RTTDC focuses on rural facilities

About 20 percent of people in the United States — a disproportionate number of them children and older adults — live in rural areas. One-third are an hour or more from a Level I or Level II trauma center. As a result, the majority of trauma deaths occur in remote regions — not only because transport times are longer but also because smaller hospitals lack the staff, blood bank reserves and other resources commonly found in big-city hospitals.

The American College of Surgeons (ACS) created the Rural Trauma Team Development Course (RTTDC) to correct these disparities. The course is designed to help providers in rural communities build teams that rapidly and effectively assess, stabilize and transfer trauma patients to definitive care.

Henry J. Schiller, M.D., a trauma surgeon at Mayo Clinic in Rochester, Minn., says the course not only addresses rural-urban inequalities in trauma care, but also disparities within the ACS Committee on Trauma verification program itself, which originally focused on well-resourced urban institutions.

He explains, "Rural centers were left out of the training, which was appropriate for Level I centers but not for smaller hospitals in the community. The RTTDC is an effort to change that. It's also a response to the recognition that rural centers may delay transfer because they want to obtain a complete data set before talking to the referring hospital. So the goal is not only to improve the care of injured patients in low-volume, high-risk settings but also to decrease the length of time from injury to definitive care."

How it works

Interested facilities can request the daylong course by contacting the ACS regional coordinator for their area or the trauma program manager or outreach coordinator at the nearest referral trauma center. It takes about three months from the time of the initial request until the course takes place. In the interim, the requesting hospital fills out a detailed questionnaire that helps course leaders pinpoint the facility's most pressing needs.

Ideally, all members of the trauma team attend the course, including nurses, physicians, lab techs, respiratory therapists as well as EMTs. Emergency Medical Services (EMS) providers are invited because they're involved in transporting patients and because in smaller facilities, almost everyone takes part in patient care.

The first four hours of the course cover key concepts relative to the organization of the trauma receiving area, utilization of available resources, recognition of injury patterns and barriers to effective care. During the second half of the class, members work on different scenarios that help them prepare for a wide range of emergencies. Included is an analysis of one or more cases referred to the trauma center by the rural facility.

"The case presentation is very important because it makes it real for participants and really engages them," Dr. Schiller says. "As we work through the case scenarios, we try to rotate the roles so that physicians aren't always the team leaders — sometimes it's nurses or EMS providers, so everyone gets comfortable with the process."

The RTTDC course also helps hospitals develop transport guidelines in accordance with state trauma criteria, including standards for activating air medical and advanced life support.

Response to the class has been positive, especially among facilities that have put the training to use. Just a week after the class, hospitals in Mankato and Albert Lea were faced with an unusual number of critically injured patients. Both centers responded more efficiently to the incidents because their trauma teams were in place.

"Everyone — both the receiving and referring centers — are driven by a sincere desire to provide the best patient care with the resources available," Dr. Schiller notes. "The course is extremely satisfying because it empowers the referring centers to call as soon as they recognize that a patient exceeds their capabilities. And the team that presents the course gets a much better view of the challenges these folks are facing and what a tremendous job they are doing."

For more information

Call 507-255-1844 or email Debra (Deb) E. Horsman, R.N.