Many U.S. regions lack trauma care access

BALTIMORE, March 25 (UPI) -- Although there has been an increase in the number of U.S. trauma centers in the last decade, some communities still do not have access to such specialized centers, which could prove essential in treating victims of a terrorist attack, a new study released Tuesday concludes.

"The number of centers has definitely increased over the last decade," the study's lead author, Ellen MacKenzie, who serves as director of Johns Hopkins University's School of Public Health's Center for Injury Research and Policy, told United Press International.

"However, there are still areas of the country where an adequate number of trauma centers seem to be lacking and that would translate into poor access to trauma care when you're severely injured," MacKenzie said.

Increased emphasis has been placed on preparing to respond to a terrorist attack involving biological weapons, MacKenzie noted, but all past terrorist attacks -- including Sept. 11, 2001 -- involved explosives that resulted in severe physical injuries, which trauma centers are specifically designed to treat.

In addition, "trauma centers are located in hospitals that are going to take the lead in responding to bioterrorism events just because they are located in larger and well-equipped hospitals," she said. These centers also have well-established links with fire, police and rescue departments that are necessary to respond to a terrorist event, she added.

"We need as a society to fund this trauma center infrastructure," MacKenzie said, noting in addition to their role in a terrorist attack, trauma centers are essential for treating severe injuries such as gunshot wounds and those sustained in automobile crashes -- the No. 1 killer of children and adults up to age 44.

Trauma centers consist of more than emergency rooms, which have a more general focus. Trauma centers are equipped and staffed 24 hours a day, seven days a week with a team of specialists trained in treating life-threatening severe injuries.

In the study, which appears in the March 26 edition of the Journal of the American Medical Association, MacKenzie's team conducted the first inventory of trauma centers in the United States since 1991. They found the number of centers more than doubled in the last decade, going from 471 in 1991 to 1,154 in 2002. Every state has at least one trauma center.

Despite the increase, many rural areas still lack access to a trauma center. About 90 percent of the level I and II centers -- considered the top-tier centers for treating traumatic injuries -- are located in metropolitan areas, the study found. In addition, 15 states -- including Alabama, Rhode Island, Vermont and several Midwestern states -- lacked a formal trauma system.

The findings suggest "federal and local governments need to look at what additional resources are needed (for trauma centers) and put those resources there," Dr. Georges Benjamin, executive director of the American Public Health Association, told UPI.

Trauma centers are "an essential public health service," Benjamin said, noting they probably will be critical to treating victims of a terrorist attack since the most likely thing that might happen "still remains an explosive device."

He pointed out, "on Sept. 11, all of our trauma centers in (the Washington, D.C.) region sprang into action." They made beds available and linked into the first responder system. Trauma centers "were very much engaged in that terrorist event and would be in future events," he added.

Trauma centers also play a role in daily living. "On any given day, someone's going to fall down the steps, someone's going to get into a car accident ... and, depending on the severity of their injury, those people can only be saved if they get good comprehensive care at a trauma center," Benjamin said.

Dr. Donald Trunkey, a surgeon at the Oregon Health Sciences University in Portland, who has 32 years of experience at trauma centers, agreed with Benjamin.

"Outcomes in trauma centers are really significantly better than going to the nearest hospital," Trunkey, who wrote an accompanying editorial to the study, told UPI.

--

(Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)