"There seems to be less aggressive resuscitation when inter-hospital transferred patients arrive at the trauma center, despite similar ISS (Injury Severity Scores) between these patients and those going directly to the trauma center from the scene," the authors wrote.
The authors aren't sure why, but hypothesize that resuscitation efforts related to the transfer, and subsequent trauma team management.
"If the time from the field to the closest hospital is not significantly longer than the time to the nearest trauma center that can deliver definitive care, it may be beneficial to bypass the closest hospital in light of improved pre-hospital care," they wrote.
The Affordable Care Act calls for increased spending and attention to providing trauma care in rural areas, although those appropriations may be in jeopardy because of funding limitations. Of course we can't build Level 1 trauma centers to cover the entire country. But a more sensitive appreciation of the limited capabilities of some rural emergency rooms, and better triaging to better equipped trauma centers, may ultimately save more lives.