Combatting the Systematic Flaws of Trauma Centers

by Navya Baranwal '20

Owen Hunt, trauma surgeon in the television series, Grey's Anatomy

The blaring rush of ambulances. A slurry of blue scrubs and white coats. An ocean of blood, tools, and quickly paced paramedics and surgeons.

With the copious reports of gun violence, car crashes, and mass casualty threats ranging from the 2012 Sandy Hooks shooting to the 2016 Orlando night club massacre, trauma is the leading cause of death in the United States for people under the age of 46 [1].
​​
Trauma centers are hospitals that are armored with specially-trained physicians and the proper tools to save people who have undergone traumatic injuries, including car crashes, gunshot wounds, and blunt trauma. While there are currently 436 civilian trauma centers in the United States [2], a person’s chance of survival unfortunately depends on when and where he gets injured.

Access to trauma centers varies widely depending on location. A study conducted in 2005 showed that the 46.7 million Americans who had no access to a trauma center within a one hour drive mostly lived in rural areas [2]. The quality of care and medical outcomes vary deeply around the country, and where you get injured can often determine whether you live or not
​
​According to the National Academies of Sciences, Engineering, and Medicine, if more timely and appropriate medical care is provided after each traumatic injury, around 1 in 5 deaths per trauma or 30,000 deaths in the USA per year can be prevented.

With location and personnel access issues, civilian trauma centers suffer from systematic and technological flaws that prevent all people from having an equal chance of being saved. On the other hand, the military trauma system has never been better. Military members get instant care when they are wounded or injured in the battlefield. Advanced technology, such as the instant use of tourniquets at the moment of injury, has allowed for the number of military deaths due to injury to decline sharply over the past few years. Notably, the number of deaths attributed to battlefield wounds decreased by 50% between 2005 and 2013 in Afghanistan. Of course, there is still room for improvement in the military trauma sector, evidenced by the statistic that an estimate of 1,000 service members who passed away between 2001 and 2011 could have been saved with better injury care [1].

Military Trauma, use of tourniquet

Civilian trauma providers rushing patient to OR

An integration of military and civilian trauma sectors would benefit both sides. For the military realm, military doctors will be able to practice care continuously while in the USA, so when they are called for duty, they will be at their sharpest. As combat is now decreasing, military doctors still need to maintain their medical skills between wars. The civilian sector will reap many benefits as well if it is exposed to military-style technology and leadership. By building more trauma centers and creating a synergistic and efficient system, access for patients would be able to increase, allowing people to get instant care no matter where or when they get injured. This joint effort between civilian and military trauma doctors could help build stronger prehospital care, hospitalization, rehab, and more.

Since military care and civilian care differ widely, a strong leadership is needed to ensure that optimal care is given in the proper context. We currently have a mishmash system of trauma care, and the best route to instate a proper joint-system is to make a national push for collaboration between the two sectors. Michael Burgess, a physician and representative from Texas, introduced the Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act or the MISSION ZERO Act last month, February of 2017, to Congress [4]. This bill amends the Public Health Service Act to create grant programs for trauma centers to incorporate full time military trauma experts and physicians into their hospitals. Currently being reviewed by the House of Representatives, this bill is supported by the American Congress of Neurological Surgeons, American College of Emergency Physicians, American College of Surgeons, and the Trauma Care Association of America.

Michael Burgess (R-TX): "Our military has made incredible strides in delivering trauma care, saving countless lives that would have otherwise been lost. This expertise should be brought home to strengthen our civilian trauma centers and systems, so that efforts to save American lives are not dependent on where one is injured and what care is readily available. The MISSION Zero Act would establish a grant program to foster a partnership between our military and civilian trauma providers to benefit all Americans."

Whether it’s assisting the Chicago area trauma centers during high crime peaks, or in rural areas where access to trauma response is severely limited, a partnership between the military and civilian trauma systems will benefit all Americans.

Please reach out to your elected officials, and encourage them to support the MISSION Act! 

Sources: 
[1] http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=23511
[2] https://www.facs.org/search/trauma-centers?country=United%20States
[3] https://pdfs.semanticscholar.org/301c/3d5950f3106741736337996cc8482052bbe4.pdf
​[4] http://burgess.house.gov/news/documentsingle.aspx?DocumentID=398261