Rural trauma care lags, report finds

CHICAGO -- A review of the nation's trauma centers found improvements in how serious injuries and mass casualties are handled, though rural care continues to lag.

The report, published in Wednesday's Journal of the American Medical Association, found that the number of U.S. trauma centers has more than doubled since 1991, from 471 to 1,154. But 15 states continue to lack a system for certifying the centers, and more than 90 percent of the best-equipped Level I and Level II centers are in metro areas.

The authors, led by Ellen MacKenzie of Johns Hopkins Bloomberg School of Public Health's Center for Injury Research and Policy, said the inventory could help officials coordinate sites to handle disasters and terrorist attacks.

Dr. Donald Trunkey of the Oregon Health Sciences University said the inventory should be repeated each year.

"One of the advantages of a trauma center inventory is that these large, public and not-for-profit hospitals also have highly competent emergency department staff who are often experts in the response to these terrorist weapons," he said. "If there were a redundancy of medical, surgical and nursing staff in these facilities, some of these people could be used in disaster medical assistance, with teams dispatched to the scene of the terrorist act."

Trunkey also noted an apparent link between the proliferation of trauma centers and lower homicide rates.

MacKenzie said in an interview that rural areas lag in comprehensive trauma care because many don't have the necessary equipment and personnel. She suggested that trauma victims in such areas be given initial care, then transferred "outside the immediate region" for specialized aid.