A bill that would create a $10 vehicle registration fee to pay for trauma care in Georgia passed the state Senate overwhelmingly Monday.

The legislation could channel $74 million a year to fund the 15-hospital network, which includes struggling Grady Memorial Hospital in Atlanta. Georgia lags behind other states in trauma care, with the state death rate for trauma victims some 20 percent higher than the national average. Grady is the only Level 1 trauma center in North Georgia.

An amended House Bill l158 passed the Senate 43-7 but must return to the House. If the House agrees to the changes, and the governor signs the measure, voters will decide whether to accept the $10 fee.

"We are not imposing a $10 fee," Sen. Eric Johnson (R-Savannah) said. "We are allowing voters to impose one on themselves," if they choose.

Some lawmakers questioned whether the legislation would be better passed as a constitutional amendment, which would ensure that money collected would go to trauma care. Under the current bill, the revenue would go into the state's general fund, and lawmakers would decide to appropriate it for trauma care.

Georgia Hopsital Association spokesman Kevin Bloye said Monday's vote is a positive step, but he warned, "It's certainly not a done deal yet."

Bloye said, "This is an issue we've been talking about for a couple, three years, just in terms of the importance of funding the trauma system."

The stakes, he said, are high: "You've got some trauma facilities that might have to pull out of the system if we leave it with nothing."

Sen. Steve Thompson (D-Marietta) said he worries that the General Assembly could divert the funding. "I'm a little bit worried about the fast and the loose things we've done in the last few years," Thompson said.

Sen. David Adelman (D-Decatur) said passing the trauma measure as a constitutional amendment would make sure the money goes to trauma care, but even so, he said, the bill should be passed as is.

"I just caution my friend not to let perfect be the enemy of the good," he said.

Tying trauma care to the registration fee for vehicles was Speaker Glenn Richardson's idea. Cars account for 75 percent of trauma patients that turn up in the emergency room, Johnson said.

"This is the culmination of three years of hard work," Johnson said. "We do not want to send money just to the existing system."

Adelman said a better-funded system could have prevented many deaths in Georgia last year.

"This legislation, if it becomes law, will save lives," he said. "Georgia trails woefully when it comes to other states in regard to trauma loss of life."

A $332 million mid-year budget adjustment that Gov. Sonny Perdue signed into law earlier this month pumps $58.5 million into the trauma center this fiscal year, which runs through June 30. Of that latter amount, $30 million is expected to go to Grady.

Staff writer Aaron Gould Sheinin contributed to this article.