Rural residents are twice as likely to die of traumatic injuries as urban residents. Organized trauma systems are critical for reducing mortality and morbidity rates in rural areas, but most of the 47 million Americans without access to at least Level II trauma care live in rural communities. The purpose of this project was to examine the degree to which CAHs are pursuing assessment, designation, and training objectives – as well as the degree to which CAHs are being integrated into larger trauma systems of care. According to data collected through telephone interviews with State Flex Coordinators, State Office of Rural Health Directors, and related EMS stakeholders, 62% of all Flex grantees included at least one trauma-related activity in their 2008-2009 State Flex grant workplans. The interviews revealed that 24 of the 28 states with trauma-related objectives targeted two or more trauma area objectives, and many states targeted all three trauma area objectives. Those data undercount rural trauma activity, because 10 states that did not include trauma-related objectives in their 2008-2009 work plans were currently engaged in trauma activities. Trauma team training was the most frequently funded workplan activity.

More than one-third of CAHs have been designated as trauma centers, with the project team identifying 560 CAHs designated as such as of March 31, 2010. Several states reported that participating in the Flex Grant Program was key to getting CAHs involved as trauma centers. However, significant barriers remain, including a lack of funding, a lack of national standards, and a lack of available Level IV and V designation in many states. Respondents also recommended using trauma registry data as a valuable educational tool. Registry data can convince rural hospitals of the need to improve their trauma care abilities. Equally important, registry data also helps educate state-level policy and program personnel about continuing disparities in rural trauma care and the need to work toward integrated, coordinated systems in which all parties have designated roles to play.