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Reducing the Burden of Injury: Advancing Prevention and Treatment
TABLE 6.1 Chronology of Trauma System Legislation
Highway Safety Act authorizes funding for, and requires states to develop, regional EMS systems; also authorizes the Department of Transportation to develop standards for EMS provider training.
Emergency Medical Services Systems Act (P.L. 93-154) authorizes additional federal guidelines and funding for the development of regional EMS systems.
Omnibus Budget Reconciliation Act consolidates EMS funding into state preventive health and health services block grants under the Centers for Disease Control and Prevention (CDC).
Health Services, Preventive Health Services, and Home and Community-Based Services Act (P.L. 98-555) authorizes the Emergency Medical Services for Children Program.
Trauma Care Systems Planning and Development Act (P.L. 101-590) authorizes funding for state and regional trauma systems development.
Trauma Care Systems Planning and Development Act is not reauthorized.
The Model Trauma Care System Plan offers a framework for states to build trauma care systems once they have procured legislative authority.1 In broad terms, the plan calls for states to link prehospital, acute care, and rehabilitation providers through leadership, systems development, planning, and evaluation, and through securing financing for system administration and patient care (HRSA, 1992). More specifically, the plan exhorts states to designate trauma centers, establish trauma registries, and ensure, in concert with communities, that triage and transport protocols are in place for the timely assessment and movement of patients to the most suitable acute care facility. Bazzoli and coworkers (1995) found that the most common problem for states was to limit the number of designated trauma centers based on community need. The ACS (1993) underscored the importance of states' limiting the number of designated centers for two primary reasons: (1) trauma teams must treat sufficient numbers of major trauma patients to maintain their expertise, and (2) unnecessary duplication of centers yields excessively high societal health care costs (see also Goldfarb et al. ). The importance of maintaining sufficient patient volume as a determi-
By 1992, 41 state and regional agencies had legal authority to coordinate and regulate trauma care systems (Bazzoli et al., 1995). Regional agencies generally refer to counties or groups of counties (Bazzoli et al., 1995) or, occasionally to, private organizations. In the absence of legislation, states have little ability to require the routing of patients to trauma centers (Mendeloff and Cayten, 1991; Bazzoli et al., 1995).