Emergency medical services (EMS)

Publications

Listed by publication date. You can also view these publications alphabetically.

2008

• Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
  Author(s): Janet P. Sutton, June Eichner
  Research center: Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS)
  Report Number: W Series No.15
  Date: 10 / 2008
  This brief presents NORC Walsh Center for Rural Health Analysis research conducted to better understand the experiences of CAHs in operating an EMS unit. Using key informant interviews, researchers examined motivations for acquiring EMS services and the effect of these services on the level of emergency care available in the community. The benefits and challenges that CAH providers face in operating EMS services are discussed.
• Rural-Urban Differences in Characteristics of Local EMS Agencies
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Findings Brief 84
  Date: 05 / 2008
  This Findings Brief describes the general characteristics of local rural EMS agencies and important ways that they differ from the characteristics of agencies located in urban areas. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
• Challenges for Rural Emergency Medical Services: Medical Oversight
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Findings Brief 85
  Date: 05 / 2008
  This Findings Brief examines the challenges faced by local rural EMS agencies in obtaining a medical director and ensuring medical oversight for EMS personnel, and also describes how the challenges faced in rural areas differ from those in urban ones. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
• Issues in Staffing Emergency Medical Services: A National Survey of Local Rural and Urban EMS Directors
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Final Report No. 93
  Date: 05 / 2008
  This report explores rural-urban differences in medical oversight and the recruitment and retention of emergency medical technicians (EMTs)and paramedics as reported by a survey of 1,425 local EMS directors.

2007

• Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
  Research center: Upper Midwest Rural Health Research Center
  Topics: Emergency medical services (EMS), Quality
  Date: 08 / 2007
  Reports 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)
  Author(s): Michelle M. Casey, D. Wholey, Ira Moscovice
  Research center: Upper Midwest Rural Health Research Center
  Topics: Emergency medical services (EMS), Quality
  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. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams. Report available upon request by calling 701.777.3848 or email raasc001@umn.edu.
• Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
  Author(s): Jill Klingner, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Quality
  Report Number: Flex Monitoring Team Data Summary Report No. 3
  Date: 03 / 2007
  Reports findings from a project that tested emergency department quality measures in a voluntary sample of critical access hospitals (CAHs) in Washington State. The quality measures that were tested focused on patients presenting to the emergency department with chest pain/acute myocardial infarction (AMI, or heart attack) or trauma, and patients seen in the emergency department who were transferred to another hospital for care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Becoming an Emergency Medical Technician: Urban-Rural Differences in Motivation and Job Satisfaction
  Author(s): P. Daniel Patterson, Victoria A Freeman, Charity G. Moore, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Working Paper No. 89
  Date: 03 / 2007
  This study uses cross-sectional data from the 2003 national Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) Project to explore urban-rural differences in why EMTs enter the field, what is important in their jobs, and whether they are satisfied with their profession.
• Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
  Author(s): David Hartley, Erika C. Ziller, Stephenie L. Loux, John A. Gale, David Lambert, Anush E. Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Citation: Journal of Rural Health, 23(2), 108-115
  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

• Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
  Author(s): P. Daniel Patterson, John A. Gale, Stephenie L. Loux, Anush E. Yousefian, Rebecca Slifkin
  Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS)
  Report Number: Flex Monitoring Team Briefing Paper No. 8
  Date: 02 / 2006
  Describes the EMS related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially states' proposals contained 239 documented EMS improvement activities. Of these, 40% focused on the Integration of Health Services attribute, 13% on Human Resource challenges, and 13% on Education Systems. Continued support of activities begun prior to 2004 was common. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Emergency Medical Services and the Federal Government's Evolving Role: What Rural and Frontier Emergency Medical Services Advocates Should Know
  Author(s): P. Daniel Patterson
  Topics: Emergency medical services (EMS), Frontier health, Health policy
  Citation: Journal of Rural Health, 22(2), 97-101
  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.
• Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources
  Author(s): P.Daniel Patterson, Janice C. Probst, Charity G. Moore
  Research center: South Carolina Rural Health Research Center
  Topic: Emergency medical services (EMS)
  Citation: Journal of Rural Health, 22(2), 102-111
  Date: 2006
  Proposes a county-level indicator of emergency medical services (EMS) resource availability that takes into consideration existing EMS resources (ambulances), population health and demographics, and geographic factors. The indicator, the EXpected annual emergency miles per AMBulance (EXAMB), provides a basis for comparing ambulance availability across counties within states. A method for calculating the EXAMB indicator is demonstrated using data from 5 states.

