TABLE 3 : Training and educational opportunities for APPs in a trauma setting Total Yes Total No Yes (%) Total Interested
ATLS 6 0 100 % n / a FCCS 0 6 0 % 6 RTTDC 4 2 66 % 2 STB 4 2 66 % 1 Disaster Preparedness 1 5 16 % 4 Bedside Procedures 0 6 0 % 6
Advanced Practice Providers ( APPs ); Advanced Trauma Life Support ( ATLS ); Fundamentals of Critical Care Support ( FCCS ); Rural Trauma Team Development Course ( RTTDC ); Stop the Bleed ( STB )
tality rate after the addition of APPs to a trauma service historically staffed by only general surgery and emergency medicine resident physicians , as well as trauma surgeons . 9 Holliday et al revealed a decrease in post-admission complications , including pneumonia , after the implementation of APPs on the trauma service . 12 Both of these studies also showed a decrease in the average hospital length of stay after implementation of APPs on their trauma services . 9 , 12 Furthermore , patient outcomes and care processes for APPs staffing a trauma ICU overnight with attending surgeon supervision are not associated with any differences when compared with resident house staff teams . 13
Although neither PAs nor NPs have specific requirements for trauma in their training , both educational tracks have elements that allow for a career in trauma surgery . PAs are trained to be generalists , with required rotations , including internal medicine , general surgery , and emergency medicine . NPs ’ clinical experience often includes critical care or internal medicine rotations and emergency medicine or urgent care rotations . Because NPs ’ training often does not include operative clinical rotations , they generally do not have opportunities to participate in the operating room setting for trauma patients . Despite core training that does not specifically require trauma training , APPs frequently work in trauma care and report interest in additional educational opportunities . Trauma centers included in this preliminary survey study employ APPs to provide care to injured patients and offer additional trauma training via continuing educational courses such as ATLS , FCCS , and RTTDC .
The stark reality is that there is a paucity of physicians to provide trauma care in rural states , such as WV . This situation mirrors the environment in military medicine , which suffers from a declining number of trauma-trained physicians and the nuances of operational demand that calls for smaller , more adaptable medical unit support in austere settings . Collaborative opportunities exist in rural states to align with the Military Health System in partnership with the academic medical departments to address these problems . 14 For example , the US Army Medical Department has worked to develop a Battlefield Trauma Physician Assistant training program to improve trauma care capabilities across the future operating environment . 15 Baylor University houses Army / Air Force Physician Assistant Studies with a residency program in emergency medicine that provides education on stabilizing the critically ill or injured patients utilizing the same skills and goals as in injured warfighters on the battlefield . 16 The continued development of partnerships between rural medical centers and military medical programs can provide opportunities to address rural trauma care needs as well as skills sustainment and training for APPs .
As a preliminary survey study there are some limitations . This study is limited to APPs in WV and , as such , has a sample size that is too small to make generalized conclusions . In addition , survey studies have inherent problems with reporting bias . A broader survey based on this pilot study , however , is planned . This future study will include a similar survey for trauma centers in nearby rural states to evaluate and define the roles of APPs in trauma for the region .
CONCLUSION
APPs provide a strong source of support for care to trauma patients across this rural state . Since WV relies on APPs to provide care for trauma patients , educational resources should be made available statewide for APPs seeking a career in trauma medicine .
REFERENCES
1 . Center for Disease Control and Prevention . National Center for Health Statistics . Leading Causes of Death . https :// www . cdc . gov / nchs / fastats / leading-causes-of-death . htm
2 . Malekpour M , Neuhaus N , Martin D , et al . Changes in rural trauma prehospital times following the Rural Trauma Team Development Course training . Am J Surg . 2017 ; 213 ( 2 ): 399-404 . doi : 10.1016 / j . amjsurg . 2016.06.015 .
3 . Bauman ZM , Loftus J , Hodson A , et al . Rural Trauma Team Development Course Instills Confidence in Critical Access Hospitals . World J Surg . 2020 ; 44 ( 5 ): 1478-1484 . doi : 10.1007 / s00268-019-05359-3 .
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