Emergency medical services (EMS) and trauma: Rural Health Research Products & Journal Articles

2024

Non-Urgent Use of Emergency Departments by Rural and Urban Adults
Policy Brief
Maine Rural Health Research Center
Date: 04/2024
This study provides updated information and addresses gaps in knowledge about rural non-urgent emergency department (ED) use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce inappropriate use of EDs in rural communities.

2023

Rural Emergency Hospital Map and Data
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 10/2023
This interactive map tracks hospitals that have converted to Rural Emergency Hospitals since January 2023.
Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 09/2023
The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies
Policy Brief
Maine Rural Health Research Center
Date: 08/2023
This brief fills the information void on the costs of running rural ambulance services and establishes a minimum access standard for ambulances servicing a 25-minute travel time radius from the ambulance station, enabling policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services.
Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services
Chartbook
Maine Rural Health Research Center
Date: 05/2023
Access to timely ambulance service is an essential part of the emergency medical system. Yet ambulance access varies widely with significant gaps across the country. This research identifies places and people that are more than 25 minutes from an ambulance station, also called an ambulance desert.

2022

Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care
Policy Brief
WWAMI Rural Health Research Center
Date: 05/2022
This policy brief examines the effects of emergency medical services (EMS) personnel level of experience and agency rurality on the provision of evidenced-based care. Compared with urban-serving EMS agencies, rural-serving agencies provided evidence-based care less often for stroke, hypoglycemia, and trauma but more often for seizures.

2021

Using CPT Charges as an Economic Proxy for Telehealth and Non-Telehealth Emergency Department Utilization
Policy Brief
Rural Telehealth Research Center
Date: 11/2021
This brief examines economic data on emergency department visits from unrelated rural hospitals. By using the reported Current Procedural Terminology code and associated charge, we explore the characteristics of the resulting dataset in terms of distribution and association with related variables.
Characteristics and Challenges of Rural Ambulance Agencies – A Brief Review and Policy Considerations
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2021
There are 23,272 ambulance agencies in the U.S., and 73% of those agencies report serving rural areas. This paper examines current rural ambulance agency characteristics and challenges and identifies public policy considerations designed to stabilize rural ambulance agencies.
HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-Site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
Journal Article
Rural Telehealth Research Center
Date: 01/2021
The Health Resources and Services Administration funded six grantees to provide telehealth services in rural emergency departments (tele-ED) and gather data for the telehealth evidence base. This paper examines trends across multiple tele-ED networks and heterogeneity in processes and outcomes.

2020

Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six Networks
Journal Article
Rural Telehealth Research Center
Date: 08/2020
In a cohort of 4,324 tele-ED cases across 26 months in 65 hospitals in 6 tele-ED networks, 20% were averted transfers, and 43% of those were then routinely discharged rather than being transferred. Averted transfers saved on average $2,673 in avoidable transport costs per patient, with 63.6% of these cost savings accruing to public insurance.
Emergency Department Telemedicine Consults Are Associated With Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
Journal Article
Rural Telehealth Research Center
Date: 02/2020
Acute myocardial infarction (AMI) is a common, deadly emergency requiring rapid diagnosis and treatment. In this rural cohort, emergency department-based telemedicine was associated with improved timeliness of electrocardiogram and fibrinolysis. This study adds to evidence that telemedicine can improve timeliness of AMI care in rural hospitals.
Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
Journal Article
Rural Telehealth Research Center
Date: 01/2020
Sepsis is a life-threatening emergency, and timely "bundled" care improves survival. In this rural cohort, telemedicine in the emergency department (tele-ED) improved sepsis bundle adherence, including timely fluid resuscitation and antibiotic administration. Tele-ED may be a scalable intervention to improve sepsis emergency care in rural EDs.

