Almost 30 Texans die every day from injuries -- almost 10,000 each year. Since trauma is the leading cause of death in persons aged 1 - 44 years, the years of potential life lost are staggering: ~290,000 in 1993. Using a per-capita income of $19,189, this represents a phenomenal $5.6 billion in lifetime income lost and a loss to the state in lifetime tax revenues of $518 million for that one year of trauma mortality alone.
Mortality is not the only side of this issue; for every trauma victim who dies, at least six are seriously injured. Total years of productive life lost to disability are not currently known, but would add greatly to the figures above. In addition, many persons with severe disabilities resulting from injuries may be dependent to some degree on federal, state and local assistance.
Trauma is a disease that can occur anywhere at any time. Critical trauma victims must reach definitive care within a short period of time, often called the "golden hour," to help prevent death or disability. To insure this occurs, a set of resources must be in place and immediately accessible at all times. These resources include informed citizens, communications systems, prehospital care providers, and multidisciplinary trauma teams in emergency departments. With the inclusion of public information, prevention activities, and rehabilitation, this coordination of resources is called a trauma system. Studies have shown that coordination of the emergency medical resources available in an area can result in a major decrease in preventable trauma death rates.
Rural areas may not have the means to provide this full continuum of resources; therefore, preventable death rates due to trauma in these areas may be considerably higher than urban areas. It has been estimated that such rates could be as high as 85%. The problem is further compounded because the large urban centers, who usually have the appropriate resources available, are overloaded with patients and may not be able to take rural trauma transfers.
The Texas legislature wanted trauma care resources to be available to every citizen. The Omnibus Rural Health Care Rescue Act, passed in 1989, directed the Bureau of Emergency Management of the Texas Department of Health to develop and implement a statewide emergency medical services (EMS) and trauma care system, designate trauma facilities, and develop a trauma registry to monitor the system and provide statewide cost and epidemiological statistics. No funding was provided for this endeavor at that time.
Rules for implementation of the trauma system were adopted by the Texas Board of Health in January 1992. These rules divided the state into twenty-two regions called trauma service areas (TSAs), provided for the formation of a regional advisory council (RAC) in each region to develop and implement a regional trauma system plan, delineated the trauma facility designation process, and provided for the development of a state trauma registry.
The Department has shown ongoing commitment to establishment of the system statewide. A task force, appointed by the Commissioner, produced a strategic plan for trauma system development to insure its success. The Bureau was reorganized to emphasize the importance of the Trauma Program. Bureau staff provide information and technical assistance to all requesting entities.
System development activities around the state clearly demonstrate positive support for this project. A RAC has been established in all of the TSAs. Two RACs have been recognized as regional trauma systems after receiving approval of their plans. Additionally, almost 100 hospitals have been designated as trauma facilities. All of this activity has occurred despite the fact that there was no funding available for either system development or uncompensated trauma care.
During the 1997 state legislative session, four million dollars was appropriated to a newly established EMS/Trauma System fund. After much debate, surplus 911 monies were allotted as the funding source. These funds will be disbursed over two years to EMS firms and RACs to promote system development, with a small percentage earmarked for uncompensated trauma care. The Department will receive approximately $100,000 over the biennium to administer the program.
Rules for disbursement are currently being developed and include requirements for EMS and hospital participation in regional trauma system development, development of regional system plans, and submission of data to the state registry. The monies are to be disbursed through counties to EMS providers and RACs based on relative population, geographic size, and trauma care provided. The Department will recommend that the funds be targeted to areas of greatest need to increase the number of lives saved and to decrease the suffering of trauma victims.
Though Texas Trauma System supporters around the state are rejoicing the victory of the last legislative session, all concerned are aware that our greatest challenge still lies ahead. The use of surplus 911 funding was controversial and may not be a permanent, dedicated funding mechanism for the trauma system. Other sources that were examined included additional fines on moving violations and a fee added to driver's license renewals. Other states use a variety of sources (i.e. fees on car registration). Estimates for total funding needed for uncompensated care range as high as $300 million a year.
A fully implemented statewide trauma system will have many positive consequences, including decreases in the number of trauma incidents, injury severity, the number of preventable deaths, severity of trauma-related disability, and the number of persons dependent on state assistance programs. It could also ultimately result in an increase in state tax revenues.
For more information, please e-mail Trauma Systems