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March 10, 1989

Trauma Systems

JAMA. 1989;261(10):1445. doi:10.1001/jama.1989.03420100079024

To the Editor.—  The article entitled "Trauma Systems: Current Status— Future Challenges"1 affirms that trauma systems and trauma centers reduce mortality from major trauma in the areas where they are used. The fact that progress in implementing regional trauma systems has been slow, and in most states nonexistent, is also demonstrated. However, I do not agree that the major barriers are economic.First, the authors assert that failure to implement regional trauma systems would open the door to outside control and regulation. Yet they also advocate legislation to define the authority to implement a regional trauma plan and to provide management structure and financial resources. This appears to relinquish control of the system from the very beginning. Physicians, especially those outside the level I trauma center, would have little, if any, input into the system.Second, this is an elitist system. To be a level I trauma center, a