(ACS Publication June 2006 A Growing Crisis In Patient Access to Emergency Surgical Care at (http://www.facs.org/ahp/emergcarecrisis.pdf) Statement of Problem

There is a growing problem in the ability of individuals and communities to receive care, according to the American College of Surgeons, as the changing face of emergency care and medical care in general is putting patients at risk. The ACS and the AMA have both recently conducted professional surveys that indicate that the source of the problem is a lack of specialized surgical providers to cover existing trauma centers and a lack of those same staff members to help to establish new centers of care in areas, with the lowest numbers of provider services. (ACS Publication June 2006 A Growing Crisis In Patient Access to Emergency Surgical Care at (http://www.facs.org/ahp/emergcarecrisis.pdf)

The ACS Publication A Growing Crisis In Patient Access to Emergency Surgical Care stresses that the existing system is not meeting patients needs, as it should and some of the reasons include the inability of existing surgical specialists to adequately cover the number of trauma centers that exist currently. Those surgery specialists are experiencing a burdensome circumstance of work load that is unsustainable at its current level, according to the article specialists surgeons take call 10 or more days a month with those in less frequently utilized specialties taking call much more frequently than that, and this is on top of the requirements of their often overtaxed professional practice responsibilities. These surgeons also often take call at more than one institution at any given time sighting frequent difficulty managing on call responsibilities. These professionals are also required to take part in on-call panels but are frequently opting out of such responsibilities as a result of the overtaxing nature of their work. Furthermore, such a high number of surgeons have been sued by patients and families for services that began in the emergency department, creating a liability situation that offers a deduction in liability insurance if the surgeon limits or eliminates his or her ED call times, and as liability insurance has skyrocketed for physicians in general over the last twenty or so years many surgical providers are taking this option therefore reducing the availability of surgical specialists even further. (ACS Publication June 2006 at (http://www.facs.org/ahp/emergcarecrisis.pdf)

Another issue that is crucial to the continued improvement, rather than dissolution of the emergency medical care system in the United States is that if nothing is done the system may break down to a point where we return to a time that is reality in most low-middle income nations.

A the absence of organized and trained emergency medical services in most low/middle-income countries. This situation lengthens the critical time interval before trauma victims are treated, contributing to increased morbidity and mortality. Even in the largest hospitals in these countries, internationally accepted guidelines for treatment of trauma and injuries are often not followed, diagnostic and imaging facilities are poorly equipped, resources are strained, and treatment practices routinely used in high-income countries are not being implemented. For example, advances in resuscitation, wound-closing procedures, and infection control have greatly increased the survival of children in the United States who experience massive burns; however, these practices are not yet commonly used in low/middle-income countries. (Hofman, Primack, Keusch, & Hrynknow, Jan. 2005, at (http://hestia.unm.edu.libproxy.unm.edu/search/i0090%2D0036/i00900036/1,1,1,B/l856~b1044007&FF=i00900036&1,1,1,0/startreferer//search/i0090%2D0036/i00900036/1,1,1,B/frameset&FF=i00900036&1,1,/endreferer/)

From this and other information on the history and development of the Emergency Care System within the United States and elsewhere it is easy to determine why it is crucial for these systems to be protected, improved and expanded. This is particularly true in the case of rural health care, which is in and of itself in a serious state of perpetual concern.

Urban areas are more attractive to health care professionals for their comparative social, cultural and professional advantages [13]. Large metropolitan centers offer more opportunities for career and educational advancement, better employment prospects for health professionals and their family (i.e. spouse), easier access to private practice (an important factor in countries where public salaries are low) and lifestyle-related services and amenities, and better access to education opportunities for their children [6,14,15]. In addition, the low status often conferred to those working in rural and remote areas further contributes to health professionals' preference for settling in urban...

While it is in the most remote and underserved areas that health problems are more prominent (Dussault & Franceschini, 2006 at (http://www.human-resources-health.com/content/4/1/12)
Though it is hardly the case that there are more doctors that can fill these vacancies, as they are all concentrated in the urban areas, it is also the case that doctors, and especially those in specialties are scarce even in the urban areas and positions often go unfilled. The development of systems that have increased efficiency has to a large extent occurred and yet many people are still considered underserved in the United States populations. The need for Level I trauma centers is essential to the continued success with regard to low mortality rates and decreased emergency deaths.

Why Level I Trauma Centers are Needed

Within many regional locations level I trauma centers are available, and the need for specialized surgical care is to a large degree being met, despite urgent issues about surgical shortages, there are still many locations where these centers are needed. Though life flight systems of emergency medical care, and even specialized web hosting technology sites that link doctors to emergency medical specialized personnel in remote locations are improving the odds for patients in critical care situations where specialized services are not available, there is still urgencies in many cases that warrant even faster service.

In severe weather conditions, such as thunderstorms, heavy snow and fog where visibility and ceiling heights are low, helicopters cannot fly and ground transport to the nearest Level I trauma center could take up precious time in traffic. (Krishnamurthy, 2004, p. 1)

Additionally, emergency care physicians are not always allowed the time to research options, broadband high speed or not, sitting down to a computer screen in order to come up with the best possible treatment option for an emergency trauma is usually not an option. Physicians are busy with critical and non-critical care in the emergency room and this is not a logical option for most.

The reasons they are needed have to do with the efficiency and efficacy of technological medical advances which have been repeatedly proven to reduce emergency deaths. Specialized diagnostic and treatment options must be available to every individual within a relatively short time after trauma event s occur and as more is understood and therefore treatable than ever before there is a greater demand for such services.

Sixty-eight percent of ED administrators surveyed indicated that patient volumes increased in the past 12 months. Eighteen percent indicated that overcrowding, due to increased patient volume, had caused them to divert patients to other hospitals; however, that number was down from 36% in a 2001 survey. Schumacher speculates that the decrease may be because many hospitals have expanded their EDs in response to rising patient numbers and are better able to handle higher volumes. Surprisingly, the lack of specialty coverage seems to be driving patient diversions at most facilities. Of those surveyed, 76% indicated that lack of physician speciality coverage was responsible for diversions -- "up 65% from 2001 -- "and 23% believed the lack of specialty coverage posed a significant risk to their ED patients. An increasing shortage of specialists has made ED coverage more difficult; and rising malpractice rates and uncompensated care make some specialists reluctant to cover the ED. In fact, 15% of the administrators said they would go to a facility other than their own in the event they were seriously injured -- "primarily (73%) due to the lack of specialty backup in their own ED (Emergency Medical Services, July 2004)

It is a difficult testimony that emergency care providers would rather be seen at other institutions as a result of the lack of specialized care in their own institution. Challenges to this systems and its set of subsystems seem imminent and yet not a lot is being done to investigate the causes. Why are individual surgeons not specializing, or is it simply that there are not enough surgeons at all?

The demand for specialized care will not end any time soon and the need for proliferation of Level I trauma centers, into areas where populations are underserved is essential and yet these things do not seem to be occurring at a rate that is significant enough to meet the growing demand that is seen at the local Emergency department level. An issue that is also paramount to answer is why are so many people seeking medical care from EDs when their illnesses and/or injuries are not life threatening. (Emergency Medical Services, July 2004) "...demand for care from these providers among the uninsured exceeded available supply." (Gold, 1998, p. 296) many health…