Sudden Impact vs Distance and Time: Rural Patients and Trauma Care

Across the US, rural patients face added challenges when looking for care. In this piece, we discuss the ways the ACS Committee on Trauma is addressing the most difficult determinants of health: distance and time.

For trauma patients, access to quality care can pose specific, and seemingly insurmountable, challenges for rural communities. ZIP codes determine outcomes, and the closures of critical access hospitals continue to exacerbate an already difficult situation. Across the US, rural trauma patients must grapple with two of the most rigid determinants of health: distance and time.

From the University of Alabama at Birmingham, Chair of the ACS Committee on Trauma, Jeffrey Kerby, MD, PhD, FACS, speaks to the need for more coordination of care via regional medical operations coordination centers (RMOCCs). The end goal? Creating a national, inclusive trauma system.

The greatest challenge for trauma patients is how quickly they can get to a trauma center. “A common misconception,” Dr. Kerby says, “is people think they have immediate access to trauma centers, and they might not.”

Mind the Gap

In the US, a study from 2017* found a staggering 30 million people lived more than 1 hour away from an ACS-verified high-level trauma center (Level 1 or Level 2). By 2022, that number increased to nearly 47 million. The race against distance and time for rural patients becomes crucial in a sudden injury.

Not every hospital is resourced to handle high-acuity, complex trauma, and “if we wanted to address the immediate needs of rural patients, we would need to build 110 trauma centers across the US, which is not realistic,” Dr. Kerby adds. The ACS and the Committee on Trauma are well-versed in and committed to approaching the problem with solutions, though it will take time.

Rural hospitals have very different needs than Level I trauma centers, which often reside in city centers or urban settings. The problems and injuries rural patients face are also, at times, unique to that specific setting.

In some counties, there may only be one ambulance and if an injury happens 2 hours away, that county is left uncovered for acute, prehospital care for a minimum of 4 hours. Injuries that may not be life-threatening, but still require more care than a small hospital can provide, may involve the patient being transported, sometimes by helicopter, to a larger facility—a huge expense for a family.

Partnering with the Community

Understanding these needs and gaps is an important first step for rural trauma, and we need visibility into these problems. Only 1%–2% of the data collected by the ACS COT comes from rural centers as current data submission opportunities are expensive for these already underfunded hospitals, a situation the COT is now attempting to address.

In lieu of the ability to mass-collect data, the ACS COT engages with frontline providers to assess their needs to improve outcomes. The rural advisory committee—made up largely of emergency, family, and internal medicine doctors—is a vital component in developing what will eventually be a rural trauma quality program. For now, the ACS COT has taken these learnings and is starting small.

In the US today, “we have an exclusionary trauma system,” Dr. Kerby explains. “But there is a way to become more inclusive. Prehospital coordination of care via regional medical operations coordination centers (RMOCCs), development of teletrauma services, as well as working directly with community hospitals, are how we start developing this system.”

Always Moving Forward

Prehospital coordination of care through RMOCCs helps level-load the system so all patients aren’t going to one hospital. With teletrauma, surgeons like Dr. Kerby can speak with physicians at community hospitals to provide initial evaluations. This may limit needed transfers, thereby providing more trauma care in the community—a common desire for patients.

At the ACS, we live by the ethos that where you live shouldn’t determine if you live. Assessing ways to provide more equitable access to care and mitigate disparities in outcomes will be a focus moving forward. With the ACS COT paving the way in trauma, we can take it one step further: we are going to find a way to meet you where you are. Understanding the value of communities, support systems, and coordination of care is what drives the rural specific program development.

While it is not realistic to build 110 new trauma centers, the ACS COT is implementing solutions to help patients now. It can be difficult for rural patients to navigate the system, but steps are being taken to make sure that everyone, no matter where they live, has access to the highest-quality care.

Do you know where your closest ACS-verified trauma center is? Use our Find a Hospital search today!

* Carr BG, Bowman AJ, Wolff CS, et al. Disparities in access to trauma care in the United States: A population-based analysis. Injury. 2017;48(2):332-338. doi:10.1016/j.injury.2017.01.008