Access to trauma systems in Canada.
BACKGROUND
Trauma is a leading cause of morbidity, potential years of life lost and health care expenditure in Canada and around the world. Trauma systems have been established across North America to provide comprehensive injury care and to lead injury control efforts. We sought to describe the current status of trauma systems in Canada and Canadians' access to acute, multidisciplinary trauma care.


METHODS
A national survey was used to identify the locations and capabilities of adult trauma centers across Canada and to identify the catchment populations they serve. Geographic information science methods were used to map the locations of Level I and Level II trauma centers and to define 1-hour road travel times around each trauma center. Data from the 2006 Canadian Census were used to estimate populations within and outside 1-hour access to definitive trauma care.


RESULTS
In Canada, 32 Level I and Level II trauma centers provide definitive trauma care and coordinate the efforts of their surrounding trauma systems. Most Canadians (77.5%) reside within 1-hour road travel catchments of Level I or Level II centers. However, marked geographic disparities in access persist. Of the 22.5% of Canadians who live more than an hour away from a Level I or Level II trauma centers, all are in rural and remote regions.


CONCLUSIONS
Access to high quality acute trauma care is well established across parts of Canada but a clear urban/rural divide persists. Regional efforts to improve short- and long-term outcomes after severe trauma should focus on the optimization of access to pre-hospital care and acute trauma care in rural communities using locally relevant strategies or novel care delivery options.
Hameed
Syed Morad
SM
Research Committee of the Trauma Association of Canada, Calgary, Alberta, Canada. morad.hameed@vch.ca
Schuurman
Nadine
N
Razek
Tarek
T
Boone
Darrell
D
Van Heest
Rardi
R
Taulu
Tracey
T
Lakha
Nasira
N
Evans
David C
DC
Brown
D Ross
DR
Kirkpatrick
Andrew W
AW
Stelfox
Henry T
HT
Dyer
Dianne
D
van Wijngaarden-Stephens
Mary
M
Logsetty
Sarvesh
S
Nathens
Avery B
AB
Charyk-Stewart
Tanya
T
Rizoli
Sandro
S
Tremblay
Lorraine N
LN
Brenneman
Frederick
F
Ahmed
Najma
N
Galbraith
Elsie
E
Parry
Neil
N
Girotti
Murray J
MJ
Pagliarello
Guiseppe
G
Tze
Nancy
N
Khwaja
Kosar
K
Yanchar
Natalie
N
Tallon
John M
JM
Trenholm
J Andrew I
JA
Tegart
Candance
C
Amram
Ofer
O
Berube
Myriam
M
Hameed
Usmaan
U
Simons
Richard K
RK
D002170:Canada; D002391:Catchment Area, Health; D006297:Health Services Accessibility; D006801:Humans; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014195:Travel