263440 Rural Prehospital Emergency Medical Services for Children

Tuesday, October 30, 2012 : 10:50 AM - 11:10 AM

Stephen Bowman, PhD, MHA , Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Sam Sharar, MD , Department of Anesthesiology, University of Washington, Seattle, WA
     
Background: Little is known about rural disparities in pediatric mortality following acute illness or injury. Prehospital contributing factors, such as access to emergency medical services (EMS), EMS response and transport time variability, availability of enhanced 911 support, prehospital medical control protocols, and EMS training and experience, may contribute to these disparities.

Methods: We conducted 10 focus groups of prehospital EMS providers in rural Washington State and Arkansas to identify perceived differences in skills and competencies in caring for critically ill/injured children and priorities for training and education. We targeted participants from geographically diverse settings and from varying EMS certification levels (EMTs and Paramedics). Participants received a $50 gift card as a thank you for participation.

Results: Eighty providers participated in the focus groups. In all settings, access to hands-on skill training was identified as a significant unmet need. Lack of funding and difficulties recruiting and retaining providers were also major issues. Rural providers also voiced concerns over long response and transport times, and minimal hospital resources to care for children in their communities. Low pediatric volume may also result in increased patient errors. Rural providers were also concerned over inappropriate EMS utilization by parents and inadequate EMS training in managing upset parents at the scene. Inadequate child safety restraints in ambulances were also identified as a safety need.

Conclusions: Opportunities exist for improving the prehospital delivery of care to children in rural communities. Efforts should focus on enhancing cost-effective training opportunities for rural providers and assuring essential pediatric equipment.

Learning Areas:
Administer health education strategies, interventions and programs
Diversity and culture
Occupational health and safety
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
1. Describe rural EMS provider attitudes and beliefs towards pediatric training and education. 2. Explore rural EMS provider attitudes and beliefs towards pediatric training and education, including areas in need of improvement and strategies to increase the quality of prehospital EMS care for children in rural settings. 3. Identify pediatric-specific EMS skills and competencies that, if enhanced, could improve survival, reduce morbidity and/or increase prehospital patient safety for children.

Keywords: Children and Adolescents, EMS/Trauma

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of this study and am responsible for all aspects of the study protocol, data collection and analysis. I also have nearly 15 years of public health practice experience with the Washington State Department of Health, including serving as the epidemiologist for the state EMS and trauma system and section manager for trauma designation, registry and quality improvement.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4121.0: Emergency Medical Services