1. Rural Level IV Trauma Center; More than a community hospital
Lynette Fair, MSN, RN, NE-BC, CEN
Director of Quality, Patient Safety and Analytics
Grove City Medical Center
Grove City, Pennsylvania

2. Learning objectives
Recite the benefits of rural community hospital participation in a trauma system
List three challenges communities and trauma victims experience in the rural setting
Recite the benefits of the emergency nurse manager’s collaboration with the trauma program manager

3. Grove City Medical Center More than a rural community hospital

4. Located in Western Pennsylvania At Interstates 79 & 80
Midway between Erie and Pittsburgh
Significant distance to Tertiary Trauma Care Centers

5. Rural Community Hospitals
Community hospital is defined:
Not having teaching or research facilities
Broad definition
Large hospitals: can be classified as community hospitals
Larger distances to other hospitals
Can be rural and not critical access

6. Rural Community Hospitals
Rural Community Hospital is defined:
Geographic Location
Governance Structure
Community Economics
Care Access
Part of the Community

7. Rural LEVEL IV trauma Center
Deemed rural when optimal care of injured patients is delayed or limited due to:
Geography
Weather
Distance
Resources

8. Rural LEVEL IV trauma Center
Provides initial care/stabilization of traumatic injury
Arranges transfer to a higher level of trauma care
May be the only nearby access to trauma care
Provides trauma care with resources available
Is part of the state trauma system

9. Rural Community hospital vs. level IV trauma accredited
Care for all types of patients
Injured arrive and are stabilized no formal process
Most times, the closest hospital in an emergency
Staff trained in resuscitation, ACLS, PALS, BLS
Cares for all types of patients with specialty injury care
Organized injury prevention programs
Organized injury pattern treatment protocols
May be the closest trauma center in an emergency
Staff trained in Trauma Care; ATLS, TNCC as well as resuscitation
Rural Community Hospital
Rural Level IV Trauma Center

10. Benefits of organized rural trauma care
Expedited care/transfer processes when linked to the trauma system
Clearer purpose for treating injuries
Clearer understanding of community injury prevention needs
Structured performance improvement programs
Structure injury prevention programs
Availability of hospital, regional, and statewide data to measure outcomes

11. Challenges of rural trauma
Greater distance to travel for emergency treatment
Seasons of unpredictable weather conditions impede patient transport from injury scenes as well as grounds flight crews
Rural recreational activities make difficult scene extractions
Closest hospital may not have critical resources or training

13. Rural Level IV trauma Center transport challenges
Because of erratic weather patterns, helicopters with critical care teams cannot always fly
Over 45 minutes away for a flight crew to be transported to our location to use local ground transport
Local critical care ground crew did not always have nurses available to transport
Delays care for critical patients while waiting; paramedics limited in scope of practice

14. Rural Level IV trauma Center Innovative care collaboration

15. Rural Level IV trauma Center taking patients from hurt to home
Training for the Level IV included early management and transport
Some single system injuries being admitted for surgery
GCMC has higher than state average geriatric trauma patient percentage
Large elderly falls population
How to assure outcomes, return to baseline, ability to care for self, and not fall again?

16. Trauma Functional assessment tool
Addresses:
Understanding care directions
Sensory and Pain
Physical impairment
Activity Participation/limitations
Home resources
Assigns interventions for multi-disciplinary team/discharge planning
Trauma program manager follows up with the care team

17. Breaking down silos: Trauma program and ED Management

20. ED Managers set the standards for their departments
Structured for oversight and accountability
Not structured for authority
Must have collaboration with the authority where the care occurs
ED Nurse managers need to have high level understanding of:
Barriers to success
Documentation requirements
Standards of care to evaluate staff
Collaborate with the 100% chart review to identify OFI
Has the authority to include high and low performers feedback in performance reviews
ED Managers set the standards for their departments

21. Conclusion Rural community hospitals:
Uniquely positioned to be an part of trauma system
Use existing resources and current patient population
First to assess injured patients and determine additional treatment needs
Important to the trauma care systems
Patients benefit from hospitals obtaining Level IV trauma accreditation

22. references
Committee of American College of Surgeons. (2014). Resources 2014 for optimal care of the injured patient.
Fair, L., & Pebbles, C. (2016). Rural level IV trauma center: More than a community hospital. Journal of Emergency Nursing. doi: /j.jen
Fair, L., Donatelli, N., & Somes, J. (2012). Accurate triage and specialized assessment needs of the geriatric trauma patient who experiences low energy trauma. Journal of Emergency Nursing, 38(4),
National Conference of State Legislature. (n.d.). Elderly falls prevention legislation and statutes. Retrieved from ncsl.org: and-statutes.aspx
Pennsylvania Trauma Systems Foundation. (2013). Redefining trauma value; Improving trauma center awareness across the commonwealth of Pennsylvania. Mechanicsburg, Pennsylvania.
Pennsylvania Trauma Systems Foundation. (2014). Executive summary; White paper needs assessment for new trauma center development in the commonwealth of Pennsylvania . Pennsylvania Trauma Systems Foundation.
Pennsylvania Trauma Systems Foundation. (n.d.). What is a trauma center? Retrieved from Pennsylvania Trauma Systems Foundation: trauma
U.S. Department of Health and Human Services Program Support Center. (2006). Model trauma system planning and evaluation. U.S. Department of Health and Human Services.