The American College of Surgeons (ACS) calls rural trauma the "neglected disease" of the 21st century. And, in fact, caring for patients in remote areas poses challenges rarely, if ever, encountered by big city providers.
To help improve rural-urban disparities — especially treatment outcomes — the ACS developed the Rural Trauma Team Development Course (RTTDC). The course is designed to help providers in rural communities build teams that rapidly and effectively assess, stabilize and transfer trauma patients in areas with difficult terrain and limited resources.
Debra E. (Deb) Horsman, R.N, trauma outreach coordinator for Saint Marys Hospital in Rochester, Minn., says the daylong course, which is conducted at a hospital's chosen site, can significantly improve care in low-volume, high-risk settings.
"The course helps providers look at and improve the system while realizing that every piece in that system is important, that every person has a role," she says.
To participate in the course, a rural facility assembles three trauma teams of at least three core members, one of whom — a physician or physician assistant — serves as team leader. Nurses as well as lab techs, EMTs and even janitors can round out the group.
"Emergency medical services providers are invited because they're intimately involved in transporting patients in and out. And in smaller facilities, almost everyone is involved in patient care in one way or another, including janitors," Horsman explains.
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 Horsman pinpoint the facility's most pressing needs.
Once the logistics are worked out, Horsman assembles a faculty team — usually herself, a trauma surgeon and pediatric expert or flight nurse. Each faculty member pairs with one of the rural teams.
Mayo Clinic covers faculty salaries and the cost of the training manual. The rural facility provides lunch and the course site.
The first four hours of the course cover the basics, including barriers to prompt, effective care.
"We watch videos of things that have gone wrong," Horsman says. "For instance, when you're racing around and the adrenaline is flowing, you think you're working quickly, but in real time, it may take six or eight minutes to do something basic and that's much too long. The point is to see what problems arise when you don't have the proper mechanisms in place."
During the second half of the class, the teams work on different scenarios that help them prepare for a wide range of emergencies — a badly injured pregnant woman, say, or a busload of hurt children.
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 Albert Lea and Mankato were faced with an unusual number of critically injured patients. Horsman says, "The feedback we got was that those incidents had much less impact because the teams were in place and everyone knew exactly what to do."
She adds, "Our goal is to help people communicate, and to work effectively as a team. When the helicopter leaves with a patient, we want the team to stand together, knowing they've done a great job, and that those receiving the patient validate the work they've done. After all, as our trauma director says, 'Every life saved in the hospital was first saved in the field.' "
For more information, email Deb Horsman or call 507-255-1844.