UAB Trauma Surgeon Advocates for Teletrauma’s Vital Role in Assisting Rural Trauma Patients

Nearly 30 million Americans lack timely access to a Level I or Level II trauma center, but patients in rural areas face the most dangerous gaps in trauma care. Researchers at the University of Alabama at Birmingham recently published an article titled “Using Telehealth to Improve Access to Trauma Care Among Injured Rural Patients in the US” that advocates for a solution to this problem — teletrauma.

The Journal of American Medical Association Surgery article makes a case for utilizing telehealth technologies in the care of injured rural patients, stating that teletrauma can fill an urgent gap in injury care — improving access for rural patients.

“Trauma systems generally aim to get patients from point of injury to the best possible care within 60 minutes; but large areas of the United States are predominantly rural, and there isn’t a Level I or Level II trauma center within 60 minutes,” said Zain Hashmi, M.D., an assistant professor in the UAB Division of Trauma and Acute Care Surgery and lead author. “This lack of access leads to injured patients’ facing poor outcomes across the injury severity spectrum. Previous research shows that severely injured patients treated at non-Level I or -Level II trauma centers are at a higher risk of death because of lack of resources and expertise.”

Researchers explain that patients with non-life/limb-threatening injuries are often transferred to Level I or Level II trauma centers after initially receiving care elsewhere. However, evidence suggests that up to 40 percent of these transferred patients are rapidly discharged after arrival at these higher-level trauma centers without any critical interventions’ being performed.

“These potentially avoidable transfers incur tremendous costs to the individual patients, emergency medical services and the trauma system,” Hashmi said.

Telemedicine is an already-established vehicle for health care delivery, especially in underserved areas. However, teletrauma has not been formally adopted and widely integrated as a strategy to improve rural trauma systems. Hashmi is now leading multidisciplinary efforts to both study nuances of delivering trauma care remotely and develop initiatives such as the Alabama Teletrauma Program.

Real-time, two-way, audiovisual communication would allow UAB trauma surgeons and subspecialists to become part of the patient’s care team from afar, providing expert, timely bedside care. Trauma surgeons would be able to advise their emergency medicine colleagues, helping make early, important decisions aimed at improving outcomes. This expanded care team can determine if a patient needs to be transferred to Level I trauma center, or if the patient would be better served with alternative care pathways such as outpatient evaluation or a local hospital admission with additional expert support available via telerounding. In addition to reviewing scans or consulting with doctors, trauma surgeons can have face-to-face conversations with patients if possible, establishing a doctor-patient relationship.

“Using this technology, we can rapidly affect care for severely injured patients and better triage others who may benefit from receiving care closer to home,” Hashmi said. “A teletrauma program would help reduce emergency department crowding and ensure that UAB trauma resources remain available 24/7/365 for patients with severe injuries.”

Co-author Jeffrey Kerby, M.D., Ph.D., director of the Division of Trauma and Acute Care Surgery and chair of the American College of Surgeons Committee on Trauma, says teletrauma has the potential to transform Alabama’s trauma care system by building a more expanded network of care capabilities.

“We look forward to helping empower multiple providers in the rural environment with the expertise to care for trauma patients in their community when feasible,” Kerby said.

Teletrauma will go hand in hand with the Rural Trauma Team Development course offered by the Marnix E. Heersink School of Medicine that is designed to empower rural hospitals to evaluate and resuscitate the seriously injured and to determine whether the patient needs to be transferred to a hospital that can offer a higher level of care. Hashmi feels hopeful that modernizing trauma care with a well-integrated telemedicine component will lead to a more inclusive trauma system and reduce disparities in rural trauma care.

“This will be a lifelong effort to figure how best to design and implement this program — to improve the trauma system and provide better care and outcomes for injured rural Americans,” Hashmi said.

The article was co-written by Eric Wallace, M.D., professor in the Division of Nephrology and medical director of Telehealth at UAB.

UAB is the only hospital in Alabama currently designated as a Level I Adult Trauma Center by the American College of Surgeons. UAB Hospital has 22 trauma surgeons. Nurses trained specifically in trauma care work in multiple areas throughout the hospital, including the emergency department, trauma/burn intensive care unit, the neurosurgical intensive care unit, trauma/burn nursing unit, and acute trauma care unit.