multicasualty incident, more lives will be saved if the local resources are maintained. The challenge is that hospital-based health care is being pushed the other way. Many small hospitals abdicate responsibility for trauma care; it is expensive to maintain and many providers are not available during off hours. Larger urban hospitals need to take a supportive approach and work with rural hospitals on training programs and system-based components to enable them to be prepared. There are a lot of resources in local hospitals that can be mobilized. Larger hospitals also need to assure rural hospitals that when the patient needs to be transferred, they are ready to take care of them.

For those that still resist accepting trauma patients, a stronger approach is making acceptance of trauma patients a condition of licensure or funding for all accredited healthcare facilities in the region. North Dakota and other states have rules, regulations, or statutes that require healthcare facilities to participate in trauma care at a facility-appropriate level. Not every facility will be a level I center, Winchell said, but all are going to have basic responsibilities and will know what to do when a trauma patient appears at the door. Across the board, that sometimes means adjusting privileges and responsibilities. If a clinic cannot be staffed with a doctor, perhaps it can employ a nurse practitioner or a community paramedic, but it must find some way to keep that facility available.

Understanding Available Resources

The second key, Winchell said, is making sure that facilities are used in a way that is commensurate with their capabilities; keeping those patients that they can treat, and transferring those that should be transferred. There may be a need for regional guidelines to aid facility decision making on who stays and who goes. One innovative solution is regional communication and triage centers. An impartial third party, who knows what resources each hospital has, helps to make the triage decision and determines where the patient will be sent. But maintaining a working knowledge of a region’s resources available in an emergency response should not be limited to just medical resources. For instance, Ken Knipper related an incident in which a worker who had fallen into a water tank he was cleaning, required a crane for extraction. Fortunately, in Kentucky, they had compiled an equipment resource information list and knew exactly where to get a crane. Another incident involving a tractor on a hillside required a wrecker. Because they had a prior agreement set up, when the local wrecker service heard the call, he automatically headed to the scene. Whether rural or urban, incidents will happen for which you simply do not have the resources, Knipper said. Therefore mutual aid agreements and regional planning are necessary.



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