Rural trauma and emergency medical service challenges in a sample of Western States.

State trauma system managers from the western region meet annually to identify and address health care issues, particularly those related to trauma care access and delivery. In each of these states, policy makers face a host of convergent problems: declining populations, rapid growth, low incomes, and high poverty rates. Challenges of providing emergency medical services to largely rural states include geographic barriers of vast expanses of unpopulated landmass, provision of services across mountain ranges, volcanoes, and extreme weather conditions, communication challenges due to lack of cell or radio coverage in some areas, and difficulty recruiting and retaining trained personnel.