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Emergency medical services in rural areas are less likely to relieve pain in trauma patients who provide proper care to children with asthma attacks and are more likely to use lights and sirens unnecessarily, according to a study published Tuesday, adding to previous research found rural health systems struggle more compared to urban and suburban areas.
The team of researchers from the Icahn School of Medicine of Mount Sinai reviewed all 911 dispatches in the US in 2019 – which consisted of more than 6 million responses from 9,679 EMS operators – and rated EMS services based on some of the National EMS Quality Alliance performance measuressuch as the effectiveness of pain management and the transfer of trauma patients to trauma centers.
More than half of EMS services failed to meet multiple performance measures, and only one in 10 dispatches followed the exact safety guidelines set forth, according to the study published Tuesday in Prehospital Emergency Care.
EMS responding to predominantly rural areas were on average more than 25% more likely to use lights and sirens unnecessarily when responding to calls and 5% less likely to improve trauma patients’ pain and treat low blood sugar in compared to agencies in suburban urban areas.
Nearly 40 percent of children with asthma attacks or breathing problems from all communities did not receive treatment from EMS, but children in rural areas received it at about 10 percent less, Tuesday’s study found.
Nearly a third of patients in all communities who had a suspected stroke did not receive a stroke evaluation, which researchers believe could delay or completely stop patients from receiving early treatment.
The national average from the time of the 911 call to the arrival at the scene is seven minutes, but that time doubles to 14 minutes in rural areas and about one in 10 encounters last 30 minutes, according in a 2017 JAMA study.
“While rapid response times are necessary for rare, critical incidents — such as when a patient’s heart stops beating or someone is choking — the vast majority of patients benefit from specialized clinical care in the early stages of a medical emergency,” lead author Michael Redlener, an associate professor at Mount Sinai’s Icahn School of Medicine, said in a statement.
Rural communities have worse or strained medical systems because they are often isolated from larger cities and tend to have a shortage of doctors, according at the National Institutes of Health. EMS operators in isolated areas answer more critical, life-threatening calls that require longer response times from suburban and urban EMS providers, primarily because rural areas are poorer, older and sick. Large geographic areas with dispersed populations, longer travel distances, and difficult weather and terrain are all factors in longer dispatch times to rural communities, the federally funded Rural Health Information Hub says. Another factor at play is the closing of hospitals in rural areas. There were 136 rural hospital closings between 2010 and 2021, with a record 19 closings in 2020 alone—the most of any year in the last decade—according to 2022 report from the American Hospital Association. Hospital closings mean the hospitals that remain have increased coverage: rural ambulance travel times increase 76% in the year immediately following a closure, a 2019 University of Kentucky study were found.
The use of sirens and flashing lights by ambulances is a topic that has long been debated in the medical community. Lights and sirens are intended to reduce response and transport times and research suggests that they cause a “modest” reduction in EMS response time between 1.7 and 3.6 minutes and reduce transport time between 0.7 and 3.8 minutes. However, some argue that they do more harm than good. The risk of a crash more than doubles when emergency vehicles use lights and sirens when transporting a patient, according to the National Security Council. The injury rate among EMS workers is approx 15 times higher when ambulances use lights and sirens compared to when they do not. The researchers looked at how many patients transported using lights and sirens received interventions in the hospital alone 4.5% of patients received this type of intervention. The rest received interventions from EMS workers before arriving at the hospital, so the researchers recommended that more research is needed to justify the use of lights and sirens in patients requiring hospital intervention.