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US trauma system said unprepared for terror attack

By Julie Rovner

Last Updated: 2003-05-28 13:05:33 -0400 (Reuters Health)

WASHINGTON (Reuters Health) - The United States is dangerously unprepared for a mass attack -- bioterrorist or otherwise -- because most states lack an organized system of trauma care, the American College of Surgeons said Wednesday.

"There's this gaping hole in our nation's organizational plan," Dr. J. Wayne Meredith said during a briefing, which focused on the need for more funding to help states coordinate hospitals and emergency personnel.

"A part of our homeland security effort, a part of our preparedness, should be building up the infrastructure of trauma care," said Meredith, who chairs the department of general surgery at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

"A local system, honed to perfection, is the best model on which to build a national response," added Dr. John Fildes, medical director of the trauma center at the University Medical Center in Las Vegas.

Yet, Fildes said, it was only in the last year that a complete list of trauma centers nationwide, and their exact locations, had even been developed.

Meredith said only about eight states currently have all the elements in place to figure out "how to deliver the right patient to the right place at the right time" for trauma care.

Yet trauma "is the leading cause of death for people under age 44," and, even more troubling, he said, most Americans think such systems are already up and running.

Most people think if they have an accident and call 911 they will be taken care of "just like it happens on television," Meredith said. "That's not the case."

One problem is that those most affected by trauma -- young adults in car accidents or victims of violence -- are least likely to exercise the clout needed to make policy-makers take notice of the lack of organization of trauma services.

"These are young people. They're just finishing high school, just finishing college. They're trying to make their car payments," Meredith said.

Another obstacle is getting the leaders of health facilities, particularly hospitals, to coordinate with each other. While hospitals cooperate on trauma planning as part of a general mission of public service, "their day job is competing with one another," Meredith said.

But what is most needed is money, according to Meredith and Fildes.

More than one-fifth of trauma patients in a recent, large study had no insurance, said Fildes, which "makes operations difficult" for many trauma centers.

At the same time, said Meredith, Congress has provided far less than the $60 million estimated to be needed to establish trauma systems nationwide.

Last year $3.5 million was appropriated for trauma system organization; this year President Bush has requested no money for the program.

"We have identified the problem. We have identified the solution," said Meredith. "What we need is the will to fix it."

Copyright 2002 Reuters.