Operative management of rural trauma over a 10-year period

Trauma victims should in most cases be transported to the nearest trauma center as soon as possible after injury. Since this is not always feasible in underserved rural areas, the community hospital occasionally must function as the trauma center. From 1977 to 1987, while working in a rural community hospital in the northern Rocky Mountains, we operated on 83 patients with visceral and vascular injuries. The typical patient was a young man who sustained multiple injuries from motor vehicle or recreational accidents. Twenty-one patients had 27 major complications, and 2 died. Many small communities cannot afford helicopter-based trauma systems. Conversely, however, distance and geographic barriers limit access to designated centers. Accordingly, rural surgeons cannot opt out of trauma care and must look to trauma surgeons to help in solving access problems.