Francisco Reyes: Post-trauma care must be equitable

June 15, 2024. The Daily Reflector. By Francisco Reyes.

2023-24 Schweitzer Fellow Francisco Reyes

No one wants to be in a position where they are required to get emergency surgery to be able to survive a physical trauma, but life happens. Thankfully, for the majority of us, we are able to lay our heads on our pillows at night without having to so much as think of traumatic injuries. However, what happens if you get a call that your niece got into your brother’s nightstand, accidentally injured him in the stomach with the handgun he keeps for home protection and he is now being rushed to the hospital to undergo emergency surgery?

Luckily for you, your brother, and the rest of your family, trauma surgeons across the country have trained for several years just for situations like this and they are extremely good at what they do. Your brother is doubly lucky because in addition to having access to excellently trained surgeons, he also has a great job with great benefits, including health insurance.

But what would happen if your brother did not have a job with benefits or if he had been let go and was now part of the 26.7 million Americans in the country living without health insurance? Surely his level of care would not change much if at all, right? The answer is not as straightforward as you would think.

Hospitals across the country have implemented trauma protocols to not only reduce patient morbidity and mortality but also to standardize immediate stabilization and intervention if it is needed across all patients regardless of race, income or other social statuses. These protocols have worked for the most part. A 2022 study showed that social determinants of health such as race, ethnicity, and income had little to no impact on time to treatment initiation for patients who experienced traumatic injuries.

Despite all trauma patients receiving more or less similar treatment when they first arrive at the hospital, health disparities show up when long-term care decisions are made. Numerous studies have shown that after initial stabilization or surgery, uninsured Americans are less likely to be admitted to the hospital.

In addition, when uninsured individuals are admitted, their hospital stays are significantly shorter and they are disproportionately discharged home rather than to rehab centers or skilled nursing facilities when compared to individuals that are insured. Discharge to home rather than to facilities that provide specialized care limit the amount and kind of rehab that patients receive, which in turn increases the probability of long-term complications and reduces quality of life.

Every citizen in the United States has a right to high-quality medical care. Hospital policies and nationwide protocols have made it so that initial care of trauma patients is for the most part free of the disparities seen in other parts of medicine. As rising physicians, medical students interested in acute care surgery must strive to make the long-term management of trauma patients beyond stabilization and initial surgical care equally free from disparities.

With over 27 million uninsured Americans, something must be done to close the gap in the care of insured and uninsured trauma patients. There is no reason for someone to have to live with long-term complications simply because they were not fortunate enough to have health insurance. We owe it to our fellow citizens to push for equality for all, whether they are insured or not.

Francisco Reyes is a 2023-24 NC Schweitzer Fellow and a member of the class of 2026 at ECU Brody School of Medicine.