Surgeon reimbursement for trauma care.

BACKGROUND: Trauma care is a well-known financial burden for hospitals, yet reimbursement for the surgeon has not been reported. METHODS: For 1999, the percent of the surgeons' bills reimbursed for general surgery services (gPR) was compared with that for trauma services (tPR). Mean tPR for various groups were compared. Factors predictive of tPR lower than gPR were identified. RESULTS: The gPR was 49%, and, for 371 trauma patients, tPR was 45% (P = 0.03). The mean tPR for injury severity score (ISS) < or =10 was 48%, and for ISS > or =11, 57% (P = 0.03). Patients transferred from outside facilities did not have a significantly lower mean tPR. Penetrating trauma (odds ratio 3.7, P = 0.008) was predictive of tPR lower than gPR. CONCLUSIONS: Surgeon reimbursements for trauma care was significantly, yet only slightly less than for all general surgery care. Surgeons should not be reluctant to take trauma call based on perceptions of low reimbursement.

Overcrowded motor vehicle trauma from the smuggling of illegal immigrants in the desert of the Southwest.

Overcrowded motor vehicle crashes caused by the very active criminal enterprise of smuggling illegal immigrants in the desert of the Southwest is a recent and under-recognized trauma etiology. A computerized database search from 1990 through 2003 of local newspaper reports of overcrowded motor vehicle crashes along the 281 miles of Arizona's border with Mexico was conducted. This area was covered by two level I trauma centers, but since July 2003 is now served only by the University Medical Center. Each of these crashes involved a single motor vehicle in poor mechanical shape packed with illegal immigrants. Speeding out of control on bad tires, high-speed rollovers result in ejection of most passengers. Since 1999, there have been 38 crashes involving 663 passengers (an average of 17 per vehicle) with an injury rate of 49 per cent and a mortality rate of 9 per cent. This relatively recent phenomenon (no reports from before 1998) of trauma resulting from human smuggling is lethal and demonstrates the smugglers' wanton disregard for human life, particularly when facing apprehension. Even a few innocent bystanders have been killed. These crashes overwhelm a region's trauma resources and must be recognized when planning the distribution of trauma resources to border states.