Panel Will Guide Surgeons on Making Critical Decisions in Rural Trauma

Rural surgeons often face workloads that vary from those of urban surgeons. A key difference is the need to provide trauma care with limited resources, irrespective of whether such surgery is a rural surgeon’s forte.

The Panel Session “Damage Control Surgery and Resuscitation in the Rural Environment: Preparation and Best Practices for Optimal Outcomes” (PS 130) this afternoon, from 4:15 to 5:45 pm in Room W-375b, will aim to help surgeons understand how to optimize their surgical outcomes in rural and other under-resourced settings.

Damage control surgery can be defined as an approach to trauma care in which a surgeon initially intervenes solely to limit the damage caused by injuries, while delaying definitive repair to later surgical procedures (sometimes via referral). The approach was initially innovated in part by military surgeons before being applied to civilian healthcare. 

Krista L. Kaups, MD, MSc, FACS, who provides general and critical care surgery at the Community Regional Medical Center in Fresno, California, will comoderate with Richard A. Sidwell, MD, FACS, a trauma surgeon at the Iowa Clinic in Des Moines. Both say the aim of this session is less about promulgating any specific, military-informed techniques than providing insights on various approaches that can optimize patient outcomes amid resource or personnel constraints.

The moderators bring substantial expertise to the session, as both began their careers in rural, Level IV trauma centers before moving to urban, Level I centers. They also continue to work with surgeons in rural and under-resourced settings.

Dr. Sidwell noted that the session is relevant for many surgeons like the moderators, whose practice is not strictly rural: “It's really for the surgeon who's working at a center where they don't have immediate access to all the depth of resources, especially the specialty surgical resources that you would have at a Level I, Level II, or even maybe a Level III center.”

Dr. Kaups noted that urban surgeons connected to such surgeons also may benefit from the session: “Although I'm in an urban Level I center, we are surrounded by agricultural areas. We're the only Level I for 4 hours in one direction, 3 hours in the other,” which means hospitals referring patients to her center are largely rural.

Surgeons in global health contexts also may benefit from the session, she said.

The broad range of interested surgeons suggests a popular session—and Drs. Kaups and Sidwell expect it to be so. In fact, they comoderated a similar session 2 years ago and drew a standing-room-only audience. 

“We really had such a good time doing it, but we weren't able to cover all potential areas that time,” Dr. Kaups explained. “We talked about orthopaedics, obstetrics, burns—but there are other specialty areas that we couldn't discuss.”

For that reason, today’s session will include experts in delivering ophthalmology, vascular surgery, neurosurgery, and pediatric surgery in rural contexts.

Deidre Wyrick, MD, FACS, from Arkansas Children's Hospital in Little Rock, will deliver remarks on pediatric trauma. Lucas L. Groves, MD, FACS, from Blanchfield Army Community Hospital in Clarksville, Tennessee, will present on ophthalmological trauma; Martina Stippler, MD, FACS, from Beth Israel Deaconess Medical Center in Boston, Massachusetts, will discuss neurological trauma; and Jonathan D. Gates, MD, MBA, FACS, from Hartford Healthcare in Connecticut, will review vascular surgery.

Additionally, the session will include a presentation on the rural surgeon’s perspective from Matthew E. Shepherd, MD, FACS, from Providence Queen of the Valley Medical Center in Napa, California.

The presentations by specialists may provide insights into potential approaches to specific injuries.  Dr. Sidwell explained, “It may be that the ophthalmologist says, ‘Here's how you do a lateral canthotomy, to temporize the problem, and then have that person come to us.’ So it may get into some of those damage control options.”

However, a key focus of the session will be sharing insights on appropriate referral or transfer for patients who present to rural or under-resourced centers. “It's more broadly about how a rural surgeon, perhaps a general surgeon, should respond to some of these injuries within these different specialties in the rural environment and understand when and how to pass somebody onward to a Level 1 urban environment,” he said.

The goal is not instant expertise, but rather intellectual advancement. 

“The idea is to give some information so that people can be more comfortable with things that aren't usual for them,” Dr. Sidwell said,

“We’re going to have a fun time,” he added, urging all Clinical Congress registrants to attend.