Rural Emergency Medical Services

SECTION I

Summary

The AASHTO Strategic Highway Safety Plan (SHSP) identified 22 goals that need to be pursued to achieve a significant reduction in highway crash fatalities. Most of those goals focus on preventive actions to reduce the frequency and severity of crashes. However, no amount of preventive action will eliminate all highway crashes. Therefore, one of the goals within the AASHTO SHSP, the goal on which this guide focuses, concerns enhancing emergency medical capabilities to increase survivability of highway crashes. Specifically, this guide addresses methods to enhance emergency medical services (EMS) in rural areas, in part because approximately 8,000 more fatalities occur annually along rural highways than on urban highways.

The challenges facing rural EMS systems markedly differ from those facing urban EMS systems. Each setting faces a host of unique challenges in the delivery of adequate EMS. The wide disparity in the delivery of EMS in rural compared with urban areas is attributable to many factors, including but not limited to the following (Rawlinson and Crews, 2003; OTA, 1989):

• Geographical barriers;
• High reliance on increasingly hard-to-find volunteer staff;
• Inadequate financial resources;
• Aging or inadequate equipment;
• Difficulty in maintaining skills due to low call volumes;
• Lack of training opportunities close to home;
• Lack of proper medical direction;
• Gaps in telecommunications;
• Absence of regionalized systems of specialized EMS care, such as trauma systems; and
• Absence of local medical facilities to adequately support effective EMS delivery systems.

The purpose of this guide is to provide information to appropriate agencies to help improve EMS in rural areas. This guide targets the EMS and highway safety communities. EMS and highway safety agencies share a common mission to prevent injuries and save lives. Although they pursue this mission differently, their priorities mesh well.

This guide identifies four main objectives for enhancing EMS in rural areas:

1. Integrate services to enhance emergency medical capabilities,
2. Provide or improve management and decision-making tools,
3. Provide better education opportunities for rural EMS, and
4. Reduce time from injury to appropriate definitive care.

In developing these objectives and subsequent strategies, the intent was to identify objectives and strategies that cost relatively little and that can be implemented in a relatively short timeframe. Within the four objectives, there are 24 strategies. Due to varying levels of sophistication and development of EMS agencies in rural areas around the country, state EMS directors, local system managers, policy makers, and state and local highway agencies are best suited to determine which objectives and strategies are most appropriate to pursue, based on their existing levels of service and resources.

By implementing the four objectives and their corresponding strategies detailed in this guide, EMS agencies in rural areas will be able to work more efficiently toward their goal of providing the best available care for injured patients involved in motor vehicle crashes. Specifically, agencies can gain the following benefits from the objectives:

1. Integrating services will enable EMS agencies to use capabilities of other organizations and to streamline processes and develop new and unique functionalities that previously did not exist.
2. Improving management and decision-making tools will enable system managers to make more informed decisions on ways to improve their services.
3. Providing better educational opportunities will improve the life-saving skills of EMS personnel and others who may not have previously been involved in EMS.
4. Reducing the time from injury to appropriate definitive care will increase the probability of survival for many patients.

Although specific data and research in EMS are sparse, principles of both good business and good medical practice indicate that meeting the above objectives will improve the care provided to injured patients involved in motor vehicle crashes and reduce the number of fatalities attributable to EMS deficiencies.