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Availability of trauma specialists in level I and II trauma centers: a national survey.

BACKGROUND
Despite American College of Surgeons Committee on Trauma's criteria, little data exists about the variability of practices in both the composition of trauma teams and timing of specialist availability across trauma centers. The purpose of the study was to determine the availability of trauma team personnel in Level I and II trauma centers across the United States.


METHODS
Two surveys were developed and mailed to trauma directors and coordinators in 450 centers. Responses were received from 254 directors (56%) and 218 coordinators (48%). The director survey was designed to collect data on trauma team composition and timeliness in response to a hypothetical scenario. The coordinator survey was designed to collect data on trauma center characteristics and general availability of trauma specialists.


RESULTS
Eighty-two percent of Level I and II centers had trauma surgeons available within 15 minutes of and 37% at patient admission. The in-house (IH) centers (60%) had a trauma surgeon at patient admission significantly more than on-call centers did (22%). The specialty surgeons, such as neurosurgeons (73%) and orthopedic surgeons (75%), were mostly available through the on-call system. An IH system, high volumes of trauma patients, and designation by American College of Surgeons were significantly associated with higher likelihood of trauma surgeons physically present at the bedside within 15 minutes.


CONCLUSIONS
There was a large variation in the availability of expertise at or shortly after a trauma admission. For centers with low patient volume, early triage, better notification systems based on advanced telecommunication technology, and compensation for IH call may be a solution to better use the trauma surgical specialties.