Experts blast report ranking Wyo. last in emergency care
The metrics lack a basic understanding of rural health care and degrade volunteerism, officials said in response to the ACEP report card
By James Chilton
CHEYENNE, Wyo. — Wyoming is dead last in the U.S. in terms of providing access to quality emergency medical care.
That's according to a ranking from the American College of Emergency Physicians.
The report, "America's Emergency Care Environment," gave poor marks to the United States overall.
The nation earned a D+ average on five separate indicators: access to emergency care; quality and patient safety; medical liability environment; public health and injury prevention; and disaster preparedness.
Even the top-ranked state, Massachusetts, only managed a B- grade, falling behind the District of Columbia, which also got a B-.
But Wyoming was the only state in the survey to pull off an F, coming in 51st behind Arkansas, New Mexico and Montana.
Dr. Waseem Khawaja is president of the Wyoming Chapter of the American College of Emergency Physicians. He also is the medical director for Mountain View Regional Hospital in Casper.
He said the report card highlights significant issues this state faces, some of which he said could be addressed through the Legislature.
For one, he said, Wyoming's Medicaid population isn’t as proportionally high as it is in other states. That suggests there are residents who qualify but don’t realize it.
The same, he said, goes for children: Wyoming has the second-highest rate of uninsured children in the nation at 22 percent.
"We could encourage people to apply for Medicaid and (the Children’s Health Insurance Program) if they don’t have the resources to pay for health care,” Khawaja said. “I think we can make some change just by creating awareness.”
On the quality and patient safety side, Khawaja said the state needs to invest more in its emergency medical system. One issue, he said, is the state lacks uniform standards for emergency medical care. And it has no centralized EMS director.
"In other states there are standard protocols and guidelines reviewed every year or every other year,” Khawaja said. “But Wyoming policymakers never drew up a state-level protocol for stroke or heart attack or trauma patients.
"So we don’t have a uniform system for pre-arrival instructions, and there is no clear pathway ambulances follow at this time. Even Casper and Cheyenne they are really on their own.”
He said the Legislature could create and fund a state EMS director who could then work with county EMS directors. The goal would be to put in place policies and procedures that ensure emergency patients get the same treatment wherever they are.
Wyoming also scored an F on public health and injury prevention. Khawaja said that is caused by the state’s highest-in-the-nation per-capita traffic fatality rate and the second-highest rate of fatal occupational injuries.
He said that might be addressed in part with stronger seatbelt laws and new helmet laws for motorcyclists.
But even then, Khawaja said, the state’s small, far-flung population centers also contribute to a higher fatality rate for injuries or other serious issues like heart attacks.
“Only 30 percent of hospitals are within 60 minutes of a trauma center, and we’re not expecting that to change,” he added.
Kim Deti with the state Department of Health, said the report card highlights some legitimate issues the state can improve on. But she added that some of the metrics used simply don’t reflect the reality of the situation in Wyoming.
“One of their big criteria was emergency medicine residents, which would be people studying to be a doctor,” Deti said. “We don’t have a medical school in Wyoming, so we’re never going to have that.”
Another metric was access to burn centers. Again Deti said that likely will never come here owing to the state’s small population.
“There are some things that just aren’t applicable to us in a way that might be applicable to a more urban location,” she said.
“That doesn’t mean there aren’t things we shouldn’t be working on, and it doesn’t mean things are perfect in Wyoming. But when you choose to live in certain locations, there are tradeoffs.”
But if Deti was skeptical about some of the report’s findings, Dr. Doug Schmitz was actually hostile toward them.
Schmitz is a general surgeon at Cheyenne Regional Medical Center. He said the report not only lacks a basic understanding of rural health-care, but it works against Wyoming’s interests by discouraging volunteers from taking part in emergency medical services.
“Their method of data collection is incompetent and inadequate, and they have no knowledge or expertise when it comes to the delivery of emergency medical care in frontier states,” Schmitz said.
He added that the report takes a distinctly urban view of emergency care. Giving an F grade to a state where rural medicine is often the only medicine, he said, distorts the hard work of the many volunteer EMTs in Wyoming.
“When someone says you get an F for getting your butt out of bed at 2 in the morning to help get someone out of a car wreck in the middle of a snowstorm and you don’t get paid for it, then you probably aren’t going to keep doing it,” he said.
“Volunteerism is on the downswing. We’re having more and more trouble, and there are a lot of reasons for that. But if these trends continue and people like (the emergency physicians) say you get an F, it’s only going to degrade that volunteerism more.”
Wyoming, he said, was the first rural state to put in place an all-inclusive mandatory rural trauma system. That includes a statewide trauma and EMS registry that requires all EMS services to report to the state.
He added that those volunteers dedicate themselves to maintaining their educations and reaching out to the most isolated parts of the state.
“I’m just furious about this (report),” Schmitz said. “If they had any concept of how much time, effort, money, volunteerism is put in to delivering emergency medical care in rural Wyoming, they would never do this.
“My grade for them is an F- for their pathetic reporting.”