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Small But Mighty: Rural Hospitals Cope With Many Challenges

by Barbara Kram, Editor | July 28, 2009

"Since they installed that particular scanner, they have seen a dramatic impact on the neurologic emergencies. They have been able to avoid transport in some cases; they have been able to treat certain patients with time-sensitive clot-busting medicines. They have been able to identify bleeding problems in some of the patients that could be managed locally as opposed to incurring the expense of flying back and forth to [Alberta] Edmonton Hospital," Dr. McDonald said.

The installation includes a telemedicine hookup for specialist consults. Compared to a fixed CT, the portable saves not just on the scanner, but power supply needs and shielding as well. In addition, local X-ray technicians can operate the unit so that a CT tech is not required, although it is important to note that in the U.S., some states vary in these staffing requirements.

Similarly, in the U.S., CAHs all have alliances with larger centers to provide acute care when needed. This creates an important role for medical transport to serve outlying areas.

"One of the problems is that many small hospitals don't have depth as far as specialties go. They don't have staffing if someone is critically ill or injured. So the helicopter is a way to bring tertiary care to a primary care area," said Daniel G. Hankins, M.D., Co-Medical Director, Mayo Clinic Medical Transport and board member of the Association of Air Medical Services. He noted that strokes, heart attacks, major trauma from motor vehicle accidents or farm injuries, sepsis, and kidney failure are among the conditions that frequently require medical evacuation.

"Increasingly, air medicine will become the safety net as hospitals close and specialists concentrate in urban settings," he said. He added that many areas of the U.S. are too remote to be within an hour of a large hospital even by air. Initial stabilization of the ER patient becomes a vital service for rural hospitals. Also, emergency medicine staffing problems persist since younger residents required for that care often choose to work in cities.

A Measured Approach to Equipment Investment

There are many clouds and some silver linings for rural providers. The economic downturn hit hard in blue collar towns and areas that were already struggling before the recession.

DMS Health Technologies
mobile PET/CT trailer



"The biggest challenge right now for hospitals in rural areas is that the economic situation has affected them greatly due to the high Medicare, Medicaid and uninsured mix. It's pretty stable, but doesn't afford the operational margins they need to continue to invest in technology," observed Mark Samii, Vice President of Sales, DMS Health Technologies, Maple Grove, MN. "The net effect is that capital budgets are on hold, they are not able to invest in technology and are in a maintenance and survival mode right now."