Treating trauma centers with care.

• Author: Hendrikson, Hollie
• Position: TRENDS & TRANSITIONS

Traumatic injuries--from incidents like car accidents, gunshot wounds and falls--are the No. 1 killer of Americans under age 45. Receiving timely treatment at a trauma center--hospitals designated to treat severe physical injuries with specially trained staff and appropriate diagnostic and treatment tools--increases survival rates by 25 percent.

There exists a major imbalance in Americans' access to trauma care, according to the latest study reported in the Journal of the American Medical Association. In 2005, although 42 million Americans had a choice among 20 or more high-level trauma centers within an hour of where they were injured, more than 46 million Americans could not have reached even one within an hour.

Policymakers are learning, however, that building more centers does not necessarily lead to better access or better care. In fact, research shows the cost of care can rise and quality can fall when trauma centers are located too close to each other. Competition among nearby trauma centers can result in fewer patients per center, making it more difficult to recoup high fixed costs. It also limits the number of opportunities for surgeons to gain experiences with specific types of injuries.

An over-saturation of trauma centers, mostly in large cities, has led to an accelerating rate of closings in recent years, disproportionally affecting African-American communities and the uninsured, according to a 2011 study in Health Affairs.

Trauma centers also cost much more to operate than conventional hospitals. Level I trauma centers require general surgeons to be on the premises 24 hours a day and specialists to be...