Research paper| Volume 25, ISSUE 2, P106-114, June 2022

Exploring user perspectives of factors associated with use of teletrauma in rural areas



      Despite the existence of universal health care for Canadians, health inequalities persist and those residing in rural regions experience disparities when accessing appropriate services. To enhance access, a teletrauma program was implemented in a rural northern region in western Canada, connecting rural clinicians to urban emergency physicians and trauma specialists during emergency cases.


      To explore reasons why teletrauma is used in rural contexts from the perspectives of service users and stakeholders.


      14 semi-structured interviews were conducted with stakeholders, clinicians (physicians, specialists), management, and researchers. Interpretive description methodology guided the study and analysis, and findings were organized thematically.


      Teletrauma was used to connect clinicians, manage complex cases when weather or distance delayed transfer, and to enable appropriate and timely treatment locally. Teletrauma was more likely to be activated when clinicians were uncomfortable with clinical management, when relationships were established, and when technology was familiar and easy to use.


      Teletrauma is more than just the technology that is deployed. The establishment of relationships between teletrauma users was vital to the success of teletrauma. To design effective, integrated, and sustainable services, rural clinicians must remain at the center of teletrauma models.


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        • Mock C.
        • Lormand J.D.
        • Goosen J.
        • Joshipura M.
        • Peden M.
        Guidelines for essential trauma care.
        World Health Organization, Geneva (Sweden)2004
        • Latifi R.
        • Weinstein R.S.
        • Porter J.M.
        • Ziemba M.
        • Judkins D.
        • Ridings D.
        • et al.
        Telemedicine and telepresence for trauma and emergency care management.
        Scand J Surg. 2007; 96: 281-289
        • Sibley L.M.
        • Weiner J.P.
        An evaluation of access to health care services along the rural-urban continuum in Canada.
        BMC Health Serv Res. 2011; : 11
        • Ministry of Health
        Rural health services in BC: a policy framework to provide a system of quality care.
        2015 (Retrieved from: [Cited 10 July 2020])
      1. Kulig J.C. Williams A.M. Health in rural Canada. UBC Press, Vancouver, BC2012
        • Canadian Institute for Health Information
        Your health system: avoidable deaths.
        2017 (Retrieved from: [Cited 1 August 2020])
        • Gomez D.
        • Berube M.
        • Xiong W.
        • Ahmed N.
        • Haas B.
        • Schuurman N.
        • et al.
        Identifying targets for potential interventions to reduce rural trauma deaths: a population-based analysis.
        J Trauma Acute Care Surg. 2010; 69: 633-639
        • Wood T.
        • Freeman S.
        • Banner D.
        • Martin-Khan M.
        • Hanlon N.
        • Flood F.
        Factors associated with utilization of teletrauma services in rural areas.
        Rural Remote Health. 2021; 21
        • University of British Columbia
        Robson Valley virtual care pilot evaluation report.
        University of British Columbia Digital Emergency Medicine Evaluation Team, Vancouver (BC)2018
        • Hameed S.M.
        • Schuurman N.
        • Razek T.
        • Boone D.
        • Van Heest R.
        • Taulu T.
        • et al.
        Access to trauma systems in Canada.
        J Trauma Acute Care Surg. 2010; 69: 1350-1361
        • Duchesne J.C.
        • Kyle A.
        • Simmons J.
        • Islam S.
        • Schmieg Jr., R.E.
        • Olivier J.
        • et al.
        Impact of telemedicine upon rural trauma care.
        J Trauma Acute Care Surg. 2008; 64: 92-98
        • Franken Jr E.A.
        • Harkens K.L.
        • Berbaum K.S.
        Teleradiology consultation for a rural hospital: patterns of use.
        Acad Radiol. 1997; 4: 492-496
        • Mohr N.M.
        • Vakkalanka J.P.
        • Harland K.K.
        • Bell A.
        • Skow B.
        • Shane D.M.
        • et al.
        Telemedicine use decreases rural emergency department length of stay for transferred North Dakota trauma patients.
        Telemed J E Health. 2018; 24: 194-202
        • Roccia F.
        • Spada M.C.
        • Milani B.
        • Berrone S.
        Telemedicine in maxillofacial trauma: a 2-year clinical experience.
        J Oral Maxillofac Surg. 2005; 63: 1101-1105
        • Saffle J.R.
        • Edelman L.
        • Theurer L.
        • Morris S.E.
        • Cochran A.
        Telemedicine evaluation of acute burns is accurate and cost-effective.
        J Trauma Acute Care Surg. 2009; 67: 358-365
        • Thorne S.
        • Kirkham S.R.
        • MacDonald-Emes J.
        Focus on qualitative methods. Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.
        Res Nurs Health. 1997; 20: 169-177
        • Andersen R.
        • Newman J.F.
        Societal and individual determinants of medical care utilization in the United States.
        Milbank Mem Fund Q Health Soc. 1973; 51: 95-124
        • Thorne S.
        • Kirkham S.R.
        • O’Flynn-Magee K.
        The analytic challenge in interpretive description.
        Int J Qual Methods. 2004; 3: 1-11
        • Thorne S.
        Interpretive description.
        Left Coast Press, Walnut Creek (CA)2008
        • Lincoln Y.S.
        • Guba E.G.
        Naturalistic inquiry.
        Sage Publications, Thousand Oaks (CA)1985
        • Canadian Tri-Council
        Tri-council policy statement: ethical conduct for research involving humans (TCPS2).
        Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada, Ottawa (ON)2010
        • Bodenheimer T.
        • Sinsky C.
        From triple to quadruple aim: care of the patient requires care of the provider.
        Ann Fam Med. 2014; 12: 573-576
        • Mohr N.M.
        • Harland K.K.
        • Chrischilles E.A.
        • Donner J.
        • Bell A.
        • Shane D.M.
        • et al.
        Telemedicine penetration and consultation among rural trauma patients in critical access hospital emergency departments in North Dakota.
        Rural Policy Res Brief. 2016; : 1-4
        • Dharmar M.
        • Romano P.S.
        • Kuppermann N.
        • Nesbitt T.S.
        • Cole S.L.
        • Andrada E.R.
        • et al.
        Impact of critical care telemedicine consultations on children in rural emergency departments.
        Crit Care Med. 2013; 41: 2388-2395
        • Rottger J.
        • Irving A.M.
        • Broere J.
        • Tranmer B.
        Use of telecommunications in a rural emergency. Brain surgery by fax.
        J Telemed Telecare. 1997; 3: 59-60
        • Tachakra S.
        • Sivakumar A.
        • Everard R.
        • Mullett S.
        • Freij R.
        Remote trauma management-setting up a system.
        J Telemed Telecare. 1996; 2: 65-68
        • Sikka N.
        • Carlin K.N.
        • Pines J.
        • Pirri M.
        • Strauss R.
        • Rahimi F.
        The use of mobile phones for acute wound care: attitudes and opinions of emergency department patients.
        J Health Commun. 2012; 17: 37-43
        • Copley M.
        • Kitson N.
        • Pawlovich J.
        It’s not about the technology: telemedicine for rural and remote British Columbia.
        UBCMJ. 2017; 8: 5-6
        • Ricci M.A.
        • Caputo M.
        • Amour J.
        • Rogers F.B.
        • Sartorelli K.
        • Callas P.W.
        • et al.
        Telemedicine reduces discrepancies in rural trauma care.
        Telemed J E Health. 2003; 9: 3-11
        • Rogers F.B.
        • Ricci M.
        • Caputo M.
        • Shackford S.
        • Sartorelli K.
        • Callas P.
        • et al.
        The use of telemedicine for real-time video consultation between trauma center and community hospital in a rural setting improves early trauma care: preliminary results.
        J Trauma Acute Care Surg. 2001; 51: 1037-1041
        • Westbrook J.I.
        • Coiera E.W.
        • Brear M.
        • Stapleton S.
        • Rob M.I.
        • Murphy M.
        • et al.
        Impact of an ultrabroadband emergency department telemedicine system on the care of acutely ill patients and clinicians’ work.
        Med J Aust. 2008; 188: 704-708
        • Al-Kadi A.
        • Dyer D.
        • Ball C.G.
        • McBeth P.B.
        • Hall R.
        • Lan S.
        • et al.
        User’s perceptions of remote trauma telesonography.
        J Telemed Telecare. 2009; 15: 251-254
        • Dyer D.
        • Cusden J.
        • Turner C.
        • Boyd J.
        • Hall R.
        • Lautner D.
        • et al.
        The clinical and technical evaluation of a remote telementored telesonography system during the acute resuscitation and transfer of the injured patient.
        J Trauma Acute Care Surg. 2008; 65: 1209-1216
        • Plsek P.
        Appendix B: redesigning health‐care with insights from the science of complex adaptive systems.
        IOM Committee on Quality of Health Care in America. Crossing the quality chasm: a new health care system for the 21st century. National Academy Press, Washington (DC)2001: 309-322
        • Lorenz A.D.
        • Mauksch L.B.
        • Gawinski B.A.
        Models of collaboration.
        Prim Care. 1999; 26: 401-410
        • Stange K.C.
        A science of connectedness.
        Ann Fam Med. 2009; 7: 387-395
        • Morse J.M.
        The significance of saturation.
        Qual Health Res. 1995; 5: 147-149