Rural ambulance teams may not get enough practice to
maintain sophisticated lifesaving skills
Emergency medical technicians (EMTs) report that less than 10
percent of rural Georgia ambulance runs involve a definite threat
to life. Nearly one-half (45 percent) of the runs are for
noncardiac medical conditions such as pain, shortness of breath,
weakness or dizziness, or elevated blood pressure. Only 10
percent are cardiac-related, with the bulk of the remaining runs
for traumatic events. As a result, it is difficult for EMTs to
maintain sophisticated clinical skills, such as cardiac
defibrillation. Since advanced care is rarely given, it may be
better to train EMTs only in basic life support and encourage
timely transport, according to a study supported by the Agency
for Health Care Policy and Research (HS06814).
The researchers used data from the Georgia Department of Human
Resources Emergency Health Section Ambulance Trip Report for
April through September 1991 to study the volume and nature of
emergency medical services provided in 12 rural counties in and
around Augusta, GA, where population density is about 40 persons
per square mile. All but two rural counties were served by their
own, single ambulance service. There were a total of 6,080 runs
in 6 months for 10 rural ambulance companies, for an average of
3.3 runs per day per company.
Advanced care—such as prehospital defibrillation—was
rarely provided. Oxygen was provided in more than 43 percent of
the ambulance runs, and one in five of the runs included an
attempt to establish an intravenous line; other procedures were
relatively uncommon. EMTs administered cardiopulmonary
resuscitation in only 1.5 percent of rural ambulance runs and
defibrillation in only 0.5 percent of runs. These findings raise
concern about the ability of ambulance teams to maintain their
competence with advanced lifesaving procedures, according to the
researchers who suggest development of more sophisticated
dispatch protocols and emphasis on identifying when advanced
services are needed prior to transport. Finally, they call for
development of more cost-effective dispatch protocols for dealing
with apparent nursing home medical emergencies, since 9.7 percent
of rural ambulance calls were from nursing homes. Overall,
elderly rural residents used ambulances nearly five times more
than younger residents.
Details are in "Rural emergency medical services: Patients,
destinations, times, and services," by Michael A. Morrisey,
Ph.D., Robert L. Ohsfeldt, Ph.D., Victoria Johnson, Ph.D., and
Richard Treat, M.D., in The Journal of Rural Health 11(4),
pp.
286-294, 1995.
Return to Contents
Proceed to Next Section