Your car crashes and you're knocked senseless, bleeding and in need of help. You expect the ambulance will arrive quickly and take you to a hospital, where you will receive proper care.

Think again. Georgia's dearth of hospitals that specialize in trauma care makes that a roll of the dice, depending on where you crash. In metro Atlanta, you may well be all right, but experts say that south of Macon, where trauma centers are few, your life is at risk.

Erik S. Lesser/Special (ENLARGE)

Personnel at Grady Memorial Hospital, metro Atlanta's only Level One trauma center, receive an emergency patient at the hospital's helipad.

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"People are dying needlessly," said Kevin Bloye, spokesman for the Georgia Hospital Association. "We assume that I will be taken in the right amount of time and receive the right amount of care, but that's not true. ... There are gaps."

Trauma hospitals — those equipped and staffed to handle the worst emergencies at all hours — are closing across the country or at least eliminating these expensive services.

Georgia is doing worse than the nation. The state death rate for trauma victims is 20 percent higher than the national average. If Georgia met the average, 700 lives would be saved yearly, say state researchers.

A year after state researchers declared Georgia's trauma services in crisis, the state Legislature is on the verge of providing long-term funding, although the proposal as it stands now has restrictions trauma hospitals don't like at all.

If lawmakers don't approve some funding, advocates say, they will miss the best opportunity in years to prop up an already fragile system. Proposals are in place and high public interest has generated momentum.

The state Senate is slated to vote on the most promising legislative proposal Monday. It is a $10 fee added to auto registrations, with proceeds channeled to fund trauma care. It would raise about $74 million a year.

One spotlight has focused on Grady Memorial Hospital, the only top-level trauma care provider in North Georgia. Grady is insolvent in large part because of the cost of trauma care. It ended last year with a $55 million deficit, with some officials warning that the hospital might close. Grady loses about $40 million a year just paying for trauma care.

Three of the most powerful elected officials in the state — the governor, lieutenant governor and House speaker — began this legislative session promising to deliver on trauma care.

With only a few days left, trauma care funding is far from a done deal. While the issue continues to inch forward, hospital officials and health care advocates worry that it won't reach the finish line in time.

"It's definitely endangered," said Dr. Arthur Kellermann, associate dean for health policy at the Emory University School of Medicine. Emory provides most of Grady's doctors, so he has become a champion of increased trauma funding. "It could be one of the greatest things [the state] does, or it could be a great tragedy.

"There is a huge expectation and a great fear that if not this year, we may never have a better shot," he said.

Worse, some advocates fear that some hospitals may pull out of the system or at least limit their operations.

Georgia has 15 hospitals that handle trauma care; four are designated Level One trauma centers such as Grady, providing a full range of care to severely injured patients. DeKalb Medical Center has stopped such services, citing prohibitive costs.

Gov. Sonny Perdue has approved a separate one-year boost of $58 million, a jump from the previous state funding, which was minimal.

"If there is no funding for '09, I think we may see a major problem with people getting out of the business," said Dr. Dennis Ashley, chairman of the Georgia Trauma Care Network Commission.

Ashley is trauma director at the Medical Center of Central Georgia in Macon, which he said has been struggling financially and considering downgrading its Level One trauma services. He and other advocates keep a close eye on the funding bills.

The $10 surcharge was approved on Thursday by the state Senate Finance Committee, emerging with a powerful backer, renewed momentum and some dramatic changes.

The fee had been linked to a controversial plan to scrap the annual auto ad valorem tax. The committee uncoupled the two proposals but would put the trauma funding fee to voters in a November referendum.

The result also restricts state money to "readiness" costs: equipment, ambulances, helicopters and fees to keep doctors on call.

More importantly, the revised bill would prohibit using state money for uncompensated care provided to poor, uninsured and underinsured people.

Senate President Pro Tem Eric Johnson saw trauma care in action after a sugar plant fire near his Savannah home.

"The recent disasters across the state have further highlighted the weaknesses, and also the strengths, of our existing trauma system," Johnson said. "We all recognize it's time to shore up and expand the existing system."

Johnson supports the restrictions. He said he believes state payments for uncompensated care can lead to socialized medicine.

Lt. Gov. Casey Cagle agrees, saying, "I'm not interested in creating an entitlement program in Georgia."

If the Senate passes the bill Monday, it goes back to the House for approval of the changes. House Speaker Glenn Richardson tied the bill to the ad valorem tax. That could mean trouble for trauma funding.

For now, trauma care advocates are torn between gratitude that the bill is moving and opposition to the spending restrictions. Predictably, advocates desperately want the money to go toward uncompensated care.

"I think the question is how important is it that you get the appropriate care ... when you're traveling down I-75 and you get in an accident," said Bloye of the hospital association.

More than anything, they want something done.

"I'm concerned that this late in the game we're at a stalemate," said Sen. Vincent Fort (D-Atlanta), a leader in the advocacy group called the Grady Coalition. "This isn't a fishing program. It's life and death."