Much of the U.S. population is more than an hour away from a trauma center, and certain vulnerable groups are at higher risk of worse access, according to a new report.
For an article in the January issue of Archives of Surgery, a JAMA & Archives journal, the authors wrote that trauma centers have been shown to decrease morbidity and mortality for injured patients of all ranges. However, as highlighted in the media and scholarly literature, trauma centers are more likely to be safety-net hospitals, are often underfunded and are more likely to be poorly or not reimbursed for their provision of lifesaving but expensive care.
These financial hardships are cited as contributing to the increasing closures of trauma centers in the United States and are part of the growing national crisis in access to emergency care.
Renee Hsia, MD, MSc, University of California, San Francisco, and Yu-Chu Shen, PhD, Naval Postgraduate School, Monterey, Calif., examined data from an annual survey by the American Hospital Association and compared it with zip code data from the U.S. census. They designated easy access to trauma care as a travel time of less than 20 minutes, moderate access as a travel time of 20 to 60 minutes and difficult access as a travel time of more than 60 minutes.
In urban areas, 67% of the population had easy access and 12% had difficult access. In rural areas, 24% had easy access and 31% had difficult access. Areas with higher proportions of certain vulnerable groups had a higher risk of difficult access.
In particular, we found that areas with a higher proportion of certain groups, such as African-American and near-poor populations in urban and rural areas and foreign-born populations in urban areas were farther away from trauma centers, the authors wrote. Stakeholders and healthcare planners should consider these factors in the development of trauma systems because a mismatch of potential need and access could signal inefficiencies in the delivery of care.