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Too Many Trauma Centers, Lower Quality of Care?


Hospitals all across the United States are adding on specialized trauma centers at an incredible pace, as American populations go up and boards of directors look to turn greater profits. But are they all needed?

Let’s look at the facts, as reported in USA Today. Since 2009, over 200 trauma centers have been opened. In addition, another 75 hospitals are seeking approvals to build them.

Are states like Alabama, Arizona, California, Florida, and Texas in danger of becoming over-saturated with trauma centers?

Is such a thing even possible?

Ironically, the current trend is the reverse of what was occuring in the 90s and early 00s, where trauma centers had been closing across America. This seems indicative of a cycle, where trauma centers are built as hospitals turn profits, and close them when the running costs become too high. Judging by the record additions being made by hospitals across the U.S., we would appear to be in the former.

Level I and Level II trauma centers, the highest level trauma centers, have surgeons, specialists, and advanced equipment available 24/7. Level I trauma centers are required to have a certain number of surgeons, emergency physicians and anesthesiologists on duty 24 hours a day, an education program, as well as preventive and outreach programs.

Most of the new trauma centers that have been built in recent years are Level III, IV, and V. These types of centers work with the more advanced centers to stabilize and coordinate transfers of patients to higher-level care.

The American College of Surgeons (ACS) has recommended a ratio of approximately 1-2 high level trauma centers for every 1 million population. As you may be able to tell from the word “approximately,” this is actually more rule of thumb than stone-set.

Many factors contribute to the optimal amount of trauma centers for a region, and nearly all of them have to do with the risk for traumatic injuries. For example, in parts of the country where the logging and mining industries have a fairly large presence, the projected “need” for trauma centers will obviously be greater. High population density, and especially dense, high-crime areas near/in cities where stabbings and gunshot wounds are more common, logically increase the need for trauma centers as well.

Yet, some healthcare experts have warned that having too many high-level trauma centers in a single location can actually equal higher costs and a lower quality of care. They say rural regions are particularly susceptible to this.

It goes like this: When one area is packed with trauma centers, they all have to hire out of the same local pool of qualified applicants. Fair enough.

They also have to “compete” for patients. But not in the traditional way — in an emergency, there’s no time for patients to “shop around.” In a sense, hospitals can charge anything they like for trauma care. And many of them do.

It’s easy, then, to see the problems that can arise when trauma centers operate in proximity: competition among facilities that results in a lower influx of patients (lower overall income) and specialists (who require higher compensation to lure them away from competitor facilities) to treat them doesn’t have good implications for either patients or hospitals.

Trauma centers are a vital link in providing quality care to patients who need it most.

As hospitals try to make up their expenses through higher bills (which has the double effect of leading to higher insurance premiums, deductibles, and co-pays), it seems all parties are actually losing out.

According to the information in USA Today, past studies have also indicated that trauma centers with a higher “traffic” rate have generally better outcomes. In other words, trauma surgeons and specialists who treat patients more regularly perform better at their lifesaving tasks. When there are too many trauma centers and less of a patient influx, this effect is negated.

Clearly the reverse is true as well: trauma centers can be spread out too far apart, resulting in overloaded facilities; resulting in a more immediate, obvious negative effect. In much of the United States, however, the “problem” seems to be the less obvious of the two.

Air Medical Net is interested in knowing where the air medical community stands on this issue. Is the proposed problem of “too many” trauma centers something that should be considered, or is more always better?

If there are negative effects from having too many trauma centers in the same region, is that problem nullified in less obvious ways, such as potentially lower transport times?

Is the possibility of a helicopter, air transporting a trauma patient, reaching its destination a minute earlier worth the potential overall drawbacks of an area having too many trauma facilities? Leave a reply below and let us know your opinion.

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  1. Alan Foster

    10 / 11 / 2012 11:52 am

    IMHO, there’s no need to worry having too many trauma centers or even too many trauma centers that don’t meet the standard of care we’ve come to expect. The invisible hand of the marketplace will make sure that supply and demand are in balance. If too many centers eventually do pop up, soon some of them will be forced out of business (the less efficient ones). It is also safe to assume that centers will poor care will also ultimately serve less patients or be driven out by high insurance costs and/or lawsuits.


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