San Diego – Trauma care in the United States is so fragmented, overwhelmed and underfunded that the survival and recovery of those who suffer major trauma often depends on where they happen to be when they are injured.
That is the conclusion expressed by Dr. Brent Eastman in his lead article in the latest edition of the Journal of the American College of Surgeons. Eastman is chairman of the Board of Regents of the American College of Surgeons (ACS), the largest organization of surgeons in the world.
High death rates in rural areas, a growing shortage of trauma surgeons and a disconnect between existing trauma systems and regional disaster preparedness plans add to a bleak picture of the state of trauma care in the U.S., according to the article.
His article in the journal’s August edition, titled “Wherever the Dart Lands: Toward the Ideal Trauma System,” marks the first time his findings have been published for public review.
Eastman initially voiced his findings during his “Scudder Oration on Trauma” at the 2009 Clinical Congress of the ACS in Chicago, which was attended by ACS Fellows (physicians, nurses, health care professionals and other interested parties).
“Coordinated, regionalized and accountable trauma systems are proven to get the right patients to the right hospital at the right time,” said Eastman. “For victims of major trauma, access to timely, optimal care during the first ‘golden’ hour has been proven to save lives, restore function and prevent disability.”
Eastman is one of the co-founders of San Diego County’s successful trauma system, which has reduced the percentage of preventable deaths in San Diego from 22 percent when it was deployed in 1984 to approximately 2 percent today. Scripps Health operates two of the county’s five adult trauma centers and treats more trauma patients than any other provider in the region.
But Eastman points out in his article that many areas of our country, especially rural areas, are not served by such systems. Assembling for the first time maps of the U.S. that show death rates due to trauma per 100,000 population, travel times to the nearest trauma center and populations of surgeons, he showed that a combination of a shortage of surgeons and gaps in regional trauma systems has stymied access to timely, appropriate trauma care in many areas of the country.
As a result, death rates due to trauma are unnecessarily high in those areas, contributing to the fact that trauma is the leading cause of death for those under the age of 45 in this country and in developing countries around the world.
In addition, Eastman revealed that his survey of trauma surgeons in each state showed that 38 percent of U.S. states reported having no statewide trauma system. And of the 62 percent of states that did report having a statewide trauma system, most states indicated that funding to sustain these systems is in jeopardy. Without funding, statewide trauma systems are unsustainable.
“Everyone living or traveling in the U.S. should be able to expect prompt transport to the appropriate level of care proportionate with their injuries,” Eastman added. “That’s the vision when I say that wherever the dart lands on a map of the U.S., there should be a system to take care of your traumatic injury.”
Eastman’s article also relays the stories of several trauma victims who were fortunate enough to have access to a trauma system. These include the journey of Johan and Jenna Otter, a father and daughter who survived a grizzly bear attack in Glacier National Park in 2005 thanks to a trauma system that flew them to a hospital in Kalispell, Mont. and then on to a trauma center in Seattle, Wash.
The article also outlines the highly developed military trauma systems in Iraq and Afghanistan as an ideal trauma model, in which the injured are rapidly transported from combat zones to sophisticated care in field hospitals, combat support hospitals, the Landstuhl Regional Medical Center in Germany and eventually to the continental U.S.
Eastman experienced this system of care firsthand as part of a visiting surgeon in combat casualty program in Landstuhl, sponsored by the ACS and the American Association for the Surgery of Trauma. Eastman’s article shares the story of Marine Cpl. William Gadsby, whose life was saved despite the loss of his right leg in Iraq.
Eastman’s article calls on his fellow surgeons to advocate for trauma systems in states or regions where fully developed systems are still lacking. It also addresses the need to include advanced trauma systems and the need for more trauma surgeons in discussions and initiatives related to health care reform.
Eastman has a unique perspective on the delivery of trauma care. He began his surgical training at one of the nation’s first trauma centers, San Francisco General Hospital during the late 1960s – a time of surging violent crimes in the wake of Vietnam War protests. During his career he has helped develop trauma systems throughout the U.S. and worldwide and has also provided care in the aftermaths of natural disasters such as Hurricane Katrina and the Haiti earthquake.
Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2 billion nonprofit community health system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,600 affiliated physicians and 12,700 employees among its five acute-care hospital campuses, home health care services, and an ambulatory care network of physician offices and 19 outpatient centers and clinics.
Recognized as a leader in the prevention, diagnosis, and treatment of disease, Scripps is also at the forefront of clinical research and graduate medical education.
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients.
The College has more than 77,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.