BOX 5-2

Suggestions for Overcoming the Challenges

  • Develop an MCI model that could be realistically applied in rural areas with limited resources.

  • Develop a planning and preparedness process for EMS departments that mirrors the Assistant Secretary for Preparedness and Response hospital preparedness program.

  • Create regions using common sense and local input:

    • Identify and respect naturally occurring barriers and dividing lines.

  • Provide equipment and education to regions to facilitate proper triage and treatment.

  • Hold regional meetings and financially support participation by EMS departments.

  • Use similar radio communications across the region.

  • Ensure adequate day-to-day response capability.

  • Maintain local hospital-based or clinic-based resources in rural areas.

  • Make acceptance of (facility-appropriate) trauma patients a condition of licensure or funding for all accredited healthcare facilities in the region.

  • Develop regional guidelines to aid facility decision making on patient transfer.

  • Establish regional communication and triage centers (where triage and patient destination decisions are made by an impartial third party).

  • Institute a regional quality improvement process to assess effectiveness postresponse.

  • Make telemedicine a requirement for all level I and level II trauma centers.

  • Provide hospital ERs with county pagers so they can follow the status of incidents.

  • Foster an understanding that small incidents can be major in a rural area.

  • Consider children and special needs populations when planning for MCI response.

major. Others provided examples from their own experiences that ranged from multiple skiing injuries from a seasonal tourist population in rural Colorado to the trend of illegal, migrant workers to travel 40 people to a vehicle, with the potential to overwhelm any rural Arizona emergency room with a single vehicle crash.

Regionalization Is About Relationships

Not only does regionalization improve overall response to incidents it also offers to expand the relationships individual clinical centers have with other local providers. An example of these types of partnerships is the Colorado Foothills Regional Emergency Medical and Trauma Advisory Committee (RETAC), which is directed by Timothy Bohlender, medical

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