(Reuters Health) – In an emergency involving face or hand trauma, barely one in four hospitals can muster a specialist surgeon, a recent U.S. study suggests.

In a survey of hospitals in New York State, excluding those in New York City, researchers found that only 27% had hand surgeons available or on call for emergency hand procedures and 29% had plastic surgeons available for facial emergencies.

“Although more people have insurance now, it doesn’t guarantee access, especially in areas with geographic barriers,” said senior study author Dr. Ashit Patel, the chief of plastic surgery at Albany Medical College.