Study Discovers Rural EMS Patients Experience Poorer Health Care and Encounter an Excessive Number of Sirens
Emergency medical services (EMS) in rural areas face challenges in effectively reducing pain for trauma patients and providing adequate care for children experiencing asthma attacks, according to a study published on Tuesday. This study, conducted by researchers from the Icahn School of Medicine of Mount Sinai, sheds light on the struggles of rural health systems in comparison to their urban and suburban counterparts.
The research team analyzed all 911 dispatches in the U.S. during 2019, encompassing over 6 million responses from 9,679 EMS agencies. The EMS agencies were assessed based on performance measures outlined by the National EMS Quality Alliance, including the effectiveness of pain management and the transportation of trauma patients to trauma centers.
More than half of all EMS agencies failed to meet multiple performance measures, and only one in 10 dispatches adhered to safety guidelines precisely, as reported in the study published in Prehospital Emergency Care.
The study revealed that EMS agencies primarily serving rural areas were over 25% more likely to use lights and sirens unnecessarily when responding to calls. Moreover, these agencies were 5% less likely to alleviate trauma patients' pain and treat low blood sugar compared to their suburban and urban counterparts.
In cases of children experiencing asthma attacks or breathing problems, almost 40% did not receive treatment from EMS. Furthermore, those in rural areas experienced a 10% lower rate of receiving treatment, as indicated by the findings of Tuesday's study.
The research also highlighted a concerning trend where nearly a third of patients in all communities suspected of having a stroke did not undergo a stroke assessment. The researchers suggest that this oversight could have potentially delayed or entirely prevented patients from receiving timely treatment.
In summary, the study underscores the disparities in emergency medical services between rural and other areas, emphasizing the need for improvements to ensure prompt and effective care for patients across diverse communities.
In a surprising revelation, a 2017 study published in the Journal of the American Medical Association (JAMA) uncovered a notable difference in emergency response times across the United States. The national average from the initiation of a 911 call to the arrival on the scene is a mere seven minutes. However, this time doubles to 14 minutes in rural areas, with one in 10 cases experiencing a prolonged wait of 30 minutes.
Michael Redlener, an associate professor at the Icahn School of Medicine of Mount Sinai and lead author of the study, emphasized the importance of swift responses for critical incidents. He stated, "While fast response times are essential for rare, critical incidents—like when a patient’s heart stops beating or someone chokes—the vast majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency."
Understanding this discrepancy requires a look at the challenges faced by rural communities. The National Institutes of Health point out that these areas often struggle with medical systems due to isolation from larger cities, a shortage of doctors, and a population that is typically older and sicker. Emergency Medical Service (EMS) agencies in rural settings respond to more critical, life-threatening calls, necessitating timelier responses compared to their suburban and urban counterparts.
Factors such as larger geographic areas, scattered populations, longer travel distances, and challenging weather conditions contribute to extended dispatch times in rural communities, according to the federally funded Rural Health Information Hub. Furthermore, the closure of hospitals in rural areas exacerbates the issue. A report from the American Hospital Association in 2022 revealed 136 rural hospital closures between 2010 and 2021, with a historic 19 closures in 2020 alone. Following a closure, rural ambulance travel times increased by a significant 76%, as highlighted in a 2019 study from the University of Kentucky.
A tangential aspect to emergency response is the use of sirens and flashing lights by ambulance vehicles, a long-debated topic within the medical community. While these signals aim to reduce response and transport times, research suggests only a "modest" reduction in EMS response time and transport time. However, concerns are raised about their safety implications. The National Safety Council reports that the risk of crashes more than doubles when emergency vehicles use lights and sirens during patient transport. Additionally, EMS worker injuries increase nearly 15 times when ambulances use lights and sirens.
A closer examination of patients transported with lights and sirens revealed that only 4.5% received interventions at the hospital, while the majority received interventions from EMS workers before reaching the hospital. This finding led researchers to call for further investigation to justify the use of lights and sirens in cases requiring hospital intervention.
In conclusion, the disparities in emergency response times between rural and urban areas underscore the challenges faced by isolated communities. Addressing these issues involves a comprehensive approach, considering factors such as geographic location, healthcare infrastructure, and the impact of hospital closures. Furthermore, the ongoing debate on the use of lights and sirens adds another layer of complexity to the quest for efficient and safe emergency medical services.