racial minorities and people living in poverty, 6 paralleling established racial and socioeconomic disparities in trauma mortality. [7][8][9][10][11][12] Rural residents face elevated risk of traumatic injury compared to non-rural residents, 13,14 and injury mortality rates are higher in rural communities than in urban and suburban settings.…”