By
Catherine Musemeche M.D.
Houston, New York, Orlando, Dallas — every week a new
domestic terror incident elbows its way into our lives and reminds us yet again
that injury is woven into the fabric of American history, from the battlefields
of the Civil War to the mass shootings that plague our society today. The
question is, how prepared are we to deal with the current wave of civilian
casualties in a country that has no national system of trauma care?
As it turns out, the answer to this question hinges in part
on where a trauma victim lives. While trauma care has greatly improved over the
last half century, the U.S. still does not have a national system of trauma
care ensuring that every citizen has access to the care they need within “the
golden hour,” the timeframe in which patient survival is critical. Our system
of trauma care is regional and the quality of care varies greatly from one
locale to another.
Many trauma centers have closed because they were not
financially viable and there are no laws that mandate that a certain number
stay open. A 2014 study by the University of California, San Francisco found
that after three trauma centers in California closed, patients who had to
travel farther were 21 percent more likely to die in the hospital than those
who did not have to travel long distances.
Distance is not the only barrier to top-notch trauma care. The
uninsured and minorities have worse trauma outcomes than white patients and
those who have health insurance.[1]
Even without the additional impact of the 288 mass shootings
that have occurred in 2016 to date[2], an
epidemic of trauma is raging: forty-two million emergency room visits, 2.8
million hospital admissions, 200,000 lives lost, an economic burden of $671
billion dollars, the number one cause of death from ages one to forty-four, and
the fourth leading cause of death. The annual cost of injury in the United
States every year is staggering, yet federal funding for trauma research
registers at a paltry ten cents within the context of years of potential lives
lost, compared to HIV funding of $3.51 and cancer of $1.65. By this measure of
burden of disease, injuries come in last in NIH funding and, while the
Department of Defense chips in more funding for specific trauma-related
research projects, these dollars tend to fade when wars wind down and other
national priorities gain the spotlight.
The 1966 National Academy of Sciences report Accidental Death and Disability: The
Neglected Disease of Modern Society put forth a number of recommendations aimed
at shoring up our nation’s response to injury. While some of the
recommendations from this now fifty-year-old report have been instituted
(safety standards for cars, minimal standards for ambulance personnel and
equipment and improved communication between emergency personnel in the field
and hospitals), others have been ignored.
We still do not have a National Institute of Trauma
dedicated to “the research of shock, trauma and emergency medical conditions”
as recommended — and so far there has been no systematized approach to training
our citizens in basic and advanced first aid. These are gaping holes in our
safety net, particularly in the event of mass casualties when first responders
are overextended or in rural areas where EMS may be precious hours away.
We find ourselves at a critical juncture in trauma care as
the wars in Iraq and Afghanistan wind down and domestic terrorism ramps up. Military
physicians and others gained valuable knowledge and techniques through treating
the injuries of our brave servicemen and women over the past decade,
information that could not be gathered any other way. Those life-saving
experiences must not only be preserved for future generations of military
physicians to draw on, but must also be transferred to the care of the civilian
population.
This country is in the midst of a wave of domestic terrorism
— a threat to public safety that is not likely to dissipate any time soon, and
will undoubtedly add significantly to the massive human and economic costs of
trauma. Now is the time to revisit the concept of a National Institute of
Trauma, finish building the framework for a national system of trauma care, and
start training all Americans in the basics of aiding the injured.
Catherine Musemeche is a pediatric surgeon and the author of
Hurt: The Inspired, Untold Story of Trauma Care (University Press of New England, 2016). She lives in Austin,
Texas.
[1] Haider, A.H., Weygandt, P.L.,
Bentley, J.M. et al: “Disparities in Trauma Care and Outcomes in the United
States: A Systematic Review and Meta-Analysis, The Journal of Trauma and Acute Care Surgery, Volume 74(5),
2295-1205. 2013.
[2] Gun Violence, http://www.gunviolencearchive.org/.
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