ACS Views on Legislative, Regulatory, and Other Issues

Trauma and EMS—

• Senators Pat Roberts (R-KS) and Jack Reed (D-RI) Letter to Senate Appropriators in Support of FY 2006 Trauma Funding (475k PDF)
• ACS Statement for the Record to House L-HHS Appropriations Subcommittee in Support of FY 2006 Trauma Care Funding, 4/15/05
• Trauma Coalition Letter to House & Senate L-HHS Appropriations Subcommittees in Support of FY 2006 Trauma Care Funding, 4/8/05
• Bilirakis-Green Sign-On Letter to House L-HHS Appropriations Subcommittee in Support of FY 2006 Trauma Care Funding, 4/8/05 (575K PDF)
• Letter to Members of the Appropriations Subcommittee on L-HHS, re: FY 2006 EMSC funding, 3/31/05
• March 15 letter to Consumer Product Safety Commission re: ATVs

The American College of Surgeons (ACS) would like to express its strong support for continued fiscal year (FY) 2006 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) Trauma-EMS Program, 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. Over the last seven years, 82 Senators have joined with over 250 House members in publicly supporting increased funding for this Title XII program. This support has led to a total of $17 million in funding over the last five fiscal years.

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. 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." According to the Centers for Disease Control and Prevention (CDC) nationally, unintentional injury is the leading cause of death for individuals 1 to 44 years old and the third leading cause for those 45 to 54 years old.

Over the past 14 years, the Trauma-EMS Program has distributed $31.4 million in funds to all 50 states and 5 territories. But today, even with this influx of federal monies, the United States' trauma systems remain incomplete with half of the states in the country still not having a statewide system of trauma care. To date, every state in the country has received funding under the program for purposes such as: establishing a state lead agency to administer a trauma system; developing state and regional trauma system plans; drafting state legislation to permit the development of trauma systems and the designation of trauma centers; and training EMS personnel in trauma assessment and triage protocols. In addition, rural grants were awarded to support studies on subjects such as: preventable trauma mortality in rural areas; training and skill maintenance for rural emergency medical services providers; and the impact of triage, documentation, and transport protocols on patient outcomes. Finally, special initiative grants were awarded to address impediments to access or to assess emerging issues related to trauma and EMS systems, such as the development of 9-1-1 telephone systems in rural areas and enhancing the ability of EMS personnel to recognize victims of domestic violence for appropriate referral.

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.

College Commissions Harris Poll on Trauma Systems

The College's Committee on Trauma, along with the Coalition for American Trauma Care, commissioned Harris Interactive to conduct a public opinion poll on the public's awareness, knowledge, and perception of the importance of trauma care and trauma systems of care. Interviews with 1,000 randomly dialed individuals were conducted between November 3-14, 2004. Some of the key findings are as follows:

• Most Americans do not recognize injury as the leading cause of death for those age 44 or younger.
• Almost all Americans feel it is extremely, or very important to be treated at a trauma center in the event of a life-threatening injury.
• Almost all Americans feel it is extremely or very important for their state to have a trauma system.
• The majority of Americans feel having a trauma center nearby is equally as important as, or more important than having a fire department or police department.
• Significant majorities of Americans feel that having a trauma system in place is equally important as, or more important than having HAZMAT teams, or state police.
• A significant majority of Americans would be extremely, or very concerned if they learned the trauma system in their state did not meet recognized standards of care.

The College released these results during a Congressional Briefing on March 2, 2005.

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. In light of ongoing concerns regarding homeland security and emergency preparedness, it is critical that the federal government increase its commitment to strengthening Title XII programs governing trauma care system planning and development. Continued funding for trauma care systems will complement the efforts of the Department of Homeland Security by assuring all states the needed resources to develop trauma care system plans and to implement these plans. Trauma systems are an integral component of our Nation's public health infrastructure and our ability to respond to emergencies in our communities. If a terrorist attack should occur again in the U.S., the presence of a coordinated trauma system to immediately respond to the injured will save countless lives.

Economic & Rural Complications

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.¹ 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.

Ongoing Support for Trauma Care Systems

In 2001, with the reestablishment of the Trauma-EMS Systems Program, HRSA began an assessment of state trauma systems across the country. The results of the report, "A 2002 National Assessment of State Trauma System Development, Emergency Medical Services Resources, and Disaster Readiness for Mass Casualty Events," were released by HRSA in August, 2003. This survey was designed to look at each state's trauma/EMS program and infrastructure and outline how prepared states are to respond when faced with traumatic injuries. Another assessment survey to determine how states have improved its trauma care system since 2001 is now underway with results expected early next year.

The 2002 survey found that states have continued to make progress toward organizing successful trauma care systems, but due to significant financial shortfalls, the presence of key trauma care system components continues to vary across the country. "Survey results specific to EMS resources suggest that Americans have some degree of ready access to well-trained pre-hospital emergency personnel ... but 10 to 25 percent of the U.S. population do not have access to basic emergency medical and communications services." Since the survey was conducted after the events of September 11, 2001, it provides many details regarding a state's ability to handle a mass casualty event. The findings conclude that while most states have developed "disaster readiness plans," the programs and policies of these plans are incomplete. Although communication systems still remain fragmented, it is important to note that the survey questions were asked just a few months following the 9/11 attack and states have successfully improved their systems for a mass casualty event since that time.

College's Commitment to the Trauma Patient

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 American College of Surgeons' Committee on Trauma (ACS-COT) 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.² During the past two years the NTDB has increased the size of its database from 400,000 to over 1.1 million cases from 268 trauma centers and can be accessed on the College's website at http://www.facs.org/dept/trauma/ntdb.html.

The ACS-COT has a long history of commitment to improving the quality of care provided to victims of severe injury. In 1976, the College first published its guidelines for the hospital and pre-hospital resources necessary for optimal care. These guidelines describe in detail the qualifications and level of commitment required of hospitals, medical and surgical personnel, and local communities to provide high-quality trauma care. The College's guidelines have been adopted by state and regional trauma systems throughout the nation; studies have shown that systems employing these standards have significantly reduced preventable deaths due to injury. These criteria are an important component of the Trauma-EMS Systems Program that is administered by HRSA.

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 2006, we are asking the Subcommittee to provide $3.5 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.

__________

1. Blincoe LJ, Seay A, Zaloshnja E, et al: The Economic Impact of Motor Vehicle Crashes, 2000. COT HS 809 446, Washington, DC: National Highway Traffic Safety Administration, 2002.
2. American College of Surgeons: National Trauma Data Bank Report, 2002. Chicago, IL: American College of Surgeons, 2002.

Revised April 21, 2005

ACS Views on Legislative, Regulatory, and Other Issues

Advocacy and Health Policy