Illinois Medicine

When you are a family doctor in a rural area, you are able to practice the full scope of family medicine and use all of the tools and procedures that you learned in residency. RESCUE FROM A 'ROLLOVER' RMED simulation training teaches how to respond in farm emergencies Beth Gullone, MD '06 O n one cloudy, damp and chilly autumn afternoon outside of Freeport, Ill., a dozen emergency personnel carefully and quickly extricated an "injured farmer"— actually a mannequin — trapped underneath his tractor, while a helicopter and crew stood ready to whisk him to the nearest hospital trauma center in Rockford. Their goal: move him from farm field to operating room within 60 minutes of the "tractor rollover" to maximize his chance of survival from myriad potential problems, including internal bleeding, abdominal injuries, broken bones and burns. Despite the staged nature of this particular event, titled "No Harm on the Farm," an annual event that's part of RMED, the audience of 40 students in medicine, pharmacy and the biomedical sciences watched attentively from the sidelines as the tractor-rollover "rescue" unfolded. The rescue demonstration followed a 90-minute tour of the farm during which co-owner Douglas Scheider discussed potential hazards, ranging from icy steps on the side of a This simulation covered an emergency rescue after a staged grain silo to noxious gases in manure tractor rollover. holding-bins. "I actually know of eight or nine people who have died in farm accidents and many more who have been injured," Scheider says. Throughout the state, 801 farmers died as a result of work-related accidents between 1986 and 2011, according to the University of Illinois Extension Service. "The problem with these types of accidents is that they happen away from the farmstead where nobody can see them. It might be hours before a family member notices [the farmer] is missing," explains Mark Baker, coordinator at Stateline Farm Rescue, in Orangeville, Ill., which organizes training programs like the one staged at Scheidairy Farms. Farmers also are prone to a multitude of job-related chronic conditions, such as lung disease, hearing loss and depression. Numerous studies have looked at the conditions that produce stress on the farm, including unpredictable income, investment risks and social isolation. 22 | Fa l l 2 013 P h o t o s : Br i a n T h o m a s Photo: Lloyd DeGrane only have access via computer to the most current medical literature, but EMRs, test results and X-rays can be transmitted to regional hospitals if a patient needs more specialized care. Primary-care specialties remain the bread and butter of RMED, which has the highest percentage of its students choosing such an emphasis of any program in RMED alumni Beth and Matt Gullone married after graduation and later joined Midwest Health the nation. That's because Clinic in rural Galena, Ill. primary-care physicians in rural areas "will handle about 80 percent of what walks through their door. Primary care is the front line for health care in rural communities," Hunsaker says. Residents of rural communities tend to be in worse health than their urban and suburban peers; their rates of high blood pressure, cerebral vascular disease, suicide among men and DUI arrests are all higher, according to the National Rural Health Association. And then there are medical emergencies related to farming, something to which medical students in urban areas are not typically exposed. Such injuries and fatalities are frequent, which is why the RMED and RPHARM programs annually stage a simulation called "No Harm on the Farm" (see sidebar at right). In addition to field trips and classroom lectures, both RMED and RPHARM include a four-month internship, or "preceptorship," in a rural setting. Some 35 rural physician/educators on staff at 25 hospitals volunteer to work with the RMED students. To hone community leadership skills outside of the confines of a medical practice, RMED students complete a community-oriented primary-care project in the same community. These address a health issue of importance in the community: "Whether it is methamphetamine addiction, teenage pregnancy or obesity, the student identifies and develops the project after getting to know the community," Hunsaker says. RMED's influence reaches beyond the four years of medical school. RMED educators worked with officials at KSB Hospital in Dixon to launch a rural medicine residency program in 2004. "It is a great recruitment tool, and it is a great retention tool as well because our physicians love to teach," says David Schreiner, president and CEO of the hospital. Of the 10 doctors who have completed the residency program, KSB Hospital has hired five of them. The hospital also plans to employ a second-year resident, Emilee Bocker, an RMED graduate, after she completes her training. Bocker, raised on a farm in Lanark, always planned to return to her rural roots. "I know there is a definite need in rural areas," she says. "That is where my heart is and where I am committed to serve."

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