RURAL EMERGENCY MEDICAL SERVICES
Category: Emergency Medicine
Abstract : Rural Emergency Medical Services Most EMS literature has been developed by
urban and suburban systems, with little emphasis on rural EMS care. The rural
environment provides a number of unique challenges to providers of emergency
care. Long distances over which to reach and transport patients are the central
issue. Specialized search and rescue capabilities may be needed for off-road an
Rural Emergency Medical Services
Most EMS literature has been developed by
urban and suburban systems, with little emphasis on rural EMS care. The rural
environment provides a number of unique challenges to providers of emergency
care. Long distances over which to reach and transport patients are the central
issue. Specialized search and rescue capabilities may be needed for off-road and
wilderness emergencies.
Because of the low population density of rural areas,
there is a decreased likelihood that an emergency will be witnessed and
emergency aid summoned. Compared with urban and suburban populations, the
population in rural areas tends to be less affluent, older, and less likely to
request emergency aid unless it is truly needed.
Implementation of a
universal emergency telephone number has not occurred in some rural communities.
Enhanced emergency telephone service, which provides automatic location
identifiers, may not be as useful in rural locations because there may not be
addresses to guide emergency providers. The infrastructure for basic radio
communications may not be as well developed or supported. The contraction of the
health care system in the United States has caused the closure of a number of
hospitals, most of them in rural areas. If an emergency facility exists, it may
not have specialty or critical care services. Therefore, access to air or ground
interfacility transport services is important.
Rural EMS systems face
particular challenges in maintaining a cadre of EMS personnel. The volume of EMS
responses in most rural communities is too low to allow for the employment of
full-time EMS providers; thus rural EMS services often use volunteers or on-call
part-time personnel who are paid only when called out. Volunteer and part-time
personnel have limited time for initial training and continuing education and
limited experience necessary for skill maintenance. Most, but not all, rural EMS
services are provided at the EMT-B level. The DOT EMT-B curriculum now allows
for an increased level of service by EMT-Bs that may be useful in rural
areas.
Some states have adopted rules allowing EMT-Bs to use certain
medications such as nitroglycerin for chest pain, epinephrine for anaphylaxis,
and 2 agonists for asthma. These modifications allow a higher level of basic EMT
service without having to commit rural providers to the much longer time
required to obtain a higher level of certification. Innovative approaches to
continuing education are also needed, particularly in isolated areas. Distance
learning approaches, often in collaboration with local schools, are invaluable.
Videotape conferences, satellite transmissions of lectures, and computer- and
Internet-based education programs are all valuable adjuncts to rural EMS
continuing education.
The provision of lifesaving services on a volunteer
basis entails particular obstacles. Daytime coverage for service is a challenge
because most volunteers or part-time personnel have other full-time employment.
As a result, many services hire a cadre of full-time providers to respond during
business hours. Dispatching volunteers from home or work directly to the scene
may be one method of providing daytime coverage and reducing response times.
Recruitment and retention of providers is an ongoing problem; incentives such as
retirement benefits, death benefits, and scholarships for volunteers and their
children are useful. Undoubtedly, the most powerful incentive for EMS volunteers
is the fellowship bonds that develop within volunteer EMS
agencies.
Medical leadership of any EMS system is crucial. Identification
of a physician who is knowledgeable and experienced in emergency care and
willing to take time away from his or her family and practice is a difficult
problem for rural systems. Many systems depend on nonemergency physicians, such
as family physicians with an interest in community health or general surgeons
with an interest in acute surgical care, to provide medical leadership.
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