Carmilo Vannucci

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TRAUMA SYSTEMS

Rural Trauma and Emergency
Medical Service Challenges in a
Sample of Western States
Jolene R. Whitney, MPA;
Susan Werner, MAS;
Susan Wilson, BSN;
Neis Sanddal, PhD;
Vicki Conditt, RN;
Peggy Sale, MSN;
Clay Mann, PhD;
Jennie Nemec, RN;
Johnathan J. Jones, BSN;
Grace Sandeno, MPH;
Diane Hartford, MS

of providing emergency medical services to largely rural
states include geographic barriers of vast expanses of
unpopulated landmass, provision of services across
mountain ranges, volcanoes, and extreme weather conditions, communication challenges due to lack of cell or radio coverage in some areas, and difficulty recruiting
and retaining trained personnel.
• KEY WORDS
Challenges of western states. Rural EMS, Rural trauma

• INTRODUCTION
Several years ago, state trauma system managers from the
western region (Alaska, Arizona, California, Colorado,
Hawaii, Idaho, Montana, Nevada, New Mexico,
Oregon, Utah, Washington, and Wyoming) began meeting annually to identify and address health care issues, particularly those related to trauma care access and deliv• ABSTRACT State trauma system managers from the western region ery. The majority of the discussions focus on the chalmeet annually to identify and address health care issues, lenges in trauma care delivery specific to the rural and particularly those related to trauma care access and deliv- frontier areas of the states. In each of these states, policy makers face a host of conery. In each of these states, policy makers face a host of convergent problems: declining populations, rapid vergent problems: declining populations, rapid growth, growth, low incomes, and high poverty rates. Challenges low incomes, and high poverty rates. This article defines some of the challenges faced in Montana, Wyoming,

Author Affiliations: Utah Department of Health, Salt Lake
Utah, Colorado, Arizona, Oregon, and Hawaii, and proCity, Utah (Mss Whitney and Hartford); Oregon Department vides a brief review of the diverse ways that states are
of Human Services, North England Salem, Oregon (Ms Werner);
meeting the challenge of providing trauma care.
Wyoming Department of Health, Cheyenne, Wyoming
(Ms Wilson); Critical Illness and Trauma Foundation,
Bozeman, Montana (Dr Sanddal); Arizona Department of
Health Services, Phoenix, Arizona (Ms Conditt); Hawaii
Department of Health, Honolulu, Hawaii (Ms Sale); University of Utah School of Medicine, Salt Lake City, Utah (Dr Mann);
Montana Department of Public Health and Human Services,
Helena, Montana (Ms Nemec); California Emergency Medical
Services Authority, Sacramento, California (Mr Jones); and
Colorado Department of Public Health and Environment,
Denver (Ms Sandeno).
Correspondence: Jolene R. Whitney, MPA, Utah Bureau of
Emergency Medical Services and Preparedness Utah
Department of Health, PO Box 142004, Salt Lake City, UT
84114 (jrwhitney@utah.gov).

158 .

Journal of Trauma Nursing • Volume 17, Number 3

• DEFINING RURAL
A review of the literature yields conflicting information
about the definitions of rural and frontier regions, which
vary according to specific state and federal programs.
Metrics used to define such regions include population
density, distance from specific services or a population
center, availability of transportation and paved roads,
and seasonal changes in access to services. Most definitions, however, are population-based. The Census bureau describes urban units, which are
utilized to describe urban areas surrounded by rural

July-September 2010

territories, population, and housing; furthermore, urban
areas or units comprise 1 or more central places and
urban fringes that have a minimum of 50 000 people.' All
other areas are considered rural.^ The US Department of
Agriculture uses rural-urban continuum codes to distinguish metro counties by size and nonmetro counties by their degree of urbanization or proximity to metro areas.^
The Office of...
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