December 2008 marks the 25th anniversary of Los Angeles County’s trauma system. Nearly 400,000 critically injured trauma patients have been treated in local trauma centers since the first trauma centers were designated in 1983. Traumatic injuries continue to be the leading cause of death for people between the ages of 1 and 44.
Critically injured trauma patients include those who require immediate life-saving surgical intervention because of major blood loss or shock as a result of motor vehicle crashes, gunshot or knife wounds, falls, or other violent accidents. These patients are brought by ambulance directly to a trauma center for specialized care rather than being transported to the nearest emergency room.
Unlike regular community hospitals, trauma centers maintain an entire team of specialized medical personnel, including a trauma surgeon, who are available 24 hours a day to ensure that life-threatening injuries to be treated at a moment’s notice. There are currently 13 trauma centers in Los Angeles County, making it the largest organized trauma system in the country.
As we saw during the recent train collision in Chatsworth, trauma centers are crucial to disaster response, says Cathy Chidester, Director of the Emergency Medical Services Agency. There are four to five multi-casualty incidents every month in the county, where critically injured victims are taken to a trauma center.
Over the past 25 years, the number of trauma patients treated annually has grown from 15,138 in 1984, to 19,481 in 2007. The most recent data shows that males have more traumatic injuries than females (14,584 males vs. 4,897 females) and that the top five mechanisms of injury are: motor vehicle crashes (5,039), falls (4,045), auto vs. pedestrian/bicycle (2,947), gunshot wounds (2,366), and motorcycle crashes (1,339). Out of 19,481 trauma patients, nearly 1,800 were pediatric.
Trauma System History
The Los Angeles County Board of Supervisors officially designated the first eight trauma centers on December 15, 1983. The system grew to a peak in 1985 with a total of 22 designated trauma centers. The county currently has 13 trauma centers.
During the initial period of growth, there were many perceived advantages in seeking trauma center designation, such as marketing advantages, prestige, and favorable impact on post-graduate training programs. However, it quickly became evident that the perceived benefits were not enough to offset the high levels of uncompensated care for trauma patients.
The decline of trauma centers was finally halted with the implementation of secure trauma catchment areas, which helped keep patient numbers high enough for trauma centers to maintain high-quality training programs, and the Board of Supervisors’ decision to allocate newly available Proposition 99 tobacco tax monies to offset the trauma centers’ financial losses.
Additionally, the recent stability of the trauma system network is largely due to the voter-approved special parcel tax (called Measure B: Trauma, Emergency and Bioterrorism Response Assessment) that was approved in 2002. Part of the money that is collected allows the county to maintain and enhance the trauma network.
The trauma system has proven to be cost effective because it lowers mortality and morbidity rates, decreases permanent disabilities, and decreases the number of productive years lost to society, says Chidester. More importantly, the system saves lives every day by providing highly specialized care for the most life-threatening injuries.