Rural trauma care: a study of trauma care in a rural emergency medical services region.

Motor vehicle-related trauma deaths in a 21-county rural emergency medical services (EMS) system are reviewed. Injury severity scores (ISS) and Glasgow coma scores (GCS) were recorded to provide baseline data for future comparison as the system progresses. The majority of deaths (67%) were related to CNS injuries. ISS in this series was similar to data reported from Orange County, California. The average GCS for all patients in this series was 5, indicating the high prevalence and severity of head injuries in motor vehicle deaths. Patients treated only in community hospitals had a low average ISS of 28.5. Those transferred from community hospitals to the regional tertiary care center had an average ISS of 36.2. Those admitted directly to the tertiary center had an ISS of 38.9. The data suggest that the rural trauma system might improve if there were training programs that promote recognition of significant injury, more aggressive resuscitation, and expeditious transfer of the injured patients.