In Washington, DC, on December 29, 1994, Marcelino Corniel sustained injuries from two 9-mm bullets, one striking his right upper thigh, the other his left anterior chest. The latter projectile traversed the liver and exited the back. The bullets were fired by a US Park Police officer as Mr. Corniel ran down Pennsylvania Avenue in front of the White House, brandishing a hunting knife and ignoring orders to drop the weapon. Mr. Corniel was rushed to George Washington University Hospital for care. After 36 hours, three operations, and more than 30 units of blood products, the patient died. The total cost for this 1.5-day hospitalization was $70,169, none of which was reimbursed.<sup>24Colburn D. Gunshot—the story of Marcelino Corniel, who was shot in front of the White House Washington Post, Health Section February 7, 1995 ;  11 (6) : 10

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It is estimated that acute medical care for trauma (both intentional and unintentional injuries) costs the United States in excess of $16 billion per year, thereby representing the second largest source of expenditures for medical care in the United States.<sup>34Harlan L.C., Harlan W.R., Parsons P.E. The economic impact of injuries: A major source of medical costs Am J Public Health 1990 ;  80 : 453 [cross-ref]

Cliquez ici pour aller à la section Références</sup> But, in addition to monies paid out for acute medical care, death and disability due to injuries cost this country much more: of the 57 million Americans injured every year, more than 2 million are hospitalized and more than 150,000 die. Annual costs due to deaths, disability, lost wages and taxes, and acute medical care secondary to trauma in this country have been estimated to exceed $150 billion.<sup>16Centers for Disease Control Setting the national agenda for injury control in the 1990s—trauma care systems MMWR 1992 ;  41 : 27

Cliquez ici pour aller à la section Références</sup> Of the 12 million years of potential life lost by those dying before the age of 65 in calendar year 1990, fully 30% (more than 3.6 million years) were lost by trauma casualties, by far the number one cause of premature mortality.<sup>17Centers for Disease Control Years of potential life lost before ages 65 and 85—United States, 1989–1990 MMWR 1992 ;  41 : 3-13

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Despite these staggering costs in lives and medical resources, the health care system in this country has not developed adequate means to deliver trauma care to its injured populace in a manner that is simultaneously efficacious and cost efficient. Although multiple studies have shown that trauma care systems in which the most seriously injured patients are triaged to specialized trauma centers result in improved patient outcome, many economic disincentives discourage the development or continuation of such systems. In one 1992 study, Dailey and colleagues <sup>25Dailey J.T., Teter H., Cowley R.A. Trauma center closures: A national assessment J Trauma 1992 ;  33 : 539 [cross-ref]

Cliquez ici pour aller à la section Références</sup> examined the factors influencing 66 trauma center closures over an 8-year period. The top three reasons cited were economic: the cost of uncompensated care, high operating costs, and inadequate reimbursement from governmental medical assistance programs. A consensus statement from the Third National Injury Control Conference of 1992, sponsored by the Centers for Disease Control, concluded:

Current financing for trauma care is grossly inadequate … Without notable change in this financial situation, development of trauma systems will cease, and more trauma centers will close … Recommendations: … Conduct a comprehensive evaluation of reimbursement problems and provide financial support for trauma care systems.<sup>16Centers for Disease Control Setting the national agenda for injury control in the 1990s—trauma care systems MMWR 1992 ;  41 : 27

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Although such financial support appears essential to the survival of trauma centers, it has been difficult to obtain. The US Congress, which had originally appropriated $4.8 million per year for funding trauma systems grant programs under the Health Resources and Services Administration Division of Trauma and Emergency Medical Systems (DTEMS), recently rescinded $4.5 million from this year's funding as part of an effort at deficit reduction, leaving this year's DTEMS program virtually unfunded.<sup>1American College of Surgeons Trauma funding is threatened Bull Am Coll Surg 1995 ;  80 : 7

Cliquez ici pour aller à la section Références</sup> Without significant financial support from outside sources, it then becomes incumbent upon each health care facility caring for victims of trauma to find and implement new ways to achieve financial solvency: to make trauma care cost efficient. To this end, this article outlines various means of reaching that goal. Although trauma centers typically operate “in the red,” many have adopted strategies to save money without compromising care. This article discusses published data and experiences demonstrating cost efficiency in trauma care from the standpoints of administration, diagnostic testing, therapeutic interventions, and injury prevention.