2005

• Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
  Author(s): David Hartley, Erika Ziller, Stephenie Loux, John Gale, David Lambert, Anush Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Report Number: Working Paper No. 32
  Date: 09 / 2005
  Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind.
• Recruitment and Retention of EMTs: A Qualitative Study
  Author(s): P. Daniel Patterson, Janice C. Probst, Katherine H. Leith, Sara J. Corwin, M. Paige Powell
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Workforce
  Citation: Journal of Allied Health, 34(3), 153-62
  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. Analysis of focus group responses showed that for a majority of respondents, emergency medical services was not a primary career path. Most respondents entered the industry as an alternate or replacement for a nursing career or as a second career following military medic service. The majority of respondents believed the job was stressful yet rewarding, and although it negatively affected their personal lives, the occupation gave them a sense of accomplishment and belonging. Respondents expressed a preference for EMT education resulting in college credit or licensure versus professional certification. Job-related stress produced by numerous factors appears to be a likely contributor to low employee retention.
• Factors Associated With Incidence of Inappropriate Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children
  Author(s): Dmitri Poltavski, Kyle Muus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Children, Emergency medical services (EMS)
  Citation: Journal of Rural Health, 21(3), 272-277
  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 (mean = 19.96 miles) to the nearest trauma center and shorter distance traveled by the ambulance squad to the receiving facility (mean = 19.07 miles) corresponded to higher probabilities of mistriage, especially when a child was Native American (16 times more likely) and the transportation was conducted in the winter (9 times more likely).

2004

• Investigating Rural EMS Infrastructure: A Developmental Methodology For Measuring The Availability Of EMS Resources
  Author(s): P. Daniel Patterson, Janice C. Probst, Charity G. Moore
  Research center: South Carolina Rural Health Research Center
  Topic: Emergency medical services (EMS)
  Date: 08 / 2004
  Explores a potential indicator of EMS availability, the Expected Annual Emergency Miles per Ambulance (EXAMB). The ambulance is used as the core unit of availability due to its importance for safe transport and the initiation of medical services. The EXAMB measure calculates expected annual emergency miles per ambulance beginning with the number of ambulances, the land area of a county as a proxy for distance, and county population. Findings showed that in three of the five states studied, EXAMB values varied in parallel with other measures of resource availability, and in all states, the EXAMB was positively related to the proportion of the county population in poverty.
• 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
  Author(s): Claudia L. Schur
  Research center: Walsh Center for Rural Health Analysis
  Topics: Emergency medical services (EMS), Emergency preparedness, Hospitals and clinics
  Date: 04 / 2004
  Reviews issues affecting rural hospitals' level of readiness for 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.
• Rural Emergency Medical Service (EMS) Infrastructure
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Frontier health
  Date: 2004
  Prehospital care has become an important element in the spectrum of health services. Approaches for comparing the availability of Emergency Medical Service (EMS) across communities are a first step in developing policies that ensure equitable access for rural and frontier communities.
• Emergency Department Use by Medically Indigent Rural Residents (Fact Sheet)
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Hospitals and clinics, Minority health
  Date: 2004
  An estimated 211 million emergency department visits were made across the United States during 1999 - 2000, 37 visits per 100 persons per year. Just under a quarter of these, 43 million visits, were made to rural emergency departments.

