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Rural residents lack timely access to trauma centers that could save their lives

Severely injured patients who wait longer than an hour for medical care are at higher risk of death than those who receive medical care sooner. According to a study supported in part by the Agency for Healthcare Research and Quality (HS10914), 46.7 million Americans who live in mostly rural areas do not have access to either a level I or II trauma center within an hour's travel distance. In contrast, 42.8 million Americans who live in mostly urban areas have access to 20 or more level I or II trauma centers within an hour.

Level I and II trauma centers provide comprehensive care for the most critically injured patients and provide immediate access to trauma surgeons, anesthesiologists, and other physician specialists. Level III trauma centers provide prompt assessment, resuscitation, surgery, and stabilization, and can transfer patients to a level I or II center when necessary.

Researchers used data from two national databases to geographically analyze trauma centers, base helipads, and block group population for all 50 states and the District of Columbia, as of January 2005. The purpose of this analysis was to estimate the proportion of U.S. residents who have access to trauma centers that can be reached within 45 and 60 minutes. Results showed that an estimated 69.2 percent and 84.1 percent of all U.S. residents had access to a level I or II trauma center that could be reached within 45 and 60 minutes, respectively. About 27 percent of U.S. residents had access to level I or II trauma centers accessible that could be reached only by helicopter within 45 to 60 minutes.

The researchers suggest that access to trauma care in the United States can be improved by selecting trauma centers based on geographic need, appropriately locating medical helicopter bases, and establishing formal agreements for sharing trauma care resources across States.

See "Access to trauma centers in the United States," by Dr. Branas, Ellen J. MacKenzie, Ph.D., Justin C. Williams, Ph.D., and others, in the June 1, 2005, Journal of the American Medical Association 293, pp. 2626-2633.

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