Critical Care Clinics of North America - Disparities in Access, Management and Outcomes of Critically Ill Adult Patients with Trauma

The results of these studies have shown disparities in cancer, infectious disease, and chronic disease outcomes among vulnerable populations.1 However, it is not a foregone conclusion that the same disparities in care and outcomes would also affect patients with trauma, because unlike care for chronic or subacute medical problems, the receipt of emergent care for traumatic injuries is a protected right under the Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA was passed by Congress in 1986 to ensure access to the treatment of medical emergencies regardless of a person’s ability to pay. Hospitals are required to provide stabilizing treatment of patients with emergency medical conditions regardless of insurance status. If the hospital cannot provide the necessary level of care, it must stabilize the patient to the best of its ability before transferring the patient to another facility.2 Consequently, patients with trauma are protected from discrimination and exclusion in ways that are not true for patients suffering from any other nonemergent medical problem. Yet, despite legal protections that guarantee access to care for patients with trauma, research has repeatedly demonstrated health and health care disparities among this population. Since trauma care is a continuum, we aimed to review disparities at each step of the journey for a severely injured patient with trauma, from prehospital care to postdischarge outcomes.