Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care


Rural populations frequently reside greater distances from emergency rooms. Longer distances to definitive care mean that rural emergency medical services (EMS) professionals often require greater skill levels than their urban counterparts. Yet rural EMS systems tend to have fewer resources, rely more heavily on volunteer staff, and have fewer personnel trained at higher levels. This study describes the relationship between prehospital EMS providers' levels of experience and provision of evidence-based care for rural and urban populations. Using electronic prehospital EMS patient care record data, we examined four EMS Compass performance measures of evidenced-based care for seizure, stroke, hypoglycemia, and trauma.

Compared with EMS agencies serving predominantly urban patient populations, rural-serving agencies less often provided evidence-based care according to performance measures for stroke, hypoglycemia, and trauma. The rural/urban difference was more pronounced with increasing rurality. Using daily 911 encounters and total time spent on 911 encounters as measures of accumulated experience, we found that EMS professionals at rural agencies had lower levels of accumulated experience than professionals at urban agencies. Experience levels decreased as agency rurality increased. Patients were more likely to receive evidenced-based care for seizure and trauma when the lead EMS professional at the encounter had accumulated more total time responding to 911 encounters. Measures of experience were not associated with evidence-based care for stroke or hypoglycemia. Agency staffing models—paid, unpaid, or mix paid/unpaid—did not influence the provision of evidence-based care except for hypoglycemia, where agencies with mixed paid and unpaid staff performed better than those with strictly paid staff.

WWAMI Rural Health Research Center
Davis Patterson, Nick Nudell, Lisa Garberson, Holly Andrilla