The emerging crisis in trauma care: a history and definition of the problem.

The crisis in patient access to emergency surgical care as articulated by the Division of Advocacy and Health Policy of the American College of Surgeons is real. It is most likely that in the next 10 years this crisis will only get worse. At last count, there were 190 Level I trauma centers in the United States, of which, 48 have been verified by the American College of Surgeons. There are 263 Level II centers, of which, 51 have been verified. These centers provide approximately 50% of tertiary trauma care in the United States. The data is overwhelming that they do make a difference in outcome. Neurosurgical professional societies participated with the American College of Surgeons in developing the recent white paper from the Division of Advocacy and Health Policy. It is now time to solve the crisis, and neurosurgery should step up to the plate and provide coverage for Level I and Level II trauma centers at a reasonable cost. Furthermore, neurosurgery should be involved in continuing to help to solve the crisis that currently exists. If neurosurgery cannot or does not want to provide coverage, they should let other surgeons provide coverage.