It is called the Golden Hour, a phrase coined by the military to describe higher rates of success when a patient gets care within the first hour of an injury. In urban American areas, getting to a trauma center within an hour is a simple feat- most people in those areas are roughly ten minutes away from such care, but for an alarming number of others, the news is not so encouraging.

Dr. Renee Hsia, an emergency room doctor at San Francisco General Hospital is the lead researcher in a study that has looked at a number of factors that are leaving millions without easy access to trauma level care. In that study, data including patient locations, driving time and other information was measured against the location of trauma centers and then compared to the same information in now closed trauma centers. The study highlights how many of these have closed in the last two decades and how many people the closings are affecting.

About a quarter of all Americans are now seeing an increase in the amount of time they would have to travel to reach such a trauma center, many of them have to lose out on that golden hour of treatment. Nearly seventy million Americans have had to travel farther in 2007 than they did six years earlier. Even more troubling, nearly sixteen million Americans must now travel at least thirty minutes or more to reach a trauma center. Hsia’s research was based on information from hospitals and health centers across the nation, with the last full year of data being 2007.

Hundreds of trauma centers have had to close in recent years, caused largely in part because of an increasing number of uninsured patients as well as rising costs of keeping  a high level trauma center up and running around the clock. In one of the most obvious facts, the study revealed that the highest number of closings were in rural centers, areas with the highest concentrations of low income, uninsured people and African Americans.

Hsia concludes that the states and individual regions will need to work together to try to cut at least some portion of the travel time for these patients. In the rural areas, the money may best be spent on increasing the level of air transports from outlying areas to the nearest trauma centers. But, there are also some question about where helicopters would land in some of the most remote areas of the nation.

There were just over 1100 trauma centers in the United States in 1990, just fifteen years later, thirty percent of those had been closed. The highest concentration of trauma centers are in urban areas with some metro regions having more than one within its borders. The majority of people in these areas are no more than ten minutes from expert, specialized care and are covered if one center is forced to close.