Rural Trauma Care

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Abstract
Background Care of the patient injured in the rural setting poses many unique challenges. This report profiles the experience of a solo, rural general surgeon with patients with multiple injuries during a 7-year period. Methods Emergency department (ED) contact sheets for 43,308 patients treated from September 1, 1988 through August 31, 1995 were reviewed. Eighty-four patients met selection criteria based on injuries with Abbreviated Injury Scale score greater than or equal to 3 in a single body region or greater than or equal to 2 in two or more body regions. Prehospital and hospital records were reviewed. Results Injury Severity Score ranged from 8 to 43 (mean, 16). Four patients died in the ED, 54 (64%) were transferred to a referral trauma center, and 26 (31%) were admitted to the community hospital. Conclusions Roles of the general surgeon in the management of multiple trauma in the rural hospital are: (1) to coordinate trauma care in the community, including educational and organizational efforts; (2) to perform the necessary techniques in the ED to achieve optimal resuscitation and stabilization; (3) to rationally prioritize patients for transfer to a referral trauma center based upon assessment of patient injuries and institutional capabilities; and (4) to provide definitive care for a subset of patients with no need for subspecially intervention.