Trauma Centers By Gabe Siegel
Short Anecdote • Example: US Congressman Bobby Rush’s son was shot and killed on the same block as a Hospital, yet he was driven 10.3 miles to the nearest trauma center.
State of Emergency Medicine • EMTALA and the ACA • Insurance ≠ Access: shortage of Primary Care physicians • ACA increases demand for resources • Poor reimbursements, uncompensated care, and utilization issues • Importance of Trauma centers and systems • Under the ACA: $224 million in grants for Trauma Centers
Trauma • Trauma-mostly severe and critical injuries. • Trauma is predictable • Injury is the leading cause of death for individuals from ages 1 to 44 • Accounts for approximately 170,000 deaths each year and over 400 deaths per day • 35 million people are treated annually for trauma -- one hospitalization every 15 minutes.
Quick Fact • For every $3.51 the federal government spends on HIV research and $1.65 for cancer, trauma gets 10 cents. And this is true despite the fact that someone dies from a traumatic injury every three minutes in the United States. Compared to every 9.5 minutes someone is infected with HIV/AIDS in the U.S.
Defining the problem • 25 % of Trauma Centers have closed in the U.S • Disproportionately burdens vulnerable populations • 46 million Americans lack access to a trauma center. • “Trauma Deserts” • Access to a trauma center reduces risk of death by 25% • The interests, individuals, ideas, institutions
Trauma System Components • 911 Access • Pre-Hospital Providers • Hospital EDs • Trauma Centers • Rehabilitation Centers • Trauma Registry and Injury Prevention
Trauma Center Levels • Level 1- 24/7 emergency care capable of providing care for any injury. Leader as a research institution. • Level 2- 24/7 essential care. • Level 3- 24/7 emergency physicians, key services, prompt availability of surgery staff, and transfer agreements. • Level 4- 24/7 physician coverage. Transfer agreements.
Trade off Parallelogram Cost Equity Quality Access
Policy Proposal • Recognizing trauma systems as a public good • National Trauma System • Linking funds to Trauma center availability • Increased and new modes of funding for EMS and Trauma Centers • Changing reimbursement • Activation Fee • Alternative payment model that incentives quality outcomes and cost-effective care • Stopping “defensive medicine”
Outcomes and obstacles • Funding • Public and professional support and policy lightening • Lowering mortality rates • Maintain and improve cost, quality, access,and equity • Prevention of Trauma Center closures • Reducing “trauma deserts” • Preparation for a major terrorist attack or disaster
Trauma map • http://www.traumamaps.org/Trauma.aspx