Sustainability dominates rural EMS conference

Conference presenters explained the pressing threats to rural EMS and health care systems and laid out creative solutions

SAN ANTONIO — The second National Rural EMS Conference drew nearly 200 attendees to hear from industry experts on the time-sensitive issues facing rural EMS and discussed how to make the changing health care market work to their benefit.

Sustainability was the most prominent theme at the conference. That's because many rural EMS organizations are seeing a decline in their respective communities' ability to support EMS and more generally health care of any form.

Changing health care landscape
Don Wood, MD, director of Utah’s Office of Primary Care and Rural Health, and Tom Nehring, director of North Dakota’s Division of Emergency Medicine Services and Trauma, specifically talked about the issues facing rural hospitals and the impact of these changes on rural EMS agencies.

Image Greg Friese

According to a recent report from the National Rural Health Association, one in three rural hospitals are at risk of closing. In addition, the rate of closure is increasing, which the presenters argued could pose a significant threat to rural EMS.

Specifically they focused on how hospital closures lead to a loss of health care providers in the surrounding community. Hospital closures also lead to longer transport times and therefore longer periods in which EMS units are out of service. There is also increased reliance on EMS to provide non-emergent transportation services, which further burdens individual EMS providers, many of whom are volunteers.

The presenters advocated that rural EMS providers must be willing to use these issues as an opportunity to increase communication and integration with other health care providers to create a more sustainable health care system using creative processes that address growing gaps in coverage.

Novel care models
Multiple presenters explained what community paramedicine is and provided examples to the attendees on how it could be applied in the rural setting. Davis Patterson, Ph.D., deputy director of WWAMI Rural Health Research Center, presented preliminary findings on structured interviews with 31 community paramedicine programs that serve rural communities.

His team found that more than 75 percent of programs were self-funded or only had a single external funding source. However most were implementing programs that managed the chronically ill with the goal of preventing hospital admissions and readmissions.

There was also discussion around the lack of mutually beneficial referral relationships that these agencies could create with other health care organizations in the community.

Although community paramedicine has been occasionally pitched as a silver bullet to the woes facing rural EMS, Patterson was quick to acknowledge outcomes data is not readily available. However, the data that does exist shows promise towards improving performance on all three dimensions of the Institute for Healthcare Improvement's Triple Aim.  

Billy Philips Jr., Ph.D., MPH, and Cole Johnson, both of Texas Tech University Health Sciences Center, provided one such example of improved performance when they discussed their telemedicine program. Although their presentation didn’t discuss community paramedicine specifically, they recognized the potential connection between telemedicine and preventative care. They said other rural providers could see similar benefits to what they have been able to produce in west Texas.

The landscape in which rural EMS exists is changing on a daily basis. Rural hospitals and other health care clinical practices are at greater risk than ever of closing.

The ensuing consequences to rural EMS will be significant, however there are novel delivery models such as community paramedicine and telemedicine that provide an opportunity for integrated, sustainable relationships between EMS and brick and mortar health care providers.

The Rural EMS Conference provides rural practitioners a unique opportunity to be at the center of the conversation on how best to modify practices to meet the changing needs of their unique patient population. The 2017 conference should be a must-attend for any rural EMS agency leader.  

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