Major trauma in the rural mountain West.

A disproportionately high percentage of trauma fatalities occur in rural areas. Almost half of these fatalities occur after arrival at a community hospital. A review of the initial evaluation and management of major trauma victims in rural community hospitals in the intermountain West revealed a surprisingly high incidence of departure from well defined standards. Reducing the magnitude of this rural hospital component of trauma facilities will require application of the same standards of initial evaluation and management which have proved effective in major medical center emergency department settings.