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This Class Helps Small Rural Hospitals Deal With Big Emergencies

Rural areas in America have high death rates from car crashes, hunting accidents and other trauma. But many rural hospitals are only equipped to handle basic emergencies. In one Iowa town trauma experts are helping a small ER prepare for big emergencies.

In the Manning Regional Healthcare Center’s emergency room, a team of about a half-dozen nurses crowd around a woman stretched out on a hospital bed.

"We have a 28-year-old female. ATV rollover. Left chest in abdominal pain. Heart rate at 120," says nurse Taya Vonnahme.

Vonnahme quickly lays out everyone’s roles.

"So I’m on crash cart. Robyn’s on IVs. You’re on oxygen. You’re on procedure," she says.

Credit Natalie Krebs/Side Effects Public Media
Brian Feist and Rick Sidwell, who work at Iowa Methodist Medical Center in Des Moines, travel around Iowa to small, rural hospitals to teach a course in rural trauma team development.

This may seem scary -- but it’s actually not a real emergency. It’s a training exercise set up by Rick Sidwell. 

He’s a trauma surgeon at Iowa Methodist Medical Center in Des Moines. On this summer day, he’s traveled west to Manning, a town of about 1,500.

He’s leading a training course so staffers learn how to work as a team on fast-paced trauma cases. 

"It’s a course that's been translated into French, into Spanish. Because this is a need that is is a universal need. Not just, not just Iowa," Sidwell says.

For more than two decades, Sidwell’s travelled to hospitals nationally -- and even internationally -- to do this training. 

It involves lessons like checking patients for neurological issues and applying tourniquets. Or keeping a checklist to make sure all of the equipment is ready.

Sidwell says Iowa is where the class started. Nearly 30 years ago, a small-town surgeon realized many trauma concepts were geared towards urban hospitals with lots of resources.

"It's all about how are we going to take care of injured people at the local center," Sidwell says, "knowing that that's completely different than how things occur at a big urban trauma center." 

Credit Natalie Krebs/Side Effects Public Media
Rick Sidwell, a trauma surgeon from Des Moines, shows Manning Regional Healthcare Center Nurse Practitioner Kathleen Core how to best apply a tourniquet to stop bleeding.

And that can be a matter of life and death — especially in rural areas. Research shows people in rural areas are 14 percent more likely to die from traumatic injuries than those in urban areas.

Nurse Brian Feist is also teaching this course and works at Iowa Methodist with Sidwell.

Feist says small hospitals — like the 17-bed Manning Regional — know how to help patients. They just face other barriers.

"The problem they have is they don't have the necessary equipment because it doesn't happen that often for them," Feist says. "So a lack of frequency is tough to justify for a $10,000 rapid infuser."

That type of equipment can be important for transfusions or surgery. And it’s more common in big city hospitals.

That’s why Feist says a large part of the class is focused on how to prepare patients for transfer to larger facilities.

"A huge amount of our injured patients come to us as transfers," Feist says. "So the better prepared we can get our critical access hospitals, the better that patient has for longevity in a great outcome." 

This is one reason that Manning Regional’s ER trauma coordinator Boni Johnson was interested in the course.

Johnson says about 50 percent of their patients are moved by ambulance or air to places like Des Moines or Iowa City.

"A lot of them are, you know, cardiology, orthopedics. We just don't have a lot of those resources right here. And not only within our facility, but within the facilities around us," Johnson says.

These days, many of the nation’s rural hospitals are under intense financial pressure. More than 100 have closedin the last nine years. And others have cut back on services like delivering babies.

Credit Natalie Krebs/Side Effects Public Media
Street scene in Manning, Iowa

Johnson says she’s impressed that the course’s instructors seem to understand the importance of rural hospitals -- and their dwindling resources.

"It’s getting harder, we’re asked -- like everything across America -- to do more with less," Johnson says. "And so we don’t always have the resources. Sometimes people don’t understand that."

Sidwell says the course is also about addressing the significance of rural trauma care.

"So if we really want to as a state, if we really want to as a country, eliminate unnecessary disability and death from injury, then we have to address the important role that the rural environment plays," Sidwell says.

The course is provided free to Iowa hospitals through the state Department of Public Health.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Natalie Krebs is a reporter for Side Effects Public Media and a health reporter for Iowa Public Radio in Des Moines. She can be reached at