Brain Trauma: Getting the Best Care

An under-reported issue in the shooting of Representative Gabrielle Giffords is availability and access to high level trauma care. If you are going to survive a brain gun shot wound or other serious trauma it is crucial to quickly access specialized trauma hospitals and physicians to maximize your chance of survival.

Fortunately for Representative Giffords and the other survivors of the Tucson Arizona shootings, the incident occurred within only a few miles of a level I adult a trauma center. University Medical Center in Tucson has the highest rating for a trauma center. (Why the University of Arizona named their medical center University Medical Center is a mystery to me. By using a generic name they lost out on millions of dollars of free publicity with this incident.)

Trauma centers in the United States are categorized in five levels--I II III IV and V. According to Wikipedia, as of May 31, 2010 there were 203 level I trauma centers in the United States. The key distinctions for levels of rating are:

• Level I: Highest level of surgical care for trauma, full range of physician surgical specialist available 24/7, significant annual number of trauma cases treated, surgical residency at site with significant educational and research program for trauma
• Level II: Collaborates with a regional level I trauma center with 24 hour availability of essential physician specialties, less stringent annual trauma case volume, not required to participate in research or surgical residency training.
• Level III: Full complement of surgical specialists not required but must provide emergency trauma care in collaboration with a level I or level II trauma center
• Level IV and level V: Only require immediate 24 availability of trauma-trained nurse and fewer specialty physician availability requirements

A study published in the New England Journal of Medicine examined the role of trauma center care on mortality in the United States. Controlling for trauma case severity, they found mortality was reduced by 20 to 25% when trauma care was provided by a level I trauma center. This effect appeared to be particularly true for younger adults groups in the age range of Representative Giffords. This study was not specific to brain trauma or gun shot wounds to the brain. The effect of level I trauma care for this type of injury has not been extensively studied.

Academic medical centers such as the University of Arizona often benefit from 24 hour in-house surgical specialist residents.  These on-call residents can provide early assessment and management during the time it takes for surgical specialists to arrive at the hospital.

A Center for Disease Control website focuses on the availability of trauma centers in the U.S.   It highlights the geographic distribution of trauma centers in the United States and provides links to additional information. The map shows where you can get to a level I or level II within one hour via a helicopter transport.   The CDC site emphasizes the key in trauma care is: "Getting the Right Care, in the Right Place, at the Right Time".  Fortunately for Representative Giffords, she was only minutes away from a facility with the highest level of trauma care.

Photo of Palm Beach County Trauma Helicopter Courtesy of Wikipedia Creative Commons: Author Captain Mark Carr.

MacKenzie, E., Rivara, F., Jurkovich, G., Nathens, A., Frey, K., Egleston, B., Salkever, D., & Scharfstein, D. (2006). A National Evaluation of the Effect of Trauma-Center Care on Mortality New England Journal of Medicine, 354 (4), 366-378 DOI: 10.1056/NEJMsa052049