No amount of discussion can alter the laws of physics and completely prevent car crashes or severe falls. But conversations may just be one of the best ways to keep victims alive in rural areas.

Nearly 60 million Americans lack timely access to a trauma center — a situation that disproportionately affects those living in rural communities.

Motor vehicle crashes are by far the largest cause of trauma, especially in Alabama, where they account for nearly 80 percent of trauma cases. While only 28 percent of car crashes in Alabama occur in rural areas, rural crashes account for more than two-thirds (69 percent) of trauma deaths. Even though 90 percent of trauma injuries are minor, the remaining 10 percent of cases with potentially life-threatening injuries require a series of high-stakes judgment calls. Patients with life-threatening injuries have a much higher rate of survival if they receive specialized trauma care within an hour of injury.

“We recently had a patient bleeding out from a large laceration,” said Mohammad Zain Hashmi, M.D., an assistant professor in the UAB Division of Trauma and Acute Care Surgery. “We were able to help the provider assess the wound and guide them in applying a tourniquet properly.”

At the time, Hashmi was several hours’ drive away from the patient. But he was able to help thanks to a pilot UAB teletrauma program.

Teletrauma in action

In September 2025, UAB eMedicine launched a pilot teletrauma program, directed by Hashmi, at Russell Medical in Alexander City and six UAB St. Vincent’s locations. Using remote consultation capabilities, UAB trauma experts are able to offer their expertise to care teams in these smaller, more rural hospitals and care facilities.

A teletrauma consultation is a two-way audiovisual communication, initiated at the rural physician’s discretion, that allows both physicians and patients to speak with the trauma surgeons at UAB. Upon review of the patient’s reports and condition, doctors can make more detailed decisions on whether a transfer is necessary or the patient can benefit from receiving appropriate care at their current care facility which may include discharge from the ED or brief inpatient observation.

The program speeds up transfers of severely injured patients to UAB, while also ensuring that patients who do not need that level of care can stay in their own communities.

“Even in the first few weeks, we have had good success in keeping those patients locally,” Hashmi said. “We have been able to avoid transfers, which cuts down on insurance costs for the patient and their insurer, and keeping the admissions at local hospitals supports those hospitals.”

Another benefit of avoiding ambulance transfers to UAB or another trauma center is that it leaves those vehicles available for additional calls. “There is often only one EMS transport vehicle in an entire county,” Hashmi said. “If UAB is two hours away, you are taking that vehicle out of commission for four or five hours as it makes the roundtrip transport to Birmingham. And in the meantime, what if someone else has a legitimate emergency, such as a stroke or a heart attack?”

The new teletrauma pilot program is the result of a decade of research and years of collaborative work among UAB researchers and clinicians in the Heersink School of Medicine and UAB School of Health Professions, as well as UAB eMedicine; medical staff and administrators in rural hospitals; and conversations among colleagues in national medical societies.

UAB President’s Award for Excellence in Support of UAB and Shared Governance

Hashmi’s role in these research and clinical efforts has brought about positive change, demonstrated his strong commitment to the UAB core value of unity of purpose, and modeled collaborative dialogue and open communication, colleagues say. That is why he has been selected as the 2025 recipient of the UAB President’s Award for Excellence in Support of UAB and Shared Governance.

“Under his leadership, the [UAB teletrauma] program has established high-impact partnerships with rural hospitals and UAB eMedicine, which will directly lead to improving trauma care access across Alabama,” said Jeffrey D. Kerby, M.D., Ph.D., FACS, Brigham Family Endowed Professor and director of the Division of Trauma and Acute Care Surgery in the Department of Surgery. “His research bridges departments across the School of Medicine and School of Health Professions, leveraging mixed-methods, big data, and health services approaches to address disparities in trauma care access and outcomes.”

Hashmi also has “cultivated a culture of inquiry and accountability through leadership roles” at UAB, Kerby added, including chairing the university’s Trauma Staff Safety and Patient Communications Initiative, serving as lead faculty member for the UAB Center for Injury Sciences Trauma Care Delivery Unit, as a member of the UAB Surgical Undergraduate Research Experiences (SURE) program selection committee, and as faculty advisor for the Surgical Critical Care Fellowship Journal Club.

But Hashmi also has established a “broad and deep” capacity to bring about meaningful change by working with a range of community, professional and governmental groups, nominators said. “His collaborations with the National Highway Traffic Safety Administration will directly influence the availability of prehospital blood products in Alabama and beyond, contributing to measurable improvements in trauma care delivery and patient survival,” Kerby said. “He has helped develop and lead updates to the Rural Trauma Team Development Course content for the American College of Surgeons, tailoring trauma education to meet the specific needs of underserved regions. His receipt of the ACS Committee on Trauma’s Future Trauma Leaders Award and the Eastern Association for the Surgery of Trauma’s Leadership Development Workshop Scholarship are national endorsements of his leadership and innovation.”

Pathway to becoming a change agent

Hashmi’s path to a career combining research and real-world changes began with his medical training and a research fellowship in trauma outcomes from Aga Khan University, completed in 2011 and 2012, respectively. He did a postdoctoral research fellowship at Johns Hopkins School of Medicine in 2014, then completed a general surgery residency at Sinai Hospital in Baltimore in 2020. His residency included a research fellowship at the Center for Surgery and Public Health at Brigham and Women’s Hospital/Harvard Medical School. Hashmi came to UAB in 2020 for a trauma and surgical critical care fellowship and joined the faculty in 2021.

“The initial work that I was doing at Hopkins was primarily trying to understand the facility-level differences in care,” Hashmi said. “In other words, why is one trauma center better than others?” The answer to that question, he said, “was as much a function of the quality of care as the injury severity and demographics at play; patients treated at low-quality trauma centers had poor outcomes, no matter what their demographics.”

His additional research training at Harvard looked at access. “We uncovered that states with poor access to trauma care had patients dying before they reached the hospital,” Hashmi said. “After I became a faculty member at UAB I said, ‘We have done about a decade of research that found that a major driver is access to care — now let’s talk about systems design to improve and mitigate those disparities.’”

Hashmi looked to two specialties — neurology and cardiology — for ideas. “These are not novel problems,” he said. Strokes and cardiac emergencies such as heart attacks “are also acute, time-sensitive conditions,” Hashmi observed. “How did they tackle it?” In each case, telemedicine had proven to be a gamechanger. “The earliest trials of telestroke were done in the early 2000s,” Hashmi said. “I wondered, Has anyone done teletrauma before?” He found scattered pilot programs but nothing that had proved to be sustainable. “One of the primary things I found out is that we as a trauma care community had not been interested and had not explored this for a system of care,” Hashmi said. There was a repeated pattern: “Teletrauma was just a cool thing to try, but then initial funds ran out and everything collapsed.”

Truly integrating a teletrauma program into the entire trauma system of care, Hashmi realized, would require buy-in at the professional level, in organizations such as the American College of Surgeons’ Committee on Trauma (which named him a Future Trauma Leader), but also a research agenda to prove what worked and what did not, along with a sustained outreach to rural hospitals and EMS teams, or what he calls “engaging the community at large.”

In 2024, Hashmi and colleague Caroline Park, M.D., a trauma surgeon at the University of Texas Southwestern Medical Center, published a special article in the Journal of the American College of Surgeons titled “Using Teletrauma to Improve Access to Trauma Care in the US: A Call for Action,” to make the case for wider use of teletrauma, following it with an original investigation paper in the Journal of the American Medical Association that demonstrated that only 8 percent of more than 4,500 emergency departments nationwide reported using teletrauma in 2020.

“With the expansion of telehealth, barriers common to any telehealth program either have been resolved or at least have some precedents available to inform teletrauma implementation,” Hashmi explained at the time. “However, trauma-specific barriers, such as evidence-based clinical workflows and staffing models, have remained largely unresolved. Currently, there are no telehealth implementation toolkits, and there is no consensus among the trauma care community regarding the standards and verification of teletrauma programs. These seem to be the major barriers hindering progress in this area.”

Collaboration and trust

For two and a half years, Hashmi and UAB colleagues have been engaging with the local Alabama trauma community, explaining that the UAB teletrauma program has two main goals: “One, improve early care of rural injured patients so that they survive to reach a definitive trauma center, and two, avoid transfers of people who have minor injuries who are flown halfway across the state, seen in the middle of the night and then promptly discharged,” Hashmi said. “We laid out strategies for how to mitigate that and recommendations going forward.”

In his years of meetings and town halls in rural communities, Hashmi has learned that rural providers are not typically concerned with technical details about internet speeds or how the UAB telemedicine carts function. “They want to know, Will you be there for us?” Hashmi said. “'Who will I call if something goes wrong?' Their concern is building trust and relationships. And we decided up front that we will never move past having near 100 percent consensus before we modify protocols — we will meet dozens of times if we need to. We had a concern one time raised by a single provider, when everyone else involved was ready, and we paused, delayed our go-live date, and had more meetings to rectify their concern. This is a community-led project. It is easy to break trust, but very difficult to build it up.”

The National Highway Traffic Safety Administration, or NHTSA, is the federal agency responsible for the Office of Emergency Medical Services and sets the agenda for reducing deaths on the nation’s roadways. “NHTSA is responsible for how roads are designed, for seatbelt laws, for how cars are tested and evaluated for safety,” Hashmi said. “They realize they have reached a plateau in all of those interventions, in terms of improving safety, and that post-crash care is where they need to be spending time and money. Simultaneously, in the trauma world we have realized that one of the major interventions in prehospital care that we can implement is blood transfusion. Loss of blood is the No. 1 cause of preventable death in all patients. There is a 10 percent mortality difference between patients who receive blood transfusion in an ambulance on the way to the hospital and those who do not. That is an unheard-of difference in any medical intervention.”

So both the Office of EMS and trauma organizations such as the ACS Committee on Trauma are working to plan how to make it feasible to have whole blood available on ambulances. Hashmi and UAB colleagues have applied for a Department of Transportation grant to plan for placement of prehospital blood in an eight-county region around Birmingham and planning for how to direct EMS crews to resuscitate injured patients in the field. “It’s the same problem all over again — an access problem,” Hashmi said. “You have to place the blood strategically: Should it be distributed so that every stretch of highway is covered? Could you deliver it by drone? Should there be roadway kiosks? These are the questions we are working to answer.”

Finding those answers will require collaboration, unity of purpose and trust, Hashmi says. UAB has recently become involved in the Southern Regional Disaster Response System, born out of centers at Emory University and the Medical College of Georgia, that establishes regional medical operations command centers that help coordinate day-to-day operations but also are designed to scale up in response to disasters. “The spirit of collaboration is something you find running throughout UAB,” Hashmi said. “We are working toward a common goal, and we are committed to working with our communities to bring these improvements.”

Creating this positive change means more committee meetings, town halls and conversations. “It also means following through on what you say you are going to do,” Hashmi said. “You can’t just talk the talk and then not follow through. You have to continue the engagement.”