There are a lot of trauma centers in the US. Unfortunately, they are not very evenly distributed. An example of this disparity can be found in Washington state. Harborview Medical Center is the only Level I trauma center serving all of Washington, Alaska, Montana, and Idaho. Yet in other metropolitan areas, there can be multiple Level I’s, II’s, and III’s. And in some other areas, new centers seem to be popping up right and left.

Unfortunately, there is such a thing as too many trauma centers. Opening a new center is a zero sum game, however. No more trauma patients will miraculously appear. They will only get redistributed from other centers, decreasing the number of their trauma admissions. Until the next one opens and begins to take patients away from the last new one, as well. Frequently, the “need” for the new center is strictly an economic one for its parent organization, not an actual population need.

The American College of Surgeons Committee on Trauma (ACSCOT) released a position statement on this phenomenon early this year. They promote the following guidelines:

• Designation responsibility falls to the governmental agency that oversees the regional trauma system. This body needs leadership and statutory authority to enforce reasonable guidelines on how many centers may exist.
• Trauma professionals must advocate for their patients in educating the lead agency about what the needs really are. The interests of the patients must supersede the interests of the providers and their health care organizations.
• The designation process should be guided by a concrete regional trauma plan.
• Needs should be assessed using concrete measures like the number of centers per 100,000 people, population location with respect to these centers, EMS transport times, trauma mortality, and frequency of diversion status.
• Trauma center allocation should be reassessed on a regular basis.
• Regional variability must be taken into account.

Bottom line: A super-abundance of trauma centers already exists in several cities around the US (and you know who you are). Unfortunately, the cat is out of the bag, and few if any designating agencies have stepped up to the plate to deal with this. The sad truth is that little will happen until hastily and poorly resourced centers start to close unexpectedly, straining established trauma centers and jeopardizing patient safety. When this crisis finally hits, our state and regional trauma systems will finally seek and wield the authority to designate more intelligently.

Reference: Statement on trauma center designation based upon system need. ACSCOT January 2015.