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  • By the World Bank’s calculation, 45.7% of the world’s population still lives in a rural area.

  • In the United States, at least 31% of rural residents live more than an hour from a Level I to III trauma center.

  • In one study in a rural area, patients transported directly to the Level I trauma center from the field arrived 1.6 hours after injury, compared to 5.3 hours when patients were first sent to a local hospital that was not a trauma center.

  • Recruiting and retaining emergency medical personnel in rural areas is difficult because of low wages, lack of training opportunities, and the need to cover a broad geographic region.

  • The Rural Trauma Team Development Course of the American College of Surgeons is aimed at small hospitals without surgical capability and only nonsurgical personnel to treat the occasional injured patient.

  • According to the National Highway Traffic Safety Administration, rural fatal crashes account for 61% of all traffic fatalities but only 39% of vehicle miles traveled.

  • Many of the most dangerous occupations are found in rural areas, most notably mining and agriculture.

  • The percentage of homes that experience a fire and have a working smoke alarm is 41.8% in urban areas but only 20.8% in rural areas.


Injury continues to be a leading cause of death and disability throughout the United States; however, there are significant differences between injuries that occur in rural versus urban settings. Rural environments account for over 85% of the North American land mass and roughly 62.5 million people live in rural areas. Although less than one-fourth of the population lives in rural areas, the population in these regions accounts for a disproportionate number of trauma-related deaths.1-4

There are some key factor differences to consider when dealing with trauma patients in rural locations. They are typically older, less severely injured, and more likely to die at the scene than urban patients. The majority of trauma in rural settings is blunt injury, with fewer penetrating injuries, whereas the reverse is true in some urban locations. Similarly, the fatal crash rate is more than two times higher in rural than urban areas, with a rural rate of approximately 2.4 deaths per 100 million vehicle miles traveled.5-7 The factors leading to these higher injury mortality rates include a lower rate of use of protective devices, greater severity of crashes due to higher speeds, and prolonged discovery time.8-11

Another important geographic disparity in these vulnerable populations is access to rural trauma care.12 Rural may be defined in accordance with census data based on metropolitan areas, in terms of geography and distance, or by virtue of limited resources. In an analysis of the general surgery workforce, Thompson et al13 identified significant differences between communities with a population between 10,000 and 50,000 (large rural) and those with 2500 to 10,000 ...

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