trauma systems development

Bethel is a small city in Alaska with a population of 6,356 in 2006 located near the western coast of the state.  It is only accessible by air and river, and is located about 340 miles west of Anchorage.  It serves as the main port along the Kuskokwin River, and is the regional hub for 56 surrounding native villages.

Health care delivery in this area is overseen and administered through the Yukon-Kuskokwim Health Corporatoin.  The YKHC oversees various facilities and services, the most relevant to trauma care being the Village Clinics and the Yukon-Kuskokwim Delta Regional Hospital.  The Regional Hospital is a 50-bed general acute care facility which includes an adult inpatient ward, a pediatric ward, an obstetric ward, an emergency room, as well as pharmacy, lab and x-ray services, and some outpatient clinic areas.  The hospital is staffed by doctors and nurses along with other healthcare personnel.  There is no general surgeon in Bethel.  The Community Health Aide Program provides staffing for the village clinics.

Trauma patients here may require multiple transfers.  Initial stabilization may be done by the Community Health Aides at the village level while awaiting medical transport.  Depending on the season, location, weather conditions, among other factors, transport may be by small plane, canoe, or even dog sled.  Patients may then be brought to the Regional Hospital in Bethel awaiting further transport to Anchorage via LearJet.  In some instances of high acuity when logistically possible and safe for the patient, the medical transport teams may coordinate a "ramp transfer," whereby a LearJet is waiting at the Bethel airport for the small transport plane from one of the villages, and conduct the transfer right at the airport.
The Bethel Airport has two runways, one with asphalt pavement and another with a gravel surface.  In comparison to the McGrath Airport, Bethel is a very busy airfield, averaging about 120,000 aircraft operations a year, an average of 330 per day.  Bethel is also served by commercial airlines, including Alaska Airlines which provides non-stop service to Anchorage, and Era Alaska which provides service to Anchorage as well as many of the outlying village areas.  The flight operation time for an aero-medical aircraft (LearJet) from Anchorage to Bethel and back would be roughly one-hour each way; thereby a trauma activation for transfer would require a minimum of 2 hours of flight time, in addition to activation time in Anchorage, medical service provision on scene or at clinic/regional hospital, and transport and activation time from the Bethel station to the outlying village.

Bethel provides a unique framework and structured approach to trauma care in a generally isolated area of Alaska.  By utilizing the Community Health Aide Program and Village Clinics and networking those to the Regional Hospital, all in coordination with a single aero-medical transport system that has a base station in Bethel, optimizes the logistical and clinical operations involved with trauma patient care and transport.