The time to invest in emergency preparedness and our trauma network and infrastructure is now.
At the time of writing this, there are numerous weather events in the Atlantic Ocean, including Hurricane Florence which threatens the Carolinas with the loss of life and massive flooding and damage. Meanwhile, a tropical storm could be forming in the Gulf of Mexico that poses a threat of flooding to Texas.
Hurricane Harvey serves as a somber reminder of the potential devastation facing any of our coastal communities, causing an estimated $125 billion in damage and resulting in over 100 deaths. Hospitals up and down the coast were impacted, with some having to evacuate patients.
Our trauma network saves lives and is an absolutely critical component of disaster response. We need to invest in the trauma network to ensure the infrastructure and personnel are in place before the next Hurricane Harvey strikes. But filling the gaps in our trauma system will require significant capital investments. Currently, these costs are a substantial barrier to hospitals making the facilities upgrades, equipment purchases and personnel hires they need to provide the highest level of care around the clock.
Every day, approximately 40 Texans die due to traumatic injuries, many of these from car accidents. In fact, trauma is the leading cause of death for Texans 44 years and under, and ranks 4th for all ages. Furthermore, for every Texan who dies from a traumatic injury, at least six are seriously injured.
Trauma results in billions of dollars of lost productivity, revenues, and local and state assistance, but we can reduce the devastating impact by making investments in trauma care. Studies have shown that getting trauma victims to a trauma center, a hospital equipped and staffed to provide care for patients suffering from traumatic injuries, within the first 60 minutes of a trauma (the “Golden Hour”) is critical to saving lives and preventing disability. Similarly, studies have found that immediately transporting severely injured patients to a Level I trauma center reduces morbidity and mortality.
In the United States, trauma centers are identified by different levels (Level I, II, III, IV, or V) based on the kinds of resources available in the trauma center and the number of patients admitted yearly. While lower level trauma centers can provide adequate care for many traumas, studies have found that patients with certain severe injuries are more likely to survive if they are treated at a Level I.
Level I trauma centers are the most advanced, serving as a tertiary care facility and capable of providing total care for every aspect of injury, from specialists to secondary care. These facilities provide 24-hour care and access to a wide array of specialists, in addition to important education and research functions.
A frequently mentioned recommendation is to have one Level I trauma center per one million population in the service area. Despite a population of over 1.5 million and growing, the Rio Grande Valley does not have a Level I trauma center. In fact, of the top 9 most populated regions of the state, only the Rio Grande Valley lacks a Level I facility.
The Rio Grande Valley currently has a Level II trauma center, but certain trauma patients have to be transported over 200 miles away to San Antonio for the proper care. In an emergency, these patients are often airlifted at a cost of up to $30,000. This arrangement is costly in both terms of time and money to trauma victims.
However, the Rio Grande Valley is not alone in its lack of access to a Level I trauma center. Approximately 25 percent of Texans, almost 7 million people, live in a county not accessible to a Level I. In fact, Texans in many rural counties are more than an hour away from any trauma center. This is unacceptable. We need to take action to reduce the gaps in our state’s trauma system. Your ability to survive or not be disabled by an injury should not depend upon your zip code.
Texas has one of the best trauma networks in the country. However, we can and should do more to reinforce our regional trauma capabilities. We must create a more robust trauma system by ensuring that we have the proper level of trauma facilities distributed throughout the state, not just located in a few urban areas. Not only will this improve the lives of Texans on a day-to-day basis, but it will vastly improve our disaster preparation.
Texas funds its trauma system through various funding streams, but many of those sources are dwindling or at threat of disappearing completely. On average, it costs over $20 million annually to operate a Level I in Texas, but hospitals must operate at the level they are seeking to be designated for at least a year before they receive the actual designation. This means that hospitals are not compensated for millions of dollars of costs during this transition period even though they provide a higher level of care during this time. Further, hospitals face millions of more dollars in startup costs.
To ensure we are ready and able to respond to any disaster, Texas should invest in our trauma network throughout the state. This coming legislative session, we need to develop a permanent funding mechanism to support current trauma centers and help defray the costs associated with centers leveling up in an effort to address gaps in our trauma system. All Texans deserve to have access to the best health care we can provide in their hour of need, regardless of what part of the state they live in. Proactively improving our trauma network will save lives every day and help the state weather the next storm.
Editor’s Note: The main photo accompanying the above guest column shows the helipad at Santa Barbara Cottage Hospital, in Santa Barbara County, California. In late 2017, this hospital received Level 1 trauma center verification from the American College of Surgeons.