"A trauma system will fully attain the benefits of improved patient care and superior outcomes only when all facilities institute and follow evidence-based guidelines to decrease variability in care and deviations from the standard of care," the report said. "Central to this evolution is the implementation of a rigorous, multidisciplinary performance improvement program."

A coordinated system of trauma care within acute care facilities would result in community reassurance that everything possible is being done to provide them state-of-the-art trauma care, the report said. It would also result in improved communications, streamlined coordination of care issues, increased physician satisfaction, and a sense of pride in trauma care providers throughout the facility, the report added.

The review team also recommended establishment of a second level II trauma center in Anchorage to meet the state's needs. The only current level II trauma center in Alaska is at the Alaska Native Medical Center in Anchorage.

A level II center provides comprehensive trauma care and supplements the clinical expertise of a level I institution. It provides 24-hour availability of all essential specialties, personnel and equipment, and works in conjunction with level I centers.

Jay Butler, the chief medical officer for the state of Alaska, said the study was conducted at the request of the state, and that ACS has conducted similar reviews in other states.

"The recommendations are technical and do not address how they would be financed," Butler said. "We will be reviewing each recommendation and working with the Legislature to determine which of the 70-some recommendations merit prioritization. Prioritization will include consideration of costs as well as benefits."

According to Butler, the state is more prepared than it has been in the past to handle mass trauma situations, such as earthquakes and major fires.

Particular areas of progress include stockpiling of medical supplies, including ventilators, personal protective equipment and anti-viral medications, he said. There has also been training of emergency management personnel medical professionals in use of distribution and use of these supplies, as well as training in general disaster preparedness and response, plus exercises in mass immunization and medication distribution, he said.

State, local and tribal agencies have participated in national mass casualty exercises, such as Alaska Shield/Northern Edge in 2007.

"However, there is more that needs to be done," Butler said. "Improving our response to any trauma will be a critical step toward improving our medical surge capacity in the event of a mass casualty disaster."

Butler also said that state and federal funds have provided support needed to be better prepared. The governor's fiscal year 2010 capital budget request includes an additional $500,000 investment for medical supplies and equipment.

A committee of representatives from the American College of Surgeons visited Alaska in November to study the state's trauma response and make recommendations for improvement.

"With Alaska's injury-related death rates higher than in other parts of the country, improving trauma care is a priority for the department," Butler said.

The Centers for Disease Control and Prevention reported in its most recent statistics that unintentional injuries, such as injuries caused by car accidents and drowning, were the fifth most common cause of death for United States residents of all ages. Unintentional injuries are the third most common cause of death in Alaska, Butler said.