American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Improved access to trauma care could save 130,000 lives a year

OCTOBER 22, 2018
Clinical Congress Daily Highlights, Monday First Edition

States with poor trauma care access have more prehospital deaths and higher overall mortality than those with better access, according to a new study led by Zain G. Hashmi, MBBS, Department of Surgery, Brigham and Women's Hospital, Boston, MA.

“If all states had the same proportion of prehospital deaths as the states with the best access, there would be nearly 130,000 fewer deaths per year,” Dr. Hashmi said.

Timely access to trauma center care is critical to meet the goals of “Zero Preventable Deaths After Injury,” an initiative launched by National Academies of Sciences, Engineering and Medicine in 2016.  However, it is unknown if some U.S. states would benefit more readily from improving access to trauma care. Therefore, Dr. Hashmi and his colleagues chose to investigate, at the state level, the relationship between:

  • Timely access to trauma care
  • Relative proportion of prehospital deaths
  • Overall age-adjusted mortality rate

The researchers performed state-level analyses of adult trauma deaths reported to the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiological Research (1999-2016) system. The researchers determined a correlation between state-level prehospital and in-hospital death – what they called the PH:IH ratio. States with higher than national average PH:IH and age-adjusted mortality ratios (AAMR) were classified as ”high prehospital burden” states. These high burden states were then compared to the other states to determine the proportion of population with access to high-level (top three levels) trauma care within 45 minutes.

Analyzing 1,949,375 trauma deaths, the researchers found that 49 percent of deaths occurred prehospital and 42 percent in-hospital; the remainder included dead-on-arrivals, nursing-home and hospice deaths. The national average PH:IH was 1.18 and AAMR was 44.4/100,000 population. States with higher overall mortality had relatively more prehospital deaths. Overall, 57 percent of the population of 28 states classified as high-burden states had timely access (45 minutes or less) to high-level trauma care, compared to 77 percent of population of the remaining states.

Dr. Hashmi said the study suggests that in these high-burden states, improving trauma care access will be critical to achieve the zero preventable deaths goal.

An effort to improve access to trauma care would require leadership from the American College of Surgeons with help from state legislatures, since they determine how Emergency Medical System (EMS) data is reported. Simply giving patients a common identifying marker that follows them throughout their trauma care journey from prehospital to in-hospital to post-treatment would be an important advancement, Dr. Hashmi said.

“We need one data source – not multiple sources – and a single ID across the continuum of care,” he said.

View this study’s abstract online here.

Additional Information

The Scientific Forum presentation, Access Delayed is Access Denied: States with Higher Age-Adjusted Mortality Rate have Poorer Access to Trauma Center Care, was held October 22 at the 2018 Clinical Congress of the American College of Surgeons in Boston. Program, webcast, and audio information is available online at

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