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Hundreds of Arizonans die unnecessarily every year because the state lacks adequate trauma care, national experts say.

Arizona does have seven "Level 1" trauma centers — including University Medical Center in Tucson — that deliver top-quality trauma care for people with life-threatening injuries.

But they're clustered mostly in the state's two urban centers, leaving vast rural areas out of the trauma loop — or at least hours from it, a statewide analysis of trauma care concluded. As many as 10 percent of all trauma deaths in Arizona could be prevented if all the state's acute-care hospitals — nearly 70 of them — also joined the trauma system, at various levels of trauma care, the analysis found.

As it is, traumatic injury is the leading cause of death for Arizonans younger than 44.

The analysis was done by the American College of Surgeons, the national physicians group that sets standards for trauma care and verifies that trauma centers meet them.

Citing a "perfect storm" of pressures in Arizona — a booming population, many elderly patients, underserved American Indian tribes, huge numbers of border crossers, as well as the rural issue — the report says Arizona must develop a "fully functional inclusive" trauma care system to save more lives.

Such a system — with all hospitals coordinated to get injured patients to the proper level of trauma care within the crucial "golden hour," when immediate care is most likely to save lives — would prevent more than 300 trauma deaths a year, the analysis concluded. But state funds will be needed to help dozens of hospitals gear up to become Level 2, 3 and 4 trauma centers — money that Arizona does not have and will not provide in the face of a severe budget shortfall.

In fact, the state's financial situation is so dire that even the funds now supporting the existing Level 1 trauma centers — from casino gambling profits via Proposition 202, passed by voters in 2002 — may be in danger.

With that threat looming, UMC trauma officials have called the idea of an all-hospital statewide trauma system "pie in the sky." They also admit fearing it may siphon off paying trauma patients from UMC.

"To be honest, it could be very detrimental,," said Eileen Whalen, vice president of UMC's trauma and emergency services, saying it could "over-dilute the trauma system."

"As it is now, we get 100 percent of Southern Arizona's trauma patients. And yes, sometimes that means we are overloaded. But if we end up competing for these patients with several Level 2 and Level 3 trauma centers in Tucson, that's where it will become difficult for us financially."

But it's not likely to happen anyway, without any funding she said. "Some hospitals will not want to be trauma centers because there are requirements they may not be able to afford."

Providing trauma care — for patients with injuries from car crashes, gunshots, falls, knife wounds, assault or burns — is expensive, especially at Level 1.

That requires a full team of trauma and specialty surgeons, also trauma nurses and dedicated equipment and operating rooms immediately available. It also performs research and provides education services.

All levels of trauma care require advanced trauma training, but provide lower levels of immediate availability of doctors and care.

As it is, UMC is straining to keep the city's lone Level 1 trauma center at peak function and financially stability, after Tucson Medical Center's trauma enter closed in 2003, because of the financial burden of running it.

Despite the formidable obstacles, state trauma officials are responding to the report, launching a major push to get as many hospitals as possible into the trauma system.

Starting this month, they'll begin approaching rural hospitals to gear up to provide Level 4 trauma care, starting with the hospital in Show Low in the White Mountains. By the end of 2008, the goal is to get at least a dozen hospitals across the state on board as Level 4s, including the hospital in Sierra Vista.

"We wholeheartedly agree with the (report's) conclusions," said Will Humble, assistant director for preparedness at the state health department.

"Look where it's been done — there are reductions in trauma costs and improvement in patient care. It's all about getting patients to the right place at the right time, and you need a fully connected and coordinated state- wide system to do that.

"The biggest improvements happen when you bring Level 4s on board in the rural areas. That's where the time factor is really critical."

Among the advantages of a statewide system are advanced trauma training at all hospitals, more accurate assessment of degree of injury and level of care needed, and more efficient transfer of trauma patients.

States that have put together such a system have seen trauma survival jump 9 percent to 20 percent, several studies show.

But Humble will have to sell the idea to Arizona hospitals "without a checkbook in hand" — without any financial incentives to get into trauma care.

"We've got to 'sell the sizzle,' so to speak," he said. "Hospitals can say they've improved care for their communities in a really critical area."

But the pitch also will include a more persuasive carrot — increased revenues by keeping and treating more patients.

"Part of it is knowing who you can handle and how. We believe there are a lot of unnecessary patient transports going on," Humble said.

"The data that comes in to a statewide system will give hospitals a much better idea of the type of injuries they are likely to see, and what they can do to handle them as a trauma center. They can keep many of these patients in their communities."

If the effort is successful, Humble estimates it may take up to three years to create a fully functioning, inclusive state-wide trauma system.

But that may be somewhat optimistic, given the struggles other states have had to achieve this. In Colorado, it took nearly 10 years — and the tragic death of a high-school homecoming queen — to get the job done.

"It took a decade and an enormous amount of work to make this finally happen, but it is the thing I am most proud of," said former Colorado state Sen. Dottie Wham, who introduced the idea in the mid-1980s but did not see it happen until 1995.

"We had to go to the grass-roots to do it, and we had to have strong rural support. But the hospital turf wars over this were almost unsurmountable — at times, I was so discouraged.

"But, finally, people came to understand that you need a statewide system, so the guy in a wreck on the highway in the middle of nowhere actually has a chance."

It took a popular homecoming queen who didn't have a chance when her car wrecked on a rural Colorado road in 1992 to finally make the trauma system happen in that state.

Suffering a torn aorta in the crash, the teen was taken first to a small rural hospital, then flown to a larger Denver hospital — neither a trauma center of any level.

Her injury — one of the most common life-threatening car-crash injuries — went undetected and untreated, and she bled to death the next day.

"A trauma center — at any level — would have found the torn aorta," Wham said.

"That's when it finally came clear to the public what we were talking about. We needed a system with all the hospitals trained at least in the basics of trauma care."

One of the Southern Arizona hospitals expressing interest in joining the trauma system — possibly as a Level 3 — is the Sierra Vista Regional Healthcare Center.

"We would consider all opportunities to provide services in our area, so if the state approaches us, of course, we would be open to it," hospital CEO Margaret Hepburn said.

"But we do see trauma patients here in Sierra Vista — we receive them from other hospitals, and we transport patients to higher levels of care. So we consider ourselves part of trauma care now."

The move toward an all-inclusive trauma system comes at a difficult time — with Arizona suffering a huge budget shortfall driven by what appears to be a nationwide recession.

The Prop. 202 casino funds that now sustain the state's Level 1 trauma centers — with about $23 million a year now — have been targeted by the Joint Legislative Budget Committee as a possible source of funds to reduce the state deficit.

UMC gets about $4 million a year out of that pot, which has proved vital to pay the trauma and specialty surgeons on the Level 1 team. But even with that, UMC's trauma center is still losing about $1.5 million a year, Whalen said.

"Every time a state government suffers a shortfall of general funds, they raid the trauma fund, even though those funds have been earmarked by the voters," said Connie Potter, executive director of the National Foundation for Trauma Care.

"At the state level, it's always hand-to-hand fighting for trauma money, and it never ends. And it's never enough.

"Nobody's in great shape."

Part of an occasional series on Tucson's troubled trauma system.

MORE INSIDE

Is UMC in danger of losing its Level 1 status? Story on A5.

On StarNet: Experience the sights and sounds of Tucson's only level-one trauma center in an audio slide show at go.azstarnet.com/starnetblog.