The demands on rural providers and the unique challenges of rural trauma systems will be the topic of discussion during a panel discussion: “Clinical Guidance Access and Applicability: The Rural Provider’s Experience” at the Design for Implementation Conference, scheduled for February 21-22, 2024.
With a passion for frontier trauma, ER/trauma nurse Alyssa Johnson is the Trauma System Manager for Montana, a state of 1.3 million people dispersed over more than 145,500 square miles.
In this role, she oversees all trauma center designations and verifications, compliance with regulations, the trauma registry, injury prevention programs, ATLS/education, and the violent death reporting system. She serves the single Level 1 center in the state, located in Billings, as well as all the tribal hospitals, clinics and Level V trauma receiving facilities that make up the bulk of the rural state’s trauma system. To suggest she’s spread thin is an understatement.
“Funding is the biggest challenge in our state,” Johnson shared. “We have an unfunded mandate, and I spend a lot of time writing grant proposals to supplement the small amount we get through our general funds every two years.”
Other big issues for rural systems relate to long transports between care centers and having minimal resources to save lives and maintain competency. Jennifer Chastek, a certified registered nurse anesthetist (CRNA) in northeastern Iowa, said, “One of the biggest challenges related to provision of trauma care in these settings is the infrequency with which trauma occurs and the variability in the skills and knowledge of the team providing trauma care.”
Lower population density means that trauma injury thankfully happens less often, but it also means that staff providing trauma care have fewer opportunities to utilize and hone their knowledge and skills—a given center might get four trauma cases in an entire year. “Similarly, the availability of experienced EMS, nursing staff, and ED providers can vary from shift to shift and hospital to hospital in the rural setting,” said Chastek.
These two factors coupled together can greatly impact the manner in which trauma care is delivered in rural hospitals. “This is one reason I maintain ATLS certification, although it is not required in my role,” she said.
Joining Chastek (DNAP, CRNA, ARNP) and Johnson (MSN, RN, CEN, TCRN) on the panel will be Mike Person, MD, MPH, FACS (Chair of Acute Care Surgery at Avera McKennan Hospital & University Health Center in Sioux Falls, South Dakota and COT Rural Advisory Chair), and Matthew Shepherd, MD, MBA, FACS (Chairman of the Department of Surgery at Queen of the Valley Medical Center in Napa, CA).
“I’m hoping this conference can bring focus and attention on the need to increase research on trauma in rural settings, including research at levels below those recognized by ACS,” Johnson said. And Chastek added, “I am excited to discover ways to support and build the knowledge and skills for providers and staff who work in these facilities.”
Tune in to the discussion!
Learn more about the conference and register to attend online: bit.ly/DesignImplement
For extra insight on trauma care access in rural America, the Dallas Morning News today published an interactive map showing access to trauma centers. View it HERE.