The challenges of trauma care in the rural setting.

Trauma occurring in the rural setting presents a unique set of challenges not found in more populated areas. Risk of death is distinctly increased, probably as a result of prehospital factors such as delayed recognition and inconsistency of EMS response and care. Lack of trauma trained physicians and hospital resources also contribute to a higher death rate. Development and designation of rural trauma centers can be instrumental in reversing this trend. The education in trauma care that goes hand-in-hand with designation is probably most responsible for better outcomes of trauma patients. The guiding philosophy in such a system should be one of 'minimal acceptable care' with early recognition of major trauma and expeditious transfer of these patients. This does not obviate the responsibility of rural trauma centers to deal quickly and effectively with patients in whom ongoing blood loss is an immediate threat to life and to exert a damage control approach as an initial phase of treatment.