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Surgeon teaches rural Arizona clinics to cope with trauma

By Dennis Wagner
Phoenix, Arizona (AP) 1-08

At dawn, Dr. Corey Detlefs takes off from a runway at Mesa’s Falcon Field Airport and heads northeast to the Navajo Nation, bringing a life-and-death message to emergency medical workers.

Put simply, his mission is to teach rural doctors and nurses how to save trauma patients, even though they may lack the staffing, equipment or training to deal with potentially lethal injuries.

Detlefs, who envisioned himself as a minister before becoming a trauma surgeon, has made two dozen mercy flights in his S35 Bonanza to the state’s outback, working with nurses from Banner Good Samaritan Medical Center and a pair of plastic dummies used to practice lifesaving techniques.

“You might say he ministers to souls in a different way, by keeping them here a little bit longer,” says Jennifer Pool, a hospital spokeswoman.

The 52-year-old Detlefs volunteers his time and aircraft because he knows that isolated clinics and hospitals suffer from disproportionately high mortality rates. One-fifth of the U.S. population lives outside urban areas, yet rural accidents accounted for 57 percent of all traffic fatalities in 2005, according to the most recent figures from the National Highway Traffic Safety Administration.

Although road conditions and demographics play a role, Detlefs says medical care is a major problem. Flying over the Mogollon Rim, he tells about a Navajo clinic that has only a family doctor, a nurse and a custodian to care for people.

“The janitor takes X-rays. It’s called multitasking,” he says.

“Most of the rural communities do the best they can. But with the resources they have, some really severely injured patients are going to die. What we’re hoping to do is make a difference in that by providing the knowledge, training and skills so they can deal with it.”

The challenges are most noticeable on Indian reservations with wide-open spaces, limited transportation, cell phone gaps and medical clinics that may lack expertise and technology.

“The resource differences can be substantial,” Detlefs says. “And a lot of these facilities have no choice (but to give trauma care). In a car crash with multiple injuries, they’ll have many patients at their door at one time.”

After landing at the Window Rock Airport, 300 miles from metro Phoenix, Detlefs heads to Fort Defiance Indian Hospital. The 5-year-old facility has more staffing and equipment than most rural medical centers but just one ambulance serving an area of 2,500 square miles. Because surrounding clinics are open only part time, staffers say the emergency room gets 100 patient visits each weekday and 300 on weekends.

About 20 nurses, doctors and therapists show up for the Rural Trauma Team Development Course.

Detlefs’ instruction opens with video of a man with a 1-inch-diameter tree branch stuck through his neck and a group of befuddled ER workers looking at him as if they haven’t a clue what to do.

“Forget about the stick in his neck,” Detlefs says, launching into the lesson. “What’s going to kill him is his airway.”

Much of the all-day instruction involves technical skills. Some medical workers in the outback need brush-up work. Others have never learned difficult ER techniques that may be needed during an overwhelming emergency.

Detlefs’ overarching message is simple: Even in a primitive clinic, workers can develop a system to cope with severe injuries. They can understand triage, know when to seek help and learn what critical steps to take until a patient gets to a trauma center.

“You are important,” Detlefs tells them. “The things you do make a difference in how these patients do, what’s the outcome.”

Dr. Steve Coniaris, an emergency doctor from Chinle, helps out with a session on intubation, the process of cutting a hole in the trachea to insert a breathing tube.

“They’re going to bleed, but there’s a dead patient if you don’t establish an airway,” Coniaris says. “This isn’t a clean procedure. It isn’t, ‘Take your time, make sure you have a clean incision, stop the bleeding.’ You have a dead person if you don’t do it right now.”

The medical workers take turns cutting into the flesh-colored dummies.

Moments later, nursing aide Jennifer Mitchell is flushed with pride after accomplishing her first cricothyroidotomy, even if it was only simulated.

“It was kind of scary at first, thinking I didn’t get the right area. When you cut somebody with a sharp object like that, it’s weird.”

Orena Sam, another nurse, says there have been times when several badly injured patients were brought to the ER at the same time and she could have assisted if she had known what to do.

Detlefs says Arizona’s major trauma centers have established a nonprofit consortium and are building an assistance network. This course, which he helped design, is offered under the auspices of the American College of Surgeons.

Suzanne Barker, a Banner Good Samaritan outreach nurse who helps with the training, says Detlefs has taught more rural trauma classes than any specialist in the nation.

“He won’t tell you this, but he’s donated so many hours of his personal time. Nobody else is doing this. He’s passionate about it.”

Detlefs says some big-city specialists don’t understand the disadvantages of emergency health care in the outback and are slow to help out. So he’s also trying to educate trauma-center physicians to support rural health care workers.

With some injuries, he says, the most important step is recognizing that an under-equipped rural facility needs to transfer a patient immediately. In other cases, stopgap emergency advice by phone may save a life.

As the class ends, Detlefs reinforces his message: “This is a public-health issue. Rural injury is a significant problem. You do so much with so little ... But rural facilities are not the big hospitals downtown.”

Back at the Window Rock Airport in the late afternoon, he revs up his plane, takes off into gathering storm clouds, then gazes down at the vast Navajo reservation sliding beneath.

“They’re kind of out there on their own,” he says.