Emergency care: identifying threats to rural communities

Emergency Medical Services can mean the difference between life and death in Georgia’s rural communities that may, in some cases, be located 20 or more miles from the nearest hospital or trauma center. 

Dr. John Rogers, chair of the rural section of the American College of Emergency Physicians, believes there are three major challenges to emergency care in rural areas:  personnel, equipment and funding.

Personnel in rural communities is a struggle because as EMTs go through their emergency medical training, their skills develop and they have opportunities to get better jobs and bigger pay checks – and they take them, leaving rural areas under-served, according to Rogers.

Other reasons for rural EMS personnel leaving their positions is that some counties are not able to provide them with benefit packages that meet their needs or “because they feel like they’re not doing as good a job as they can because there may not be enough people to man all the units,” according to Rogers.  “They say ‘why am I beating my head against the wall when I can go somewhere else?’”

These cases often involve the lack of up-to-date or adequate equipment.  EMTs in the field need to have equipment for “things that kill people quickly,” said Rogers. 

Some actions common in trauma centers but more difficult in the field include establishing airway access and intubation, according to Rogers.  He said both procedures have newer equipment for doing these procedures in less-than-ideal circumstances, but many EMS departments don’t have the equipment, or the personnel trained in using it. 

Both of these issues boil down to one common factor:  funding. 

“Some counties just don’t put much into their programs, and if you don’t have the people and you don’t have the equipment they need, it just isn’t going to happen,” said Rogers.  “To me, an EMS service is a necessary public service, just like the fire department, just like the sheriff’s office.  But when it comes to EMS, people want it to be profitable.  I don’t think it has to be.”

EMS departments generally do not rely heavily on revenue from services rendered, according to Oglethorpe EMS director James Matthews.  Each patient medicated or transported “in the back of the truck,” as he calls the county’s ambulances, receives a bill, but only about 68 percent of the department’s total billing amount is recovered. 

Rogers acknowledged that rural communities would likely have difficulty generating enough funding for their EMS departments, which is why he thinks the state has an obligation to step in. 

Rogers advocates for the creation of a statewide trauma system, in which all calls go to a regional dispatch, and patients can be routed to trauma centers that are closest, but also most appropriate for their specific ailments. 

“It’s more or less a glorified 911 system but it kind of takes it to a different level,” Rogers said.  Once set up, the trauma system could be used for other purposes, such as homeland security or disaster control.

“Not everybody injured needs to go to a trauma center,” Rogers said,  “But people that do need to be able to get there quickly.  People injured that have immediate life threats that really can’t wait 30 or 40 minutes really need to be taken care of in the field or they’re going to die.”