RURAL TRAUMA CARE - ROLE OF THE GENERAL SURGEON

Background: Care of the patient injured in the rural setting poses man y unique challenges, This report profiles the experience of a solo, ru ral general surgeon with patients with multiple injuries during a 7-ye ar period. Methods: Emergency department (ED) contact sheets for 43,30 8 patients treated from September 1, 1988 through August 31, 1995 were reviewed. Eighty-four patients met selection criteria based on injuri es 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: Inju ry Severity Score ranged from 8 to 43 (mean, 16). Four patients died i n the ED, 54 (64%) mere transferred to a referral trauma center, and 2 6 (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, includi ng educational and organizational efforts; (2) to perform the necessar y techniques in the ED to achieve optimal resuscitation and stabilizat ion; (3) to rationally prioritize patients for transfer to a referral trauma center based upon assessment of patient injuries and institutio nal capabilities; and (4) to provide definitive care for a subset of p atients with no need For subspecialty intervention.