A typical argument for preserving the existing health care system in the United States goes something like this:
Sure, you wouldn’t have to pay for that transplant in Canada, but you'd probably die while on a waiting list for it.
Here in Chester County, which has double the population density of the rest of Pennsylvania and the highest per-capita household income in the state, this argument gets put on its head. In this picturesque section of Southeast Pennsylvania, you might have to pay for your emergency craniotomy, but there's also a decent chance you'll complicate your recovery or even die while trying to reach the operating room.
You see, Chester County has no trauma center, which significantly increases the travel time required for injured patients to receive appropriate care. In many cases, this can make the difference between life and death. According to the Chester County Trauma Center Initiative:
By law, EMS must transport patients to the nearest appropriate trauma center. Because Chester County doesn’t have a trauma center, some individuals and families needing these services must travel farther distances for treatment. Victims treated within 60 minutes of injury are more likely to survive, recover faster and have fewer long-term effects. But on average, it takes 70 to 75 minutes from the time of a Chester County resident’s injury for them to be admitted into a trauma center.
A study conducted by UPenn provides the following succinct criteria to distinguish trauma centers from other hospitals:
Although the precise criteria used in differentiating levels of trauma care varies by state, most are based on the guidelines published by American College of Surgeons Committee on Trauma. Level I and II trauma centers provide comprehensive care for the most critically injured patients and have immediate availability of trauma surgeons, anesthesiologists, and certain other physician specialists. Level III centers provide prompt assessment, resuscitation, surgery, and stabilization, with transfer to a level I or II center when indicated.
As a hospital in a foreign country, Mogadishu’s Keysaney Hospital can't receive the American College of Surgeon's (ACS) designation of "trauma center" either. And, like the hospitals in Chester County, Mogadishu's only hospital is ill-equipped to handle the intake of seriously-injured trauma patients.
Trauma patients in Chester County have an advantage, though; unlike the injured in Mogadishu, they can be transported to a trauma center, albeit one a substantial distance away from where the injury occured. The following map shows Chester County (circled in red) and the locations of the closest trauma centers.
Note that the closest hospital with a trauma center is more than 30 miles away. Again, the population in this area is twice as dense as the rest of the state, a fact reflected by the traffic congestion. Nonetheless, Chester County residents have an average travel time that’s 15 to 20 minutes longer than residents of neighboring counties.
In a scenario that’s probably playing out at hospitals across the country, the reason why Chester County lacks a trauma center is an obvious one: lack of funding. The last time Chester County had a trauma center was in 2002, but it shut down after failing to keep up with skyrocketing costs. Currently, area hospitals are unable to assume the expenses associated with a trauma center, and insured and uninsured trauma patients alike do not provide sufficient payment to cover the cost of care.
In 2005, UPenn conducted a study (pdf) that found 84% of US residents lived within 60 minutes of the closest level I or level II trauma centers. The remaining 16% have less likelihood for survival, as the standard rule for optimal care is to admit the patient within the first hour after injury.
According to the study:
Although the overall number of trauma centers has increased over the last decade, recent studies have shown that their geographic distribution varies widely across states. These studies suggest that in many areas of the country residents are without timely access to trauma centers that could save their lives. In other areas, there may be too many trauma centers, possibly leading to inefficiencies, lower patient volumes per center, and reduced quality of care
The study observed that those living in rural areas are the most likely to have limited access to trauma centers. Notably, though, Chester County—a burgeoning suburb of Philadelphia that’s also proximal to Baltimore and Wilmington—is about as rural as the I-4 corridor that connects Orlando and Tampa. Yet access to trauma centers is dangerously restricted. So the next time someone quips about how wonderful it is to receive a heart transplant in the United States, please remind them of Chester County Pennsylvania.