Trauma is often referred to as the neglected disease of the 21st century. HRSA reports trauma-related injuries in the United States are estimated to exceed 161,000 deaths each year, ranking as the 5th most common cause of death. Trauma is the leading cause of death for Americans 35 and younger; with children and youth comprising 25% of traumatic deaths. Most alarmingly, it is estimated 60% of all injury deaths in the U.S. occur in rural areas, even though only 20% of the nation’s population live there.
Several agencies and organizations are actively seeking ways to reduce rural trauma. Standards have been created to support organized levels of trauma care, model plans are available to help states and regions develop trauma systems, and training programs are available to assist rural medical and ancillary staff become better prepared to provide trauma care. It is widely believed that with an integrated approach deaths due to trauma can be reduced much like other contemporary diseases.
Sources
Model Trauma System Planning and Evaluation; Health Resources and Services Administration (HRSA) Related Guides
Frequently Asked Questions
Tools
Access to Trauma Care: Getting the Right Care, at the Right Place, at the Right Time
Web site
An interactive tool that allows the user to find the trauma care centers in their region and across the United States.
BrainLine.org
Web site
Provides access to personal stories, a directory of state resource centers, and various sources of information on topics related to traumatic brain injury (TBI) as a way to help prevent, treat, and otherwise help people living with a TBI.
EMTALA.com
Web site
A resource for current information about the Federal Emergency Medical Treatment and Active Labor Act, also known as COBRA or the Patient Anti-Dumping Law.
Farm Rescue and EMS: A State by State Directory
Web site
State-by-state list of farm rescue or response programs, Cooperative Extension Safety Specialists, and State EMS Training Coordinators.
FastStats A to Z: All Injuries
Web site
Detailed statistics on all injuries in the U.S. that include: morbidity, ambulatory health care, hospital inpatient health care, and mortality data.
National Trauma Data Bank (NTDB)
Web site
A large aggregation of trauma registry data containing over 2 million records from trauma centers in the U.S. and Puerto Rico.
Safety & Health Fact Sheets
Web site
A list of fact sheets on critical safety and health topics including agricultural safety, school bus safety, and on the road safety.
Trauma Systems Evaluation and Planning Committee (TSEPC)
Web site
Provides a variety of resources to assess and evaluate trauma systems. Includes consultative guidance for future trauma system development.
United States Atlas of the Surgical Workforce
Web site
Provides a picture of the supply and geographic distribution of institutions and individuals providing surgical services to help practitioners, policy makers and patients anticipate the current and future distribution and identify places with limited access to surgical services.
WISQARS (Web-based Injury Statistics Query and Reporting System)
Database
An interactive database system that provides customized reports of injury-related data.
Funding
USDA Community Facilities Loan and Grant Program
Funding to construct, enlarge, or improve essential community facilities for health care, public safety, and public services in rural areas.
Inactive Funding
Inactive Funding Opportunities -
Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.
Maps & Map Collections
Map Tool to Assess Timely Access to Trauma Centers
Interactive
Geographic coverage: United States
Depicts Level I/II trauma center coverage throughout the United States. Identifies the availability of helicopter or ambulance for transport method.
Date: 2010
Regulations, Forms & Other Useful Documents
Community Paramedicine Evaluation Tool
Sponsoring organization: U.S. Department of Health and Human Services
Provides a framework by which data can be collected from multiple community paramedicine programs to develop common successes and challenges. Designed to address rural settings.
Date: 03 / 2012
Contributing Factors and Issues Associated With Rural Ambulance Crashes: Literature Review and Annotated Bibliography
Author(s): Nels Sanddal, Steve Albert, Joseph Hansen, Douglas Kupas
Identifies published literature that describes the frequency, epidemiology, etiology, typology, and cost of ambulance crashes generally and rural ambulance crashes specifically.
Date: 08 / 2008
Definitive Care Facilities
Sponsoring organization: American College of Surgeons
Section from the ACS publication "Resources for Optimal Care of the Injured Patient 2006." Lists and defines the levels of trauma care found in a trauma care system.
Date: 2006
Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2011
Sponsoring organization: Centers for Disease Control and Prevention
Update of the guidance recommended in the 2006 Guidelines for Field Triage of Injured Patients. The new version provides changes to the decision scheme for EMS providers who care for and transport patients injured from motor vehicle crashes, falls, penetrating injuries, and other injury mechanisms each day in our nation’s communities.
