Improving ambulance services for effective rural emergency care

Rural BC emergency departments are often unequipped to treat a variety of emergencies, including major trauma, surgical emergencies, severe burns, complicated obstetric cases, neurological emergencies, complex cardiac cases, complicated pediatric cases, toxicological emergencies, rare or severe infectious diseases, and mental health emergencies. This is because rural emergency departments primarily depend on physical examinations, basic laboratory investigations, and point-of-care ultrasounds for diagnosis.[1] It is often necessary to transfer patients to urban centres by ambulance for further assessment and treatment.

BC Emergency Health Services is a centralized dispatch system that coordinates ambulance responses across the province.[2] In our opinion, at least two ambulances should be on standby near each sizable rural community. However, current realities often deviate from this ideal. In urban areas, a fully equipped hospital is often only a short drive away. In contrast, rural ambulance services may encounter hours-long journeys, during which they are unavailable for other emergencies. In rural areas, a limited number of ambulance units, a lack of paramedics with advanced training, and staffing shortages can lead to significant service gaps.[3]

In the face of this challenge, telemedicine, such as the Emergency Physician Online Support program in BC,[4] has become a vital resource. Paramedics can now receive real-time guidance from physicians before they reach the hospital.[4] However, signal connectivity in rural areas can be poor, and while telemedicine can guide care, it cannot replace the need for increased staffing and more equipment on rural ambulance units.

Operational costs for ambulance services can also rise in rural settings. Longer runs increase fuel consumption and wear and tear on vehicles. Unfortunately, reimbursement models, particularly in regions where such services might be publicly funded or subsidized, may not account for these added operational demands, placing financial strain on these service providers.[5]

To truly alleviate the pressures on rural ambulance services, the core issue—funding and expanding rural hospitals—must be tackled head-on. In the interim, recruiting more paramedics, better equipping ambulances, delivering more advanced training to paramedics, integrating telemedicine