2019

Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
Journal Article
Rural Telehealth Research Center
Date: 11/2019
This was a study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication. The effect of tele-ED varied by network, suggesting network characteristics may influence the realized tele-ED benefit for stroke care.
Hospital Closures and Short-Run Change in Ambulance Call Times
Journal Article
Rural and Underserved Health Research Center
Date: 11/2019
Hospital closures affect the availability of emergency department services. This paper examines changes in ambulance ride times in areas with hospital closures compared to those in similar areas without hospital closures and separately analyzes changes in ambulance ride times between urban and rural areas and among Medicare-eligible patients.
Tele-Emergency Behavioral Health in Rural and Underserved Areas
Journal Article
Rural Telehealth Research Center
Date: 11/2019
This paper describes how two distinct tele-emergency department (ED) behavioral health models address challenges in access and placement for patients in rural and underserved areas presenting to EDs. The notable difference in disposition rates between cases and controls shows the impact each model is having on care practices and processes.
Pediatric Tele-Emergency Care: A Study of Two Delivery Models
Journal Article
Rural Telehealth Research Center
Date: 04/2019
This study describes two tele-emergency programs that provide care to pediatric populations. Qualitative descriptions of the two tele-emergency department (ED) models and key characteristics of the patient populations served by tele-ED are presented. The study informs others about evaluative measures and how tele-ED works in practice.

2018

Serum Anion Gap Predicts Lactate Poorly, but May Be Used to Identify Sepsis Patients at Risk for Death: A Cohort Study
Journal Article
Rural Telehealth Research Center
Date: 04/2018
Our study of 4,159 emergency department patients determined anion gap and serum bicarbonate poorly predict changes in lactate and mortality. In resource-limited settings where lactate is unavailable, anion gap ≥ 20 mEq/L may be used to further risk-stratify patients for ongoing sepsis care, but lactate remains a preferred biomarker.

2017

Identifying Variability in Patient Characteristics and Prevalence of Emergency Department Utilization for Mental Health Diagnoses in Rural and Urban Communities
Journal Article
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 10/2017
Patients needing behavioral healthcare can get more appropriate, cost-effective treatment if they are redirected from emergency departments (EDs). This study examined whether a larger proportion of rural versus urban patients went to went to EDs.
The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 07/2017
Uses 2007-2010 Medicare data to examine the relationship between Rural Health Clinic (RHC) use and potentially preventable hospitalizations and emergency department (ED) visits. RHC use was associated with an increase in both preventable hospitalizations and ED visits among all Medicare enrollees, regardless of their reason for eligibility.
Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients
Journal Article
Rural Telehealth Research Center
Date: 07/2017
This article examines the use of telemedicine to help improve care for trauma patients and to try to close the gap between rural and urban outcomes for these patients. The study involved patients treated in critical access hospitals and emergency departments.
Rural and Urban Utilization of the Emergency Department for Mental Health and Substance Abuse
Policy Brief
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 06/2017
Utilizes data from the Healthcare Cost and Utilization Project's (HCUP's) State Emergency Department Databases (SEDD) for seven states. Researchers explore, and describe in this brief, the use of the Emergency Department for mental health and substance abuse among Urban, Large Rural, Small Rural, and Isolated Small Rural residents.
Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study
Journal Article
Rural Telehealth Research Center
Date: 02/2017
Traumatic injury is a leading cause of death in the U.S. Rural residents have limited access to trauma care, and telemedicine has been proposed to improve trauma care locally. This study describes patient-level factors associated with telemedicine and measures the association between telemedicine consultation and interhospital transfer.

2016

What Is the Potential of Community Paramedicine to Fill Rural Healthcare Gaps?
Journal Article
WWAMI Rural Health Research Center
Date: 11/2016
This study collected information on rural community paramedicine in the U.S. programs to describe their goals, target populations, services offered, connections with local community providers and resources, outcomes measured, and results, where available.

2015

Prehospital Emergency Medical Services Personnel in Rural Areas: Results From a Survey in Nine States
Report
WWAMI Rural Health Research Center
Date: 08/2015
This study examines supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation in rural and urban emergency service personnel (EMS) agencies in nine states.

