The Boston marathon bombing is a horrifying, ongoing tragedy
this week.
Three people died when the bombs exploded, and scores of
others were maimed or otherwise injured.
But there was one bright spot for the wounded and their
families. According to the American Trauma Society, “it now appears
that every one of the wounded alive when rescuers reached them will survive.”
The reason for this
is that they were all fortunate to have almost immediate access to some of the
finest, most extensive trauma services in the nation.
According to an interview with the chief of medicine of one
of the area hospitals, there were four Level I trauma centers within a mile or
so of the marathon finish line – Boston Medical Center, Brigham and Women’s,
Mass General, and Tufts Medical Center. They
were already treating victims within thirty minutes of the blast.
There are five levels of trauma centers in the United States
and there are slight differences in how these are designated in different
states. But there is general agreement
about one thing – if you receive a life-threatening injury, either accidental
or intentional, your best hope for survival is to be as close as possible to a
Level I or Level II trauma center.
So what would have
happened if this bombing had taken place during some other marathon?
I have run in two marathons in my life, both in Austin. Austin has one verified Level I trauma center
– University Medical Center. Expected to
serve the Austin area’s million plus residents, it would probably be overwhelmed
with victims in the aftermath of a similar tragedy.
And I have run a half marathon as part of the Palm Beach
County marathon. For its million plus
residents, Palm Beach County has no Level I trauma centers. According to Tallahassee
Memorial Healthcare Center, it does have two Level II trauma centers – St.
Mary’s Medical Center in West Palm Beach and Delray Medical Center in Delray Beach.
The American College of Surgeons does not designate, but it
does verify, the presence of Level 1 and Level II trauma centers in all fifty
states. It has a list of verified centers on
its website. The four Boston centers are all on the list. The only ACS independently-verified Level I center in the
entire state of Florida is in Tampa.
The truth is that having
Level I trauma centers nearby saved lives in Boston this week. And their families
and friends understand that the higher prices they pay for one of the finest
health care systems in the world paid off big time when they needed it.
But we were also sadly reminded this week that mass injuries
are not just tied to acts of terrorism.
The fertilizer plant explosion in West, Texas, leveled so much of that
community, took too many lives, and left scores more injured, too.
So just how accessible was Level I trauma care to the people
of West, Texas, and how accessible would it be to the rest of us if we were to
face such horrifying mass tragedies as the people of Texas and Massachusetts
faced? The American Trauma Society has a
set
of maps on its web site for you to look at.
They are scary.
Here’s one for the country as a whole, identifying those
areas that are within 45 minutes by ambulance or helicopter of a Level I or
Level II trauma center. Over 30 percent of our population does not have access.
Keep these maps in mind the next time someone tries to argue
with you:
- That services are pretty much the same in all areas of the country.
- That spending more for access to high-quality healthcare doesn’t make a difference.
- That having teaching and highly-specialized hospitals aren’t worth the investment.
- That no matter where you live you will have plenty of access to trauma care if you ever need it.
A good example of failing to look at all the facts. In Florida 97.2% of the population is within 1 hour of a trauma center by ambulance or helicopter. All trauma centers in the state of Florida are level I or II and must meet the Florida Trauma Center Standards which are based on the ACS trauma center requirements. While everyone would like to have a trauma center located immediately in their neighborhood the reality of the situation is that the costs of operating an effective trauma center are so high that having them located in all neighborhoods is not an option. The other major limiting factor is that there are simply not enough resources to have trauma centers in all neighborhoods. Trauma centers need surgeons who are skilled in trauma care (general surgeons, orthopaedic surgeons, neurosurgeons as well as multiple other specialties) and highly trained nursing and ancillary staff who function as a team because they work together and have the VOLUME of patients required to maintain their skills. The current efforts in Florida to de-regulate the trauma system will have the effect of increasing the number of trauma centers AND decreasing the quality of care the patients receive in those trauma centers. If you truly care about the trauma victim you would fight to maintain quality over quantity.
ReplyDeleteI'm not sure if you're trying to argue that Boston had too many Level I trauma centers, but I think you also missed my central point. Because Level I centers were close by, Boston victims didn't have to wait for helicopters and it didn't take an hour to get them into treatment. That's why so many are alive today. The people of Boston may pay a premium for the level of care they have available, but I can't imagine that too many people there are thinking today that the investment wasn't worth it. And if more FL hospitals (or those in other states, for that matter) want to become Level I or II trauma centers to help us prepare for mass tragedies (via terrorism, fertilizer plant explosions, or other natural or man-made disasters), I would hope that at the very least we could all find a way to support them.
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