A Comparison of Rural and Urban Emergency Medical System (EMS) Personnel: A Texas Study

Abstract

Introduction:In treating accident victims, actions by the Emergency Medical Personnel (EMP) at the scene may be the difference between life or death, full recovery or permanent disability. Development of selected profiles based on locale of services, tenure, and paramedic certification will provide valuable insight into the diversity within the Emergency Medical Services (EMS) profession. Not only will these profiles enable administrators to improve their recruitment, training, and retention of the emergency medical workforce, it potentially could enhance the quality of health care in the community.Population:Emergency medical personnel attending a statewide conference in Texas in late 1996 (n = 425).Hypotheses:1) There is no difference between the profiles of urban and rural emergency medical personnel; 2) There is no difference between the profiles of urban EMP with <9 years of experience and those with ≥9 years of experience; 3) There is no difference between the profiles of rural EMP with <9 years of experience and those with ≥9 years of experience. 4) There is no difference between the profiles of urban EMP with paramedic certification and those without certification; and 5) There is no difference between the profiles of rural EMP with paramedic certification and those without certification.Methods:EMP attending the conference completed 425 survey instruments measuring five demographic features, five work-related features, and two psychological features. Survey instruments were included in each registrant's conference package. Completed surveys were deposited anonymously in labeled receptacles throughout the statewide conference site. Data collection ceased at the end of the conference. Discriminant analysis identified distinct profiles for the urban and rural EMP.Results:The urban EMP, more than rural subjects, was younger (mean = 36 years), more likely to be compensated 100% for their services, had a higher level of education (mean = 13.8 years), and reported a lower level of burnout. Urban EMP with <9 years of experience tended to be younger, male, married, and reported less burnout. Urban paramedics were more likely to be compensated 100% for their services, and had achieved a higher level of education. The rural EMP with <9 years of experience were less likely to be paramedic, reported lower burnout scores, and was younger. The rural EMP without paramedic certification was more likely to be a volunteer, and have had fewer years of service.Conclusions:In Texas, locale of service (urban or rural), length of tenure as an EMP (>9 years), and paramedic certification appear to be significant factors that define the EMP population in Texas.

Extending Acute Trials to Remote Populations

“…Implementation of such a strategy in dispersed remote populations20 may be difficult. Rural first responders or paramedics are often volunteers and have less training and exposure to stroke cases compared with their urban counterparts 21,22. It would be an overwhelming task to maintain the necessary skills and certifications to be successful coinvestigators for a large and dispersed workforce.…”

Designated Medical Directors for Emergency Medical Services: Recruitment and Roles

“…Can distance learning technologies be used to bring the EMS Medical Director course to rural physicians? The Rural and Frontier EMS Agenda suggests that the content of the current Medical Director's course may not be applicable for rural physicians 10 . Is that the case, and, if so, how can it be modified? A physician serving as DMD must have sufficient involvement to take responsibility for the medical care provided by the rural EMS agencies, but some DMD functions are currently provided by others (eg, certified EMS instructors or training officers responsible for continuing education).…”

“…Are there models of shared responsibility for selected DMD functions that would decrease the time commitment of rural DMDs and encourage their service? Although not the most commonly reported barrier, a lack of local physicians to serve as DMD is a factor in recruitment, particularly in the most rural areas. Currently, some states allow medical oversight by consortium whose members cover multiple local EMS agencies, but concerns have been raised regarding the amount and quality of contact between the DMD and the local agency 10 . What has been the experience of those agencies with oversight by consortium and how can this system be improved to meet the needs of other local agencies, including those that may have their own local DMD with limited time and expertise to meet all their needs?…”

“…Can distance learning technologies be used to bring the EMS Medical Director course to rural physicians? The Rural and Frontier EMS Agenda suggests that the content of the current Medical Director's course may not be applicable for rural physicians 10 . Is that the case, and, if so, how can it be modified?…”

Population density and racial differences in the performance of emergency medical services

“…A recent Institute of Medicine report on EMS discusses longer travel times and higher per capita overhead costs in less densely populated areas (IOM, 2007; also see Erisman, 2001). Empirical research indicates that urban and rural EMS systems differ on a number of dimensions, such as call volume, response time, and personnel makeup (Giordano and Cagliuso, 2002;Mears and Cummings, 2002), including evidence of more rapid response times in urban areas compared with rural areas (Vukmir, 2004), and that EMS personnel in urban areas may on average have higher qualifications than do rural EMS personnel (Chng et al, 2001).…”