Emts rule

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.