2008

Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
NORC Walsh Center for Rural Health Analysis
Date: 10/2008
This brief presents research conducted to better understand critical access hospitals' (CAHs') experiences in operating emergency medical service (EMS) units. The benefits and challenges that CAH providers face in operating EMS services are discussed.

2007

Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
Upper Midwest Rural Health Research Center
Date: 08/2007
This policy brief reports the results of a study of rural emergency department staffing and discusses potential implications of staffing for the quality of emergency care provided in rural areas.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
Upper Midwest Rural Health Research Center
Date: 06/2007
The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas.
Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
Journal Article
Maine Rural Health Research Center
Date: 2007
Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face.

2006

Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources
Journal Article
University of South Carolina Rural Health Research Center
Date: 04/2006
Proposes a county-level indicator of emergency medical services (EMS) resource availability that takes into consideration existing EMS resources, population health and demographics, and geographic factors. The indicator, the expected annual emergency miles per ambulance, provides a basis for comparing ambulance availability across counties.
Emergency Medical Services and the Federal Government's Evolving Role: What Rural and Frontier Emergency Medical Services Advocates Should Know
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 2006
Examines the debate around recent recommendations for an expanded federal role in supporting Emergency Medical Services (EMS). If federal expansion were to occur, the author recommends that responsibility for EMS be placed in the Department of Health and Human Services.

2005

Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
Maine Rural Health Research Center
Date: 09/2005
This survey investigates the extent and types of cases that present with mental health problems in critical access hospital emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to these patients.
Factors Associated With Incidence of Inappropriate Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children
Journal Article
Upper Midwest Rural Health Research Center
Date: 2005
An analysis was conducted to identify a set of significant predictors of cases of inappropriate deliveries to acute care facilities with no trauma-center designation of any level. Greater distance to the nearest trauma center and shorter distance traveled by the ambulance squad to the receiving corresponded to higher probabilities of mistriage.
Recruitment and Retention of EMTs: A Qualitative Study
Journal Article
University of South Carolina Rural Health Research Center
Date: 2005
Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics.

2004

Understanding the Role of the Rural Hospital Emergency Department in Responding to Bioterrorist Attacks and Other Emergencies: A Review of the Literature and Guide to the Issues
NORC Walsh Center for Rural Health Analysis
Date: 04/2004
This report reviews issues affecting rural hospitals' levels of readiness for a bioterrorist attack. Issues examined include physical capacity, sufficiency of health personnel, preparedness plans, disease surveillance systems, and communication/coordination. Concerns about funding cut across all the issues of preparedness.

2003

Survey of Critical Access Hospital (CAH)-Affiliated Emergency Medical Service (EMS) Providers
NORC Walsh Center for Rural Health Analysis
Date: 09/2003
This survey provides a description of emergency medical services providers in rural communities, particularly those with critical access hospitals.

2002

Federal Funding for Emergency Medical Services
NORC Walsh Center for Rural Health Analysis
Date: 07/2002
This report includes recent trend data from 1994 to the present on aggregate federal spending on emergency medical services (EMS) and funding targeted explicitly to rural areas. It also discusses the role various federal agencies have played and traces the history of federal legislation to support EMS programs.
Essential Research Issues in Rural Health: The State Rural Health Directors' Perspective
NORC Walsh Center for Rural Health Analysis
Date: 03/2002
This policy brief describes the key issues confronting state rural health directors. Issues repeatedly raised by directors from a wide variety of states included workforce, telemedicine, emergency medical services, mental health, and lack of local data.

2001

Establishing a Fair Medicare Reimbursement for Low-Volume Rural Ambulance Providers
NORC Walsh Center for Rural Health Analysis
Date: 07/2001
This national study of ambulance transport costs looks at the advantages and disadvantages of several options for Medicare to compensate low-volume rural ambulance providers.

2000

The Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly
Journal Article
WWAMI Rural Health Research Center
Date: 01/2000
OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.
METHODS: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.
CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.
Emergency Department Use by the Rural Elderly
Journal Article
WWAMI Rural Health Research Center
Date: 2000
This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.