{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T03:50:55Z","timestamp":1793418655729,"version":"4.5.0"},"reference-count":16,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2026,2,5]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Rural Americans face persistent and widening disparities in trauma and emergency care driven by geographic isolation, limited workforce capacity, longer transport times, and fragile hospital finances. These challenges are poised to intensify under the 2025 tax and spending reconciliation law, which substantially reduces federal Medicaid and Children\u2019s Health Insurance Program funding and is projected to increase uninsurance, placing already vulnerable rural hospitals at heightened risk of service reduction or closure. This article examines the structural pressures confronting rural trauma systems and proposes strategic, scalable solutions to strengthen resilience. Key recommendations include the development of Regional Medical Operations Coordinating Centers to enhance regional and interstate collaboration, optimize patient flow, and support disaster preparedness; targeted investments in workforce recruitment, retention, and teletrauma infrastructure; and hospital stabilization through right-sizing, repurposing underused capacity, and expanding telehealth and mobile care models. While new Rural Health Transformation Program grants may offer limited relief, sustained leadership and coordinated policy action will be required to ensure equitable access to high-quality trauma and emergency care in rural communities and to prevent geography from determining survival.<\/jats:p>","DOI":"10.1136\/tsaco-2025-002170","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T15:55:23Z","timestamp":1775577323000},"page":"e002170","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Strategies for improving rural trauma health systems"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2306-9951","authenticated-orcid":false,"given":"Chavi","family":"Rehani","sequence":"first","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA"},{"name":"Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1510-3032","authenticated-orcid":false,"given":"Joseph","family":"V Sakran","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Person","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of South Dakota-Sanford School of Medicine, Vermillion, South Dakota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Bernard","sequence":"additional","affiliation":[{"name":"Division Chief of Acute Care Surgery and Trauma, University of Kentucky, Lexington, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"G Hashmi","sequence":"additional","affiliation":[{"name":"Department of Surgery, UAB Heersink School of Medicine, Birmingham, Alabama, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Kerby","sequence":"additional","affiliation":[{"name":"Department of Surgery, UAB Heersink School of Medicine, Birmingham, Alabama, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Krause","sequence":"additional","affiliation":[{"name":"Northeast Georgia Health System, Gainesville, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nakul","family":"Raykar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"W Russell","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4749-969X","authenticated-orcid":false,"given":"Lacey","family":"N LaGrone","sequence":"additional","affiliation":[{"name":"Department of Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"2026040708551413000_11.2.e002170.1","unstructured":"U.S. Census Bureau . Nation\u2019s urban and rural populations shift following 2020 census [press release]. 2022. Available: https:\/\/www.census.gov\/newsroom\/press-releases\/2022\/urban-rural-populations.html"},{"key":"2026040708551413000_11.2.e002170.2","doi-asserted-by":"crossref","unstructured":"Davis JC , Cromartie J , Farrigan T , Genetin B , Sanders A , Winikoff JB . Rural America at a Glance: 2023 edition (Report No. EIB-261). U.S. Department of Agriculture, Economic Research Service; 2023. Available: https:\/\/doi.org\/10.32747\/2023.8134362.ers","DOI":"10.32747\/2023.8134362.ers"},{"key":"2026040708551413000_11.2.e002170.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.06.020"},{"key":"2026040708551413000_11.2.e002170.4","article-title":"Traumatic injury and access to care in rural areas: leveraging linked data and geographic information systems for planning and advocacy","volume":"19","author":"Yuma","year":"2019","journal-title":"Rural Remote Health"},{"key":"2026040708551413000_11.2.e002170.5","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3109\/10903127.2015.1086846","article-title":"National Characteristics of Emergency Medical Services in Frontier and Remote Areas","volume":"20","author":"Mueller","year":"2016","journal-title":"Prehosp Emerg Care"},{"key":"2026040708551413000_11.2.e002170.6","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.injury.2017.01.008","article-title":"Disparities in access to trauma care in the United States: A population-based analysis","volume":"48","author":"Carr","year":"2017","journal-title":"Injury"},{"key":"2026040708551413000_11.2.e002170.7","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1001\/jama.2022.8097","article-title":"Access to American College of Surgeons Committee on Trauma-Verified Trauma Centers in the US, 2013-2019","volume":"328","author":"Choi","year":"2022","journal-title":"JAMA"},{"key":"2026040708551413000_11.2.e002170.8","unstructured":"Alker J , Osorio A , Park E . Medicaid\u2019s Role in Small Towns and Rural Areas. Georgetown University Center for Children and Families. 2025. Available: https:\/\/ccf.georgetown.edu\/2025\/01\/15\/medicaids-role-in-small-towns-and-rural-areas\/ [Accessed Oct 2025]."},{"key":"2026040708551413000_11.2.e002170.9","unstructured":"Levinson Z , Neuman T , Godwin J . What are the implications of the 2025 budget reconciliation bill for hospitals?. KFF 2025. Available: https:\/\/www.kff.org\/medicaid\/what-are-the-implications-of-the-2025-budget-reconciliation-bill-for-hospitals\/ [Accessed 3 Oct 2025]."},{"key":"2026040708551413000_11.2.e002170.10","unstructured":"Swagel PL . Letter to Ron Wyden, Frank Pallone Jr, and Richard E. Neal; 2025. Available: https:\/\/www.cbo.gov\/system\/files\/2025-06\/Wyden-Pallone-Neal_Letter_6-4-25.pdf"},{"key":"2026040708551413000_11.2.e002170.11","unstructured":"Burns A , Ortaliza J , Lo J , Rae M , Cox C . How will the 2025 reconciliation law affect the uninsured rate in each state?. KFF. 2025. Available: https:\/\/www.kff.org\/uninsured\/how-will-the-2025-reconciliation-law-affect-the-uninsured-rate-in-each-state\/ [Accessed 3 Oct 2025]."},{"key":"2026040708551413000_11.2.e002170.12","unstructured":"Department of Health and Human Services Administration for Strategic Preparedness and Response . Technical resources, assistance center, and information exchange. Medical operations coordinations centers toolkit (third edition); 2024. Available: https:\/\/files.asprtracie.hhs.gov\/documents\/fema-mocc-toolkit.pdf"},{"key":"2026040708551413000_11.2.e002170.13","unstructured":"American College of Surgeons . Committee on trauma. National trauma and emergency preparedness system (v2.0); 2025. 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