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ACS Advocacy and Health Policy Staff Interim Director Assistant Director, Regulatory Affairs and Quality Improvement Programs Manager, State Affairs General Information |
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STATEMENT
of the
AMERICAN COLLEGE OF SURGEONS
to the
Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies
Committee on Appropriations
U.S. House of Representatives
RE: FY 2004 Funding for Trauma System Development
May 23, 2003
The American College of Surgeons (ACS) would like to express its strong support for increased fiscal year (FY) 2004 funding for Parts A-C of Title XII of the Public Health Service Act governing trauma systems. This program, administered by the Health Resources and Services Administration's (HRSA's) Division of Trauma and EMS (DTEMS), was created in 1990 by the Trauma Care Systems Planning and Development Act, P.L. 101-590. The College has worked tirelessly to educate members of Congress regarding the importance of the program and as a result of this effort, significant support for this program has developed in both the House and Senate. Currently, 48 Senators have joined with over 125 House members in publicly supporting increased funding for this Title XII program. This support has led to a total of $9.5 million in funding over the last three fiscal years.
America Needs Trauma Care Systems Now More Than Ever
The 15th anniversary of National Trauma Awareness Month was celebrated throughout the month of May. This education and awareness effort was initiated by Congress in 1988 to raise national attention to trauma and what must be done to reduce the devastating impact of traumatic injuries. This anniversary year offers the College a chance to acknowledge the many accomplishments of trauma care systems in the states, but also identifies the pressing need for more funding to assure all states are ready to respond to natural or manmade emergencies.
Over the past decade, the Trauma-EMS Program has distributed almost $25 million in funds to all 50 states and 5 territories. But today, even with this influx of federal monies, the Unites States' trauma systems remain incomplete and unfortunately, only one fourth of the U.S. population lives in an area served by a trauma care system.
The Trauma Care Systems Planning and Development Act was developed in response to a 1986 General Accounting Office Report (GAO/HRD-86-132) which found that severely injured individuals in a majority of both urban and rural areas of the U.S. sampled were not receiving the benefit of trauma systems, despite considerable evidence that trauma systems improve survival rates. Nationally, unintentional injury is the leading cause of death for individuals 1 to 34 years old; the second leading cause for those 35 to 44; and the third leading cause for those 45 to 54 years old. Studies of conventional trauma care show that as many as 35 percent of trauma patient deaths could have been prevented if optimal acute care had been available. A subsequent report in 1999 by the Institute of Medicine (IOM), "Reducing the Burden of Injury," called on Congress to "support a greater national commitment to, and support of, trauma care systems at the federal, state, and local levels."
Trauma care systems are based upon proper organization of existing health care resources. These systems of care are necessary to prevent needless deaths and to control the number and severity of disabilities suffered by those who are seriously injured despite our best efforts to develop safety devices and promote safe behavior. It has been estimated that 20-40 percent of deaths due to severe injury could be prevented if all Americans lived in communities that are organized to transport severely injured patients promptly to an area hospital that is staffed and equipped to provide expert trauma care. Current medical practices prove that the care and treatments delivered within that first hour of severe injury are likely to mean the difference between temporary and permanent disabilities, as well as between life and death.
Also key to an effective and efficient trauma system is a comprehensive information system to provide a foundation for evidence-based practice, performance improvement, and research. In 1994, the College established the National Trauma Data Bank (NTDB) as a repository of trauma data for use by trauma program directors, hospital administrators, health planners, and governmental agencies. This year, the NTDB doubled the size of its database to more than 400,000 cases and can be accessed on the College's website at http://www.facs.org/dept/trauma/ntdb.html.
In addition to lives taken, the financial impact of trauma is staggering. In 2000 alone, motor vehicle crashes cost Americans $230.6 billion, the equivalent of $820 for every U.S. citizen and 2.3 percent of the U.S. Gross Domestic Product. The lifetime economic cost to society for each fatality is over $977,000 and more than 80 percent of this amount is directly related to lost workplace and household productivity. Clearly, the nation has a significant public health problem that is costly, potentially preventable, and requires immediate action. While the College has succeeded in establishing a federal focus for these trauma system grants, many state and federal policy makers still do not fully grasp the role that these coordinated systems play in assuring coordinated responses to natural disasters or acts of unconventional terrorism.
When injuries occur in rural areas, the dangers are even higher. The remoteness of some areas of the country can severely complicate the process of receiving timely, high quality care. Coupled with a more hazardous working and living environment, rural distances slow access to treatment often leading to injury, disability, or death. It is for this reason that 10 percent of all funds appropriated to the trauma care systems program are directed to HRSA's Office of Rural Health Policy, and are designated to be specifically targeted to rural trauma-EMS issues.
Trauma Systems and Terrorism
Many troubling issues remain unresolved. The latest findings indicate that almost half the states still lack a comprehensive trauma care system. With the events of September 11, 2001, still fresh in our minds, and with our nation's renewed focus on enhancing disaster preparedness, it is critical that the federal government increase its commitment to strengthening Title XII programs governing trauma care system planning and development. Trauma systems are a crucial component of homeland security. If a terrorist attack should occur in the U.S., the presence of a coordinated trauma system to immediately respond to the injured will save countless lives.
Commitment to Support Trauma Systems
The National Highway Traffic Safety Administration (NHTSA) and HRSA convened a stakeholders group in 1998 to craft a vision for the trauma care systems of the future. Participants included the College and its Committee on Trauma, as well as the American Trauma Society, National Association of Emergency Medical Services Physicians, National Association of State Emergency Medical Services Directors, American College of Emergency Physicians, Ambulatory Pediatric Surgical Association and others. The stakeholders met this spring and reviewed an update to the "Model Trauma Systems Planning and Evaluation" plan. The document provides a primer on a public health approach to statewide trauma systems, as well as the tools to evaluate and select improvements that best serve the trauma care needs of their communities. HRSA is also in the process of developing a strategic plan to identify national priorities for trauma care, as well as to provide guidance to increase efficiency, improve outcomes, and allow for continuous quality improvement. Ultimately, we hope this continued investment will help build strong, yet flexible trauma systems prepared to respond to whatever the community needs.
Conclusion
Clearly, much groundwork has been completed, and the models and guidelines are in place to direct future efforts. But, as the IOM concluded, a focal point is needed at the federal level to support research and cultivate the growth of state and regional trauma systems. The Trauma Care Systems Planning and Development Act provides that focus and increased funding should be provided to allow it to continue. For FY 2004, we are asking the Subcommittee to provide $5 million for this crucial program.
Thank you again for the opportunity to express the College's support for this important program. We look forward to working with you in the months ahead.
Revised March 17, 2005
ACS Views on Legislative, Regulatory, and Other Issues
