Rural Dwellers Face Greater Trauma Risk

Rural home
Rural home | Image by Gary Rolband/Shutterstock

Rural Americans living in the South and West face greater risks of dying as the result of a traumatic injury, data suggests.

An investigation by The Dallas Morning News and the San Antonio Express-News has pointed to a disparity in emergency medical care. Overall, they revealed a national health crisis in which trauma patients are losing too much blood before reaching a hospital. They also allegedly found that preventable deaths occur at much higher rates in certain areas, namely in rural communities in the South and West.

Although the medical community has long referred to the “golden hour” — the time in which a patient with a traumatic injury needs to be treated to increase his chances of survival — new studies cast doubt on the label. Instead, research has suggested that the “golden half-hour” might be more correct, especially when blood loss is a factor.

Data also indicates that less than 1% of trauma patients — over 3 million in total — were given blood before they reached the hospital in 2019, according to the DMN/Express-News investigation. Most ground ambulances do not carry blood despite evidence that doing so could have a dramatic impact on fatalities that result from traumatic injuries. Equipping military medical personnel with blood nearly two decades ago led to a dramatic decrease in troop mortality rates from traumatic injury, as previously covered by The Dallas Express.

Still, so-called “trauma care deserts” exist, creating a sometimes lethal delay in emergency care delivery and contributing to the estimated 31,000 preventable deaths occurring among U.S. trauma patients each year.

Approximately 25% of Americans live over 30 minutes away by car from a Level I or II trauma center, according to the investigation. These facilities are most equipped to handle critical injuries, while the emergency rooms of smaller hospitals tend to be unequipped to adequately treat hemorrhaging patients, as explained by Dr. Julie Dunn, who co-wrote a study on trauma outcomes in Colorado.

Millions of Americans living in Wyoming, Montana, South Dakota, Idaho, and Alaska have no in-state Level I trauma centers, according to data from the American Trauma Society.

The number of high-level trauma centers has risen by almost 40% in the last 10 years in Texas, yet the state still performed 17th-worst in the nation in prehospital deaths, the DMN/Express-News investigation found.

“People deserve good quality care, but I also think they have to take into account where they choose to live,” Chris Rowland, EMS coordinator for Mesa County in Colorado, said, according to the DMN. “If I choose to live four hours away from a trauma center, that’s my conscious choice that I made ahead of time.”

This sentiment was echoed by Mesa County’s EMS medical director, Dr. Glenn Burket.

“If you’re in Downtown Dallas, you call an ambulance, [and] you have five paramedics on [the] scene in five minutes,” claimed Burket. “People have to have that understanding of, if you go out in the backcountry, you’re on your own.”

Adding to the problem is the “strong association” between obesity and the severity of traumatic injuries that occur, the pattern of those injuries, the frequency of complications occurring, the length of time people are hospitalized, and mortality, among other things. Over the past few decades, a dramatic increase in obesity has taken place, with the prevalence of obesity nearly doubling between 1980 and 2008. The Dallas Express has extensively covered the rise in obesity.

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