Disparities in Trauma Care Access Raise Concern : Data on quality of care, financing, and manpower should be used to guide the needed improvements.

Dr. Larkin said he agrees that more “well-institutionalized” interstate arrangements are needed. He said he worries, on the other hand, that the potential of helicopters—which he said are now too often “big billboards for hospitals”—will be overstated and used as part of a cookie-cutter approach to solving access discrepancies.

He would rather see investigators and policymakers pair the new data on access with epidemiologic data—looking, for instance, at where motor vehicle crashes (the most common cause of trauma) occur most frequently.

“I hope people don't misread the data and assume it's the last word on trauma care,” said Dr. Larkin. “There is a whole host of other issues that need to be addressed.”

These include the issue of financing trauma care, a significant portion of which goes unpaid for, and issues of manpower and varying “densities” across the country of board-certified trauma surgeons and emergency physicians, he said.

Dr. Larkin emphasized that there's “a pretty big difference between level I and level II centers.” He advised paying more attention to access within 45 minutes than to access within the 60-minute time frame, since—as the investigators also point out—the so-called golden hour cutoff is supported by little scientific evidence and is probably too long.

Because the study excluded pediatric trauma centers and did not stratify access by age, the findings understate the access problems faced by the younger population, Dr. Larkin noted. “Trauma,” he said, “is the most common cause of death in the first four decades.”