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Trouble in Trauma

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Recently there has been a lot of news about trauma care, and much of it isn't good. Whether the story is dwindling resources or dreams unfulfilled, the press lately has been full of bad news.

As October began, the Wall Street Journal ran a story titled "A Dangerous Gap in Trauma Care." It included personnel accounts of success and failure. Although there are examples of systems that appear to be working well, other stories of too few resources were reported as well. CNN and other networks ran stories and interviewed medical professionals and politicians and there were accounts of blood shortages and the closings of trauma and burn centers.

Dreams Unfulfilled

Some of you may remember the late 60's and early 70's when EMS and trauma systems were rolled out. Hospitals were designated as trauma centers all over the country. Training was developed for specialized physicians, nurses and prehospital personnel. The effectiveness of systems, protocols and treatments were studied and changes were made based on evidence. Other changes over the years were not dictated by science but by economics and failed public policy.

Change

When dictated by science, change is good, but when brought about by failures in planning and funding, it's a tragedy. When populations that have the patient volume sufficient to support trauma and burn centers don't have them it's a failure of funding and the policies to provide that funding. All over the country, hospitals have pulled back from providing the highest level of care to patients with the greatest need due to lack of funding and resources -- not due to a lack of patients.

Trauma as a Disease

I'm certainly not coining the phrase, but it needs to be said again and again that trauma should be considered a disease. Millions are dedicated to prevention and treatment of all kinds of diseases affecting every body system. This is a good thing, and this investment is bearing fruits resulting in disease prevention, people with disease living better lives and others being freed of it. The argument is not against investing in the fight against disease but to bring the same attention to trauma.

Is Trauma a Disease Worth Fighting?

When making arguments to develop programs, ask for funding or your pledge to support, organizations will describe what is lost if we don't fight. In the case of trauma, what's the cost of not fighting? All of us who take trauma training know that it robs us of our best and brightest. Trauma kills all but it's the biggest killer of the young. In fact trauma is the leading cause of death in people less than 40. In classrooms all over the world I've asked my students, how many Einsteins, Beethovens or Schweitzers have been prevented from reaching their productive years. How many young mothers and fathers have been lost to their families? As the article in the Wall Street Journal noted, 140,000 deaths and 80,000 disabled Americans is significant. It's a battle worth fighting.

Will the Efforts Pay Off?

Consider this: We have studies that show the effectiveness of training. Science has shown us ways to stop doing things that don't work and do things that do work faster -- to work while we're moving and getting patients to surgery faster. Technology is applied in new ways to new patient situations. Prevention programs have shown that the investment in developing and implementing these programs saves lives. There's lots of evidence showing that our investment of time and money toward trauma can save lives.

Alright, so what do we do?

It's time for us to push harder. Nearly every month, legislation comes before lawmakers funding research, hospitals, healthcare providers and prehospital programs. Professional organizations representing all of us, doctors, nurses and prehospital care providers track this legislation and educate their members. All of us need to support our organizations when they go after this legislation and all of us need to make our elected officials get the message. Trauma kills our young, and it doesn't discriminate between wealth, poverty, race or creed. We need to invest in it. We need to study, plan, implement and study again. All of us will benefit.

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