Across Oklahoma, the obstacles that emergency responders face vary widely, from serving dense urban populations to reaching rural residents in the furthest corners of the state.
Regardless of where emergency care is being delivered, it must be well managed and organized to ensure the best results, said Dr. Eric Beck, associate chief medical officer at American Medical Response and Evolution Health.
Beck was recently in Oklahoma City at an Emergency Medical Services Authority workshop and answered a few questions about care in rural and urban areas.
Q: What challenges do rural emergency responders face?
The fundamental building blocks of an emergency medical system are similar, regardless of location, Beck said.
However, rural emergency responders do face unique challenges.
“In rural areas in particular, oftentimes there are challenges with resource availability, access to care, transportation, specifically transport time and intervals, which are very real challenges in rural environments,” Beck said.
Q: What are the obstacles to delivering care in an urban setting?
In an urban setting, resources are usually available, but the population is dense, Beck said. Emergency responders must find effective ways to navigate patients to the right resources in the right amount of time, he said.
“When you talk about an urban setting, typically, the population is high, the density is great, oftentimes there are vertical elements to their location that don’t exist typically in rural settings, so they may be on the 30th floor of a building, for example,” Beck said. “Because the population is larger and denser, there’s a higher volume of calls, which means there may be competing priorities in a system at any given time.”
Also, there is a difference in how 911 calls are answered.
The expectation in an urban setting is that someone with formal emergency training will answer 911 calls, providing the caller with directions on delivering CPR, Beck said. Also, there’s likely a physician who is a medical director on staff who’s involved in managing the emergency system’s operations.
“In other settings, particularity rural settings, sometimes this is a regional function where a number of communities share resources and even then the volume may be somewhat low, and so there are challenges there in terms of refining that model,” Beck said.
Q: What does data show about survival rates of rural residents versus urban residents?
Beck said there are a number of studies that have looked at whether people in rural settings are more likely to die from lesser injuries than people in urban settings, who may be closer to hospitals and emergency services.
“Really, it’s a more a function on the system design, the protocols, the oversight and the resources,” Beck said. “So in a system that’s designed well, good outcomes can be achieved in rural settings, and in some rural settings, they compare to those in urban settings.”
There are a lot of urban settings that are rich in resources, with plenty of hospitals and ambulances available, but those systems, instead, struggle with the logistics of managing those resources effectively.
“It’s not as simple as rural versus urban,” Beck said. “It’s really more about system design, active improvement, and quality initiatives, medical oversight and how all the pieces have been brought together toward that unifying goal.”