2003

• Survey of Critical Access Hospital (CAH)-Affiliated Emergency Medical Service (EMS) Providers
  Research center: Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS)
  Date: 09 / 2003
  To provide a description of EMS providers in rural communities, particularly those with CAHs
• Emergency Department Use By Medically Indigent Rural Residents
  Author(s): Kevin Bennett, Janice C. Probst, Charity G. Moore, Judith A. Shinogle
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Federally Qualified Health Centers (FQHCs), Health services, Hospitals and clinics
  Date: 07 / 2003
  Examined emergency department (ED) use, combining national data and South Carolina state data to estimate the uncompensated charges in rural EDs nationally and the ameliorating effects of rural community health centers on ED use by rural residents. Executive summary available online.

2002

• Federal Funding for Emergency Medical Services
  Author(s): Penny E. Mohr, Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topic: Emergency medical services (EMS)
  Date: 07 / 2002
  Includes recent trend data from 1994 to the present on aggregate Federal spending on EMS and funding targeted explicitly to rural areas. Also discusses the role various Federal agencies have played and traces the history of Federal legislation to support EMS programs. Activities funded under Title XII of the Public Health Service Act. Discussion of pending EMS-related legislation and future goals specified by the agencies included in the study. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
  Author(s): Astrid Knott
  Research center: Minnesota Rural Health Research Center
  Topics: Emergency medical services (EMS), Health services
  Report Number: Working Paper No. 38
  Date: 02 / 2002
  Reports the findings of a survey of state EMS directors regarding access to rural EMS; programs and initiatives by state EMS agencies that target rural and volunteer EMS providers; integration initiatives by rural EMS providers; issues in medical direction for rural EMS; and anticipated effects of the new Medicare fee schedule on rural EMS providers. Findings include: there is substantial state-by-state variation in the approach to EMS issues; EMS system development has not been a priority in state efforts; state EMS agencies address rural EMS provider needs in a limited manner; medical direction in rural EMS is a major issue in most states, but few states place a high priority on it; and EMS integration is sometimes seen as a panacea, but is not easily accomplished. Concludes that the time is right for a new national initiative to address EMS issues and to stimulate the development of EMS as a system, beyond its current fragmented state.

2001

• Establishing a Fair Medicare Reimbursement for Low-Volume Rural Ambulance Providers
  Author(s): Penny E. Mohr, C. Michael Cheng, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Emergency medical services (EMS), Health care financing, Medicare
  Date: 07 / 2001
  National study of ambulance transport costs looks at the advantages and disadvantages of several options for Medicare to compensate low-volume rural ambulance providers. Among its conclusions: many low-volume rural volunteer EMS providers will benefit from the new Medicare fee schedule; a volume-based premium offers a disincentive for small providers to grow and take advantage of economies of scale; and cost-based reimbursement for a select class of rural providers would not over- or under-pay vulnerable providers. Report available on request.

2000

• Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly
  Author(s): Roger A Rosenblatt, GE Wright, Laura-Mae Baldwin, Leighton Chan, P Clitherow, Frederick M Chen, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Emergency medical services (EMS), Physicians
  Citation: American Journal of Public Health, 90(1), 97-102
  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
  Author(s): Denise M Lishner,Roger A Rosenblatt, Laura-Mae Baldwin, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Emergency medical services (EMS), Hospitals and clinics
  Citation: Journal of Emergency Medicine, 18(3), 289-297
  Date: 2000
  This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. The U.S. Health Care Financing Administration’s National Claims File was used to identify services provided to Medicare beneficiaries in Washington State in 1994. Patients were classified by urban, adjacent rural, or remote rural residence. We identified ED visits and associated diagnostic codes, assigned severity levels for presenting conditions, and determined the specialties of physicians providing ED services. The rural elderly living in remote areas are 13% less likely to visit the ED than their urban counterparts. Causes of ED use by the elderly do not vary meaningfully by location. Most ED visits by this group are for conditions that seem appropriate for this setting. 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.