pagers and can follow the whereabouts of the ambulances. This improves situational awareness and provides the hospital the opportunity to prepare for incoming patients, without having to exclusively communicate with the first responders in the field who are providing care. Whether informal or formal, bolstering communication systems can help to assuage individual fears that regionalization equates to inefficient centralization.


Leonard Weireter, Jr., is the Arthur and Marie Kirk Family Professor of Surgery at Eastern Virginia Medical School, medical director of the Shock Trauma Center at Sentara Norfolk General Hospital, and current chair of the Disaster Preparation Committee for the American College of Surgeons, Committee on Trauma. Weireter said that the College of Surgeons recognizes there is a huge void in knowledge among its members about disaster preparedness. Surgeons work at the definitive care end of the spectrum, and the mindset is generally one of waiting for patients to be delivered. There are nearly 1,200 counties in the United States without a general surgeon. The long distance traversed to reach a surgeon presents the major problem of time lost from the previously discussed “golden hour” (see Chapter 4). The College of Surgeons has been grappling with how to better integrate trauma surgeons into the larger system. Studies indicate that about 20 percent of the casualties in a mass casualty incident are critically injured; the quandary is figuring out who they are, and getting them to definitive care.

Strategies to Integrate Trauma Surgeons

Finding the right solution is challenging. In Iraq and Afghanistan, the military brings surgery to the patient, stabilizing them with limited, rapid operative care, then transporting them to higher-level care. The average time from battlefield injury to immediate surgical care is slightly less than 30 minutes. If the patient survives the first level of care, their overall chance of survival is about 97 percent. While participants have heretofore mentioned military models as potential examples for rural policy makers to follow, in the case of trauma surgery, there is a key difference. The establishment of forward military operating bases means personnel and materials are pre-positioned in short proximity to a known high-risk environment. Yet in rural traumas, predicting where an event will occur over a vast distance is often impossible.

Several issues need to be addressed to make integration work. One is whether it is feasible to establish a force of surgeons that could be rapidly mobilized. A participant suggested that the first step would be a voluntary pre-registration and pre-credential process for surgeons willing to be part

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