Trauma Care at Rural Level III Trauma Centers in a State Trauma System

Abstract

Level III trauma centers performed as expected in a state trauma system. Acuity and severity were less as was corresponding mortality. There were a paucity of life-threatening head, chest, and abdominal injuries, which provide a challenge to the rural trauma surgeon to maintain necessary skills in management of these critical injuries.

Surgical Trauma Referrals From Rural Level III Hospitals: Should Our Community Colleagues be Doing More, or Less?

“…It is our failing as academic trauma surgeons for not educating our community colleagues on the utility of damage control procedures before transport, as 2% to 3% of all patients presenting to a rural trauma center may benefit from this procedure. 11 Finally, although the time spent at the referring hospital was similar whether the patient lived or died (Table 3), community surgeons appropriately identified the acuity of severely injured patients and had them transported by aircraft in all circumstances. This compares to 57% of all patients and only 55% among nonsurvivors from level IV hospitals.…”

“…[13][14][15][16][17][18] Perhaps, the most significant issue is that caring for a severely injured patient is a relatively infrequent event in the presence of a mature prehospital system. 1,3,11,19,20 This is once again particularly applicable to North America, where prolonged transport times and remote environments have necessitated the evolution of an efficient and rapid air transport program. Less than 5% of all trauma patients presenting to rural hospitals display hypotension, severe brain injury, or an injury severity score (ISS) greater than 24.…”

“…[7][8][9][10] Although these discrepancies are significant, the care of the rural trauma victim has only recently begun to achieve an increased focus at both local and national levels. 1,11,12 Unfortunately, the factors conspiring to challenge optimal treatment of a rural trauma patient are multiple and varied. [13][14][15][16][17][18] Perhaps, the most significant issue is that caring for a severely injured patient is a relatively infrequent event in the presence of a mature prehospital system.…”

“…This applies to novel resuscitation and imaging techniques and to the latest damage control procedures. 11 The impact of this reality on the referral pattern from surgically capable community hospitals within Canada is unclear.…”

A Population-Based Analysis of Injury-Related Deaths and Access to Trauma Care in Rural-Remote Northwest British Columbia

“…However, data on rural hospital trauma outcomes are conflicting with several studies showing equivalent survival compared with urban centers. 2,10,13,17 Northwest (NW) BC is a vast area of nearly 200,000 km 2 with a population of ϳ80,000 (Ͻ1 person/square mile) distributed in widely separated communities with populations ranging in size from 600 to 18,500. There are no designated trauma centers, although acute care services are available in larger communities with variable access to general and orthopedic surgeons.…”