The nation's trauma care infrastructure must be strengthened to maintain maximum emergency preparedness. That is the message the Chicago-based American College of Surgeons is delivering to members of Congress in Washington, D.C., this week.
"Trauma is a plague upon our land. It is not recognized as such, but it is," says J. Wayne Meredith, M.D., chair of the ACS committee on trauma and chairman of general surgery at Wake Forest University School of Medicine in Winston-Salem, N.C. "There is a gaping hole in the nation's organizational plan to deal with this problem."
Trauma is the leading cause of death for Americans between the ages of 1 and 44 and is the third leading cause of death in the general U.S. population, according to Congressional findings cited in legislation introduced by Senate Majority Leader Bill Frist, M.D. (R-Tenn.). The total cost of traumatic injury in the United States in 1995 was estimated at $260 billion, the bill says.
Injuries result in 140,000 deaths each year, and studies show that as many as 40% of trauma-patient deaths could be prevented if optimal acute care were available, Meredith says.
But only one-quarter of Americans live in an area served by a trauma care system, according to the National Center for Injury Prevention and Control, part of the Centers for Disease Control and Prevention in Atlanta.
Ten years ago, Congress authorized the original Trauma Care Systems Planning and Development Act to encourage the development of trauma care networks. Although the legislators' initial recommendation for annual funding was $60 million, over the last decade, the total amount allocated has been just $25 million, Meredith says.
ACS is asking Congress to reauthorize the Trauma Care Systems Planning and Development Act of 2003, which would provide $12 million in fiscal year 2004 to enhance each state's capability to develop and sustain trauma care systems. The bill also would amend and increase funding for Title XII of the Public Health Service Act, which provides a network to update training, share best practices and plan improvement strategies for treating trauma patients.
The College is using the National Trauma Data Bank to gather and provide information about who becomes injured and how, and what each patient's eventual outcome is. The database currently includes 450,000 patient encounters over eight years reported from about 20% to 25% of the nation's Level I and Level II trauma centers in 28 states.
"Only in the last two years have we begun to paint a picture of the kind of care that goes on in these trauma centers," says John Fildes, M.D., chair of the subcommittee on the NTDB and medical director of the trauma center at University Medical Center in Las Vegas.
The data shows that self-pay accounts for 21% of the source of payment for trauma care. The reason is an overwhelming number of young trauma patients, Fildes says, many of whom have wage-earning jobs that don't provide insurance. The payment pressures often are passed along to the system, he says.
"Recovery of costs can be inconsistent," Fildes says. "Hospitals have to be prepared to cover trauma care very imaginatively."