Journal citation: MMWR (Morbidity and Mortality Weekly Report) Volume 61 Issue 1
Date: 01 / 2012
Longitudinal Trends in the U.S. Surgical Workforce 1981-2006: Overall Growth Has Stalled; General Surgery Supply Contracting
Author(s): Stephanie Poley, Daniel Belsky, Katie Gaul, Thomas Ricketts, Erin Fraher, George Sheldon
Sponsoring organization: American College of Surgeons Health Policy Research Institute
Discusses U.S. surgical workforce trends over the last 25 years and the problem of geographic distribution of surgeons in future years.
Date: 05 / 2009
Model Trauma System Planning and Evaluation
Sponsoring organization: Health Resources and Services Administration
Designed to provide trauma care direction to trauma care professionals, including public health officials and health care policy experts, when developing and evaluating trauma systems.
Date: 02 / 2006
Model Trauma System Planning and Evaluation: Trauma System Self-Assessment Supplemental Tool: Benchmarks, Indicators, and Scoring
Sponsoring organization: Health Resources and Services Administration
Designed to accompany HRSA's Model Trauma System Planning and Evaluation document, a guide to modern statewide trauma system development. Focuses on state and regional trauma system self-assessment.
Date: 02 / 2006
Quality Through Collaboration: The Future of Rural & Frontier EMS in the U.S. Health System
Sponsoring organization: Health Resources and Services Administration
Compares the findings of the Institute of Medicine's Future of Emergency Care reports with previous work on Rural Health and with the Rural and Frontier EMS Agenda for the Future and HRSA Model Trauma System Planning and Evaluation document. Identifies similarities and overlaps of the recommendations and approaches.
Date: 2007
Regional Trauma Systems: Optimal Elements, Integration, and Assessment Systems Consultation Guide
Sponsoring organization: American College of Surgeons
Provides guidelines and plans for health care institutions and public health agencies in the implementation of trauma systems.
Date: 12 / 2007
Rural Trauma Victims Dying of the "Golden" Rule
Author(s): Julie Ardery
Describes how death rates from traumatic injury are higher in rural United States and identifies successful statewide trauma care systems with a focus on Maine.
Date: 08 / 2007
State Flex Program EMS/Trauma Activities and Integration of Critical Access Hospitals into the Trauma System (Briefing Paper)
Author(s): Walter Gregg, Nicholas Jennings, Christopher Dickerson
Sponsoring organization: Flex Monitoring Team
Provides information on State Flex Program EMS and trauma-related activities. Focuses on the designation of Critical Assess Hospitals as trauma centers.
Date: 03 / 2010
State Flex Program EMS/Trauma Activities and Integration of Critical Access Hospitals into the Trauma System (Policy Brief)
Author(s): Walter Gregg, Nicholas Jennings, Christopher Dickerson
Sponsoring organization: Flex Monitoring Team
Reports that more than one-third of all Critical Access Hospitals in the U.S. have been designated as trauma centers. The project team identified a combined total of 560 CAHs designated as trauma centers.
Date: 03 / 2010
Surgical Deserts in the US: Places Without Surgeons
Author(s): Daniel Belsky, Thomas Ricketts, Stephanie Poley, Katie Gaul, Erin Fraher, George Sheldon
Sponsoring organization: American College of Surgeons Health Policy Research Institute
Describes the uneven distribution of surgeons across the United States, with more surgeons located in urban centers and fewer in rural communities.
Date: 07 / 2009
Trauma Systems Save Rural Lives
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Discusses organized trauma care systems, which are critical to reducing mortality and morbidity in rural areas. Highlights include how access to trauma care varies by state, how rural hospitals play a role in trauma care, and a future goal of having coordinated care nationwide.
Journal citation: Rural Monitor
Date: 11 / 2007
Organizations
American Association for the Surgery of Trauma (AAST)
National organization
Studies the practices of traumatic surgery in the United States and Canada. Serves surgeons dedicated to the field of trauma patients.
American College of Emergency Physicians (ACEP)
Nonprofit/Foundation
Represents physicians who practice emergency medicine. Provides a national report card that includes an assessment of the support that each state provides for its emergency medicine system.
American College of Surgeons (ACS)
National organization
A scientific and educational association of surgeons who work to set high standards for surgical education and practice. Sponsors the Rural Trauma Team Development Course.
American College of Surgeons Health Policy Research Institute (ACSHPRI)
Academic/Research
Studies and reports on issues related to the state of the surgical profession, the surgical workforce, and surgical utilization in the United States. Provides advice, data analysis, and research for surgical professional associations and boards, policymakers, and the health services research community.
American Trauma Society (ATS)
National organization
Supports trauma care and trauma prevention. Offers trauma courses. Provides maps of trauma centers throughout the United States.
Brain Trauma Foundation (BTF)
National organization
Works to improve the outcome of Traumatic Brain Injury (TBI) patients by developing best practice guidelines, conducting clinical research, and educating medical personnel.
ChildTrauma Academy (CTA)
National organization
Works to improve the lives of traumatized and maltreated children through education, service delivery, and program consultation.
Critical Illness and Trauma Foundation (CIT)
Nonprofit/Foundation
Focuses on improving outcomes for people who become suddenly ill or who are injured in rural areas of the U.S. and around the world. Dedicated to the prevention of injury and illness, research into rural injury and illness and training for rural emergency medical care providers.
National Center for Injury Prevention and Control (NCIPC)
Federal government
Works to reduce morbidity, disability, mortality, and costs associated with injuries. Part of the Centers for Disease Control and Prevention.
National Safety Council (NSC)
National organization
Educates people in prevention of accidental injury and death, and safety issues. Includes a directory of state chapters and local offices which provide training, conferences, workshops, consultation, newsletters, and safety support materials.
Orthopaedic Trauma Association (OTA)
International organization
Promotes excellence in care for the injured patient, through provision of scientific forums and support of musculoskeletal research and education of Orthopaedic Surgeons and the public.
Rural Emergency Medical Services & Trauma Technical Assistance Center (REMSTTAC)
Federal government
Serves as a national focal point for the dissemination of information on rural and frontier emergency medical services (EMS) and trauma care. REMSTTAC can be utilized by various rural and frontier EMS providers including federal grant recipients, state EMS and rural health offices, and their constituencies, such as rural hospitals and communities.
Society of Trauma Nurses (STN)
International organization
A membership-based, non-profit organization whose members represent trauma nurses from around the world. Members are nurses involved in trauma care in clinical, administrative, research and educational roles.
Terms & Acronyms
Benchmark Global overarching goals, expectations, or outcomes. In the context of the trauma systems, a benchmark identifies a broad system attribute.
Casualty Any person who is declared dead, missing, injured, or ill as a result of an incident.
Catastrophic Incident Any natural or man-made disaster that results in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure, environment, economy, national morale, and/or government functions.
Comprehensive trauma care system A coordinated inclusive system of care for the injured that encompasses all phases of care, from the prehospital setting to rehabilitation services and follow-up care. Such systems include data systems for injury surveillance and prevention as well as for performance measurement and improvement.
Definitive care Medical care intended to improve rather than stabilize a patient's condition. It includes the full range of preventive, curative acute, convalescent, restorative, and rehabilitative medical care leading to rehabilitation.
Golden hour The brief span of time just after a serious injury; survival usually depends on whether someone receives skilled critical care within those first 60 minutes.
Injury Physical harm or damage to the body resulting from the transfer of or exposure to mechanical, thermal, electrical, or chemical energy or from the absence of such essentials as heat or oxygen.
Injury risk assessment The process employed to determine the likelihood that injury will result from an incident, taking into account the identification of the hazard type, population affected, severity of injury, and volume or number affected.
Mass casualty incident (MCI) A situation in which a large quantity or number of either physical injuries or deaths, or both, occur.
Trauma Center A specialized hospital facility distinguished by the immediate availability of specialized surgeons, physician specialists, anesthesiologists, nurses, and resuscitation and life support equipment on a 24 hour basis to care for severely injured patients or those at risk for severe injury.
Trauma injury Acute physical injuries, including burns and head injuries, which pose a risk for death or long-term disability.
Trauma system A pre-planned, comprehensive, and coordinated statewide and local injury response network that includes all facilities with the capability to care for the injured.
Article Searches & Bibliographies
RAC Documents Search: Trauma care
An annotated list of all documents in the RAC database on the topic of rural trauma.
PubMed Database Search: Trauma and Rural Health articles
Searches PubMed’s collection of journal article citations with abstracts for items related to this topic and published in the United States within the last 3 years. Some citations have links to the full-text of articles accessed through PubMed Central, through your library’s electronic and print holdings, or through the publisher (the latter may require a subscription or a pay-per-view charge). Check your local library for details about full text links or call your Regional Medical Library at 800.338.7657.
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