Access to Trauma Centers, this weeks JAMA

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Access to Trauma Centers in the United States

<http://jama.ama-assn.org/cgi/content/full/293/21/2626#AUTHINFO> C.

Branas, PhD; Ellen J. MacKenzie, PhD; C. , PhD; C.

Schwab, MD; Harry M. Teter, JD; Marie C. Flanigan, PhD; Alan J. Blatt, MS;

S. ReVelle, PhD

JAMA. 2005;293:2626-2633.

ABSTRACT

Context Previous studies have reported that the number and distribution of

trauma centers are uneven across states, suggesting large differences in

access to trauma center care.

Objective To estimate the proportion of US residents having access to

trauma centers within 45 and 60 minutes.

Design and Setting Cross-sectional study using data from 2 national

databases as part of the Trauma Resource Allocation Model for Ambulances and

Hospitals (TRAMAH) project. Trauma centers, base helipads, and block group

population were counted for all 50 states and the District of Columbia as of

January 2005.

Main Outcome Measures Percentages of national, regional, and state

populations having access to all 703 level I, II, and III trauma centers in

the United States by either ground ambulance or helicopter within 45 and 60

minutes.

Results An estimated 69.2% and 84.1% of all US residents had access to a

level I or II trauma center within 45 and 60 minutes, respectively. The 46.7

million Americans who had no access within an hour lived mostly in rural

areas, whereas the 42.8 million Americans who had access to 20 or more level

I or II trauma centers within an hour lived mostly in urban areas. Within 45

and 60 minutes, respectively, 26.7% and 27.7% of US residents had access to

level I or II trauma centers by helicopter only and 1.9% and 3.1% of US

residents had access to level I or II centers only from trauma centers or

base helipads outside their home states.

Conclusion Selecting trauma centers based on geographic need, appropriately

locating medical helicopter bases, and establishing formal agreements for

sharing trauma care resources across states should be considered to improve

access to trauma care in the United States.