Trauma Centers: Life-or-Death Difference

Oct. 23, 2002 -- If you're badly injured, the nearest hospital isn't always the best place to go. You're better off at one of your state's top-level trauma centers -- if it's not too far away.

We worry about terrorist attacks and, more recently, an unpredictable sniper. But we've much more to fear from more mundane misfortunes such as car wrecks -- especially if we're among the many millions of Americans without access to a trauma center.

"In the last 13 months since 9/11, we've probably lost 165,000 or more Americans as a result of trauma," trauma surgeon Jeffrey Salomone, MD, tells WebMD. "About 30% of these patients may have survived had they received proper trauma care. Better trauma systems are needed."

Salomone, associate professor of surgery at Emory University, serves as an attending surgeon at Atlanta's Grady Memorial Hospital. Grady has a "level 1" trauma center designation, meaning that every day, all day, a full medical team is on hand to respond to life-threatening injuries. It's no small effort.

"It's a lot more than just having a good surgeon on hand," says Salomone, who is the designated surgeon for the Atlanta Police Department. "You need a team effort. You need emergency physicians and nurses who understand the priorities. You need radiology technicians. You need lab personnel, especially a blood bank person. You need operating-room personnel trained in trauma, and you have to have an operating room available. You need anesthesia personnel to put patients to sleep and resuscitate them. You need intensive-care nurses to care for patients after surgery. And then you need ward nurses and rehabilitation specialists."

Obviously, all this costs money. It's up to individual states to provide it. Quality varies widely from state to state, and even within states.

"Forty-four states have trauma systems," Sonny Oztas, spokesman for the American Trauma Society, tells WebMD. "Some are more effective than others."

At the heart of the trauma center is the idea of getting a patient to surgery as quickly as possible.

"From the point of the incident, whether it is a car crash or a gunshot wound, the time it takes to get the victim to the surgery table is what makes a trauma system valuable," Oztas says. "If the system is in place, it will be done within the golden hour -- 60 minutes after the incident. It is a fact that if they get to surgery within an hour, patients have at least a 25% chance of surviving. That is what a trauma system is: everything from first responder to helicopter evacuation to clearing roads to the hospital staff being ready when the patient arrives."

A case in point is the man who survived an attack by the Washington-area sniper outside of an area steakhouse.