Monday, October 10, 2016

Domestic Terror Attacks: Are Our Trauma Systems Ready?

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.


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