Much of Indiana lacks the access to major trauma centers needed to treat victims of attacks like the one in Tucson that killed six people and left U.S. Rep. Gabrielle Giffords of Arizona and 12 others wounded, Indiana's health commissioner said Tuesday.

Commissioner Greg Larkin said that although many Indiana hospitals have emergency rooms that can treat simple gunshot wounds and other minor trauma, there are not enough hospitals with certified trauma centers.

Giffords, one of 13 people injured who survived the attack Jan. 8, arrived at an operating room within 38 minutes of being shot through the head and received care from an experienced team of surgeons and other health care workers. She has made remarkable progress and doctors have upgraded her medical condition from critical to serious.

Larkin said no hospital in western Indiana north of Evansville is prepared for similar trauma cases.

"She would not have had the chance to survive if she was campaigning in Gary or Terre Haute," Larkin told a meeting of the Indiana Rural Health Association. Giffords was meeting constituents outside a Tucson supermarket at the time of the shootings.

Indiana has certified trauma centers only at hospitals in Indianapolis, Fort Wayne, South Bend and Evansville. Severe trauma patients in heavily populated northwest Indiana must go to South Bend or to hospitals in Chicago, if the latter are willing to accept them, he said.

"In Indiana we don't have very good distribution," Larkin said.

Mel Burks, a Gary native and executive director of administrative services at Terre Haute-based mental health provider Hamilton Center Inc., said Larkin's remarks came as a "shock." He said the health care community in Terre Haute and across Indiana had a lot of work to do to upgrade trauma care.

But Larkin's comments didn't surprise Meredith Addison, a nurse at Terre Haute Regional Hospital and a past Indiana president of the Emergency Nurses Association.

"The facts hurt sometimes," Addison said outside the meeting. She applauded Larkin for bringing attention to the matter.

She said a large swath of western Indiana, from Vincennes in the south to Kentland near the Illinois border in the north, are more than an hour's travel away from a trauma center in either state. Larkin said doctors refer to that period as the "golden hour" of treatment for producing the best outcomes for gravely injured patients.

Some severely injured Indiana residents, depending on where they are hurt, can receive treatment at trauma centers in Chicago, Cincinnati and Louisville, but out-of-state hospitals are not obligated to accept them. Major trauma cases are expensive to treat, and patients may not have health insurance, Larkin said.

"Chicago is being very selective about which cases they're going to accept," Larkin said.

Larkin and Addison serve on a state trauma care task force that meets quarterly to study ways to upgrade Indiana's trauma care. Larkin said they don't know when they'll report back to Gov. Mitch Daniels, who created the panel by executive order in November 2009.