Rural trauma care: role of the general surgeon.
BACKGROUND
Care of the patient injured in the rural setting poses many unique challenges. This report profiles the experience of a solo, rural general surgeon with patients with multiple injuries during a 7-year period.


METHODS
Emergency department (ED) contact sheets for 43,308 patients treated from September 1, 1988 through August 31, 1995 were reviewed. Eighty-four patients met selection criteria based on injuries with Abbreviated Injury Scale score > or = 3 in a single body region or > or = 2 in two or more body regions. Prehospital and hospital records were reviewed.


RESULTS
Injury Severity Score ranged from 8 to 43 (mean, 16). Four patients died in the ED, 54 (64%) were transferred to a referral trauma center, and 26 (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, including educational and organizational efforts; (2) to perform the necessary techniques in the ED to achieve optimal resuscitation and stabilization; (3) to rationally prioritize patients for transfer to a referral trauma center based upon assessment of patient injuries and institutional capabilities; and (4) to provide definitive care for a subset of patients with no need for subspecialty intervention.
Bintz
M
M
Department of General Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wisconsin, USA.
Cogbill
T H
TH
Bacon
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D013502:General Surgery; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D010819:Physician's Role; D012189:Retrospective Studies; D012423:Rural Health; D014194:Traumatology; D014922:Wisconsin