One hour can spell the difference between life and death for victims of severe injury, but about a quarter of Americans now have to travel farther to reach the nearest hospital trauma center, a study published Wednesday concludes.
The reason: Hundreds of trauma centers have closed over the past two decades.
Sixty-nine million people had to travel farther to reach a trauma center in 2007 than in 2001, according a study in the journal Health Affairs.
The median _ or midpoint _ increase in travel time was 10 minutes. But for nearly 16 million people, travel times increased by 30 minutes or longer.
Most of the trauma centers that closed were overwhelmed by financial problems from a combination of treating many uninsured patients who couldn't pay, and having to maintain high-level, life-saving capabilities on round-the-clock alert.
The greatest impact from diminished access has been on people in rural communities and in areas with high shares of African-American residents, low-income people and uninsured. The trend exacerbates disparities in health care.
Lead researcher Dr. Renee Hsia, an emergency room doctor at San Francisco General Hospital, said the study points to a need for state and regional coordination to reduce travel time to trauma centers. In rural areas, more resources may have to be devoted to air transport.
The researchers obtained longitude and latitude coordinates for every trauma center in the United States. They then measured driving distances and times between trauma centers and area ZIP codes, factoring in Census population data. They compared the results for 2001 and 2007, the latest year for which data was available.
Hsia said researchers were surprised. "A quarter of the population is significant," she said.
In 1990, there were 1,125 trauma centers around the nation. Fifteen years later, 339 had closed, or about 30 percent. That compares to 66 closures between 1981 and 1991.
Designed and equipped to handle complex injuries, trauma centers are not the same as emergency rooms. A person with a broken leg should go to the emergency room; a victim with multiple fractures belongs in a trauma center. A patient with a concussion can be treated in the emergency room; someone with a brain injury should be taken to a trauma center.
Time is of the essence. Medical experts agree that a severely injured victim's chances of surviving and returning to a normal life are greatest if they can get the right treatment within an hour. It's called the "golden hour," a concept derived from military medicine during the Vietnam War and still guiding medical units in Afghanistan and Iraq.
"A 30-minute increase means half that time is wasted on driving," said Hsia, who also teaches emergency medicine at the University of California, San Francisco.
The study found that some vulnerable groups, notably the elderly as a whole, have not seen an increase in the time it takes to get to a trauma center.
Also, the impact of trauma center closures in urban areas has been lessened because metro regions tend to have more than one such facility. The researchers estimated that more than two-thirds of residents in urban areas live within 10 miles of a trauma center, while in rural areas only a quarter have a trauma center within that distance.
"We're not saying that we should build a trauma center on every street corner. That would not be cost-effective," said Hsia. "But we do have evidence that access for certain populations is already pretty bad, and it's getting worse."
Hsia now plans to investigate whether the longer travel times to trauma centers have cost lives.