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American College of Surgeons Releases Position Statement Stressing Importance of Trauma Center Designation Based Upon Population–Based System Need

New statement developed to support state and local agencies in making designation decisions that advocate for optimal care of injured patients

NEWS FROM THE AMERICAN COLLEGE OF SURGEONS | FOR IMMEDIATE RELEASE

CHICAGO (February 6, 2015): The American College of Surgeons (ACS) recently released a statement emphasizing that the allocation of trauma centers should be based upon the needs of the population, rather than the needs of individual health care organizations or hospital groups. The position statement, developed by the ACS Committee on Trauma’s (COT) Trauma Systems Evaluation and Planning Committee, was approved by the ACS Board of Regents last fall and recently published in the January issue of the Bulletin of the American College of Surgeons.

Trauma systems have long been of concern to the ACS and the COT. “Historically, the ACS has taken the lead in establishing standards and promoting quality in trauma care, and has long supported the principle that trauma centers should be allocated on the basis of need; ensuring that the welfare of injured patients remains the primary goal,” said statement coauthor Robert J. Winchell, MD, FACS, Chair of the ACS Trauma Systems Evaluation and Planning Committee, and professor of surgery and chief of trauma at the University of Texas Health Science Center, Houston.

The statement notes, “The importance of controlling the allocation of trauma centers, as well as the need for a process to designate trauma centers based upon regional population need, has been recognized as an essential component of trauma system design since the 1980s. Nonetheless, few trauma systems are able to operationalize these concepts, especially when faced with real or potential challenges that stem from powerful health care institutions or providers.”

At their core, trauma systems are developed to achieve care that is optimal for injured patients.  Ronald M. Stewart, MD, FACS, Chair of the COT, and professor and chair of the department of surgery at the University of Texas (UT) Health Science Center, San Antonio, said that in the beginning of trauma system development, the problem was a lack of trauma centers. However, some areas are now seeing a perceived oversupply of trauma centers because the provision of trauma care can in some instances become highly profitable. “We believe it is very important to the injured patient to get this balance right, thus the need for this position statement,” Dr. Stewart said.  Further, Dr. Winchell said, “History has shown that market forces are insufficient to guarantee a stable system.  Police, fire and EMS services are not provided based on market profitability; the same criterion must be held true for trauma services.”

The statement lays out guidelines for optimal trauma system function. Among these is the principle that designation of trauma centers is the responsibility of the governmental lead agency with oversight of the regional trauma system. Furthermore, the lead agency should be guided by the local needs of the region(s) for which it provides oversight, and trauma center designation should be guided by the regional trauma plan based upon the needs of the population being served, rather than the needs of individual health care organizations or hospital groups.

The intent of developing this statement is to support state and local agencies in making designation decisions and to develop policy at the state and national level that ensures the focus on centers being allocated on the basis of need, according to Dr. Winchell. “At a high level, the intent is to reach leaders and policy makers at the regional, state, and national level, to raise awareness and to stimulate the comprehensive development of public health policy and supporting legislation that establishes trauma care securely as a basic public health component.”

Trauma systems today are based upon the understanding that injury is a public health problem. As A. Brent Eastman, MD, FACS, past-President of the ACS, noted in the  2009 Scudder Oration on Trauma delivered before the Clinical Congress of the American College of Surgeons , the concept of injury as a public health problem was integral to the 2006 document “Model Trauma System Planning and Evaluation” from the U.S. Department of Health and Human Services.  This 2006 document was in turn influenced by the 1992 document “The Model Trauma Care System Plan.” Dr. Eastman noted, “Do trauma systems make a difference?...they do and they must make a difference. If we are to decrease the unacceptably high death rates…we must establish trauma systems.”*

The new trauma systems statement sets forth this premise, and goes on to note, “The problem arises when a lead agency passively allows health care organizations and hospital groups to establish new trauma centers in areas that yield an economic advantage, while ignoring areas of true need.”

In looking to the future of trauma systems in the U.S., Dr. Stewart said, “My hopes are that we, all the elements of the trauma system, are committed to doing the right thing and doing things right for our patients and our fellow citizens—this includes all patients and all regions of the country.”

The new trauma systems statement is available at http://bulletin.facs.org/2015/01/statement-on-trauma-center-designation-based-upon-system-need/.


*Eastman AB. Wherever the Dart Lands: Toward the Ideal Trauma System. Journal of the American College of Surgeons. August 2010; 211(2): 153-168.

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About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

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