Statement on Alabama State Trauma System by the Alabama Chapter of the American College of Surgeons

The following statement was developed by the Executive Council of the Alabama Chapter of the American College of Surgeons at its 2012 Winter Executive Meeting.

The following statement was created in order to assist the development of a comprehensive trauma system for the State of Alabama. The comprehensive trauma system has been designed to provide the appropriate and timely trauma care for the all of the citizens of our State.

The Alabama Chapter of the American College of Surgeons acknowledges the following facts:

  • Trauma is the most common cause of death for patients less than 45 years of age.
  • Trauma is more commonly a disease of the young (15-34 years) and thus has a greater economic impact.
  • Total yearly economic cost of trauma in Alabama is 6.5 billion dollars.
  • Alabama has the 11th highest per capita highway trauma death rate in the U.S.
  • The death rate is twice as high in the rural areas as in the metro areas.
  • 80% of trauma is blunt force injury vehicular crashes or falls.
  •  Without the trauma system, 60% of trauma patients initially go to hospitals without trauma capabilities causing delays in treatment.
  • The Department of Public Health has reviewed hospitals within the State and designated them as Level I, II, or III, based on manpower and infrastructure to care for trauma patients.
  • Since September 2011, Alabama has had a 60% functioning triage system that routes patients to the most appropriate hospital. Trauma system patient triage is controlled by a single electronic communication center that coordinates patient transport to the appropriate facility initially and facilitates transfer of patients that must be stabilized locally before transfer to a higher level facility for definitive care.
  • The Alabama trauma system is constantly monitored to correct problems, improve the system, and validate the quality of care provided.
  • The Alabama Department of Transportation has identified decreases in trauma deaths in Alabama each year the system has been in place. In 2009 when the system was only 43% operational, the death rate decreased 25% from the previous 4 years.
  • Designation of a hospital system in the current system is voluntary.  In several areas of the State (Regions 4 and 5) and cities (Montgomery, Dothan) there are no level I  or II trauma centers,  largely because of the tremendous financial and infrastructure needs related to the provision of trauma care. There are major cities in Alabama without any designated trauma centers.
  • Contiguous states such as Florida, Georgia, Tennessee, and Mississippi, have statewide trauma funding for the hospitals and surgeons providing care to trauma victims.
  • Currently, there is no public funding for the trauma system hospitals, or medical personnel, including surgeons, in Alabama.
  • The “golden hour” is critical for the acutely injured patient. Prompt surgical care is lifesaving and this type of care cannot be delivered without a coordinated effort among emergency medical technicians hospitals, and medical staff to provide appropriate levels of care.
  • Insurance companies do not reimburse adequately for the level of care delivered to severely injured patients.
  • Participation in the trauma system is a huge financial loss for many hospitals and physicians in Alabama.
  • Some hospitals recognizing the financial losses and the reluctance of surgeons in particular to staff the emergency trauma cases have reduced their participation in the trauma system. Currently, there is no financial incentive to be a Level I or II trauma center; in fact, there is a huge disincentive for any hospital to participate at more than a Level III in the State of Alabama because of the high cost of infrastructure and personnel required. Since September 2011 several hospitals have downgraded their designation from Level II to Level III and there has been no interest in hospitals designating themselves as Level I or Level II in Regions 4 and 5.
  • The trauma system currently relies heavily on the three Level I hospitals in the State to maintain the infrastructure and manpower to provide access to care for the traumatized patient. The cost of providing that service is immense and is straining the budgets of the hospitals and the physicians involved.

In order to make sure that the system provides adequate access to trauma care in Alabama; we strongly recommend public funding of the hospitals and medical personnel currently providing care to maintain the infrastructure. Furthermore, funding would incentivize hospitals and physicians to upgrade designation. In order to improve access to lifesaving, time-sensitive trauma care the Alabama Chapter of the American College of Surgeons recommends additional public funding of the Alabama trauma system. Options for funding include:

  • a surcharge on health insurance companies and workman’s compensation for each activation of the system;
  • increased reimbursement to physicians involved in providing emergency trauma care when activated through the State system;
  • fee for purchases of all-terrain vehicles;
  • fees on license renewals for motor vehicles, boats, motorcycles, and commercial vehicles;
  • a hospital fee that would be levied on a hospital that opted out of the trauma system completely or participate at a lower level if they could otherwise qualify for a higher level;
  • a fee on life insurance policies;
  • a fee on tires purchased; and
  • combinations of all of the above.