Regionalized health care and the trauma system model
How close are we to having the manpower to meet the needs of such a network of hospitals? Over the past 4 years, 10%-12% of the current 1,100 graduates of general surgery training programs go on to do a surgical critical care residency. That’s actually more than or equal to vascular, pediatrics, hand, or thoracic surgery specialty training. In 2009 there were 2,583 surgeons who take their board in surgical critical care, and 1,204 of them have been recertified at least once (J. Trauma 2010;69:1619-3).
In addition, there is the ongoing development of acute care surgery training programs, spearheaded by the American Association for the Surgery of Trauma, with a goal of 20-30 such training programs. (J. Trauma 2005;58:614-6; J. Trauma 2007;62:553-6; J. Trauma Acute Care Surg. 2012;72:4-10; J. Trauma 2010;68:753-60).
So we have the manpower, and we have a great distribution of trauma centers across this country, with authoritative legislation in most of the states. A total of 83% of the population is within 1 hour of trauma center care by ambulance or helicopter (JAMA 2005;293:2626-33).
Western rural states have the unsolved problem of adequate access to trauma center care, primarily because the population density cannot support such highly specialized centers. But with improved organization of regionalized transportation, this issue could be addressed, and these patients and resources concentrated. Urban America has a different problem in some locations, which is the oversubscribing of trauma centers because of ego, greed, lack of cooperation, and a presumed drive for prestige. This problem could be solved with legislation and changes in funding for trauma and acute care.
Trauma care systems are a model for regionalization of all time-sensitive illnesses, not just trauma, and not just surgical issues; the integrated trauma system model can be the future of regionalization of all health care.
Dr. Jurkovich, an ACS Fellow, is chief of surgery at Denver Health, and vice chairman of surgery, University of Colorado in Denver.
