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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.

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