[A_Tradition_Continues]

Most US hospitals do have general surgeon(s) but the majority of hospitals do not have OR staff and equipment to handle head injuries. In rural America most ER's are staffed with "rent-a-doc" physicians that are fellows and residents moonlighting to make a few bucks.

Emergency Departments are classified 1 thru 3 with #1 being a designated Trauma Center. Consider this...In the Pacific Northwest (includes Washington, Idaho, Montana and Alaska) there is only one medical facility designated as a Level 1 Trauma Center (Harborview Medical Center in Seattle).

The lack of air ambulance service in PQ is the exception and not the rule in Canada. Most provinces in Canada do offer air services. In Quebec the lack of air services has been and will continue to be a political decision.

[devere]

“Consider this...In the Pacific Northwest (includes Washington, Idaho, Montana and Alaska) there is only one medical facility designated as a Level 1 Trauma Center (Harborview Medical Center in Seattle).”

All the States you mention do have at least one level II trauma center, which is a 24 hour complete-coverage facility, but possibly without a research or residency program, or with a lower volume of patients. In a dire emergency there is rarely any practical difference between level I and level II.