Table 4 Enablers—Summary of rural clinicians’ experience and example quotes

Enablers

Patient

The resilience of people in rural areas

my standard patient is an Italian farmer in his mid-80 s who is still working. The patients under triage their own trauma. They come in three days after being squashed by a trailer. DR3

he had some fractures in his hands that he didn’t tell anybody about …because he was such a toughie. RN1

he was very determined that he was going to get back to the farm. RN1

even if there aren’t those services set up or available, you’d be able to draw on community support to find someone to help out…those kinds of community connections just exist a bit more in that remote environment. OT2

Staff

The experience and training of rural clinicians

These guys have been out there for decades… they’ve seen it all. They can do a lot with nothing. DR6

I have a couple of orthopaedic surgeons, and two general surgeons [who] are amongst the most physician-like surgeons. They’ve got to be here because you just don’t have back up. You’ve got to be a generalist doctor. DR2

what the geriatric term was really helpful for, was… learning how to find out about (patients) function … what they’re trying to achieve. Now I’d be comfortable [to] have that discussion about goals of care.” [DR3]

Relationship between clinicians and the rural community

Clinicians out there would know a lot of the community. That previous knowledge of the patient and their clinical history I think really helps. Whereas you won’t necessarily get that in an urban setting. “They look different” or “They wouldn’t usually present for this”. DR5

System

Delivering better care through a multidisciplinary approach

the orthopaedic team was relatively well supported by ortho geris, medical teams. I think that made them less anxious about admitting comorbid people. DR2

a lot of those trauma patients don’t need to be in a big tertiary hospital, but they need good multidisciplinary, good holistic care. DR5

A robust system for major trauma

In every small hospital, we have early notification trauma guidelines where, if someone presents with the usual anatomical, physiological, mechanisms… we would be very quickly looking to move them to the nearest place that can look after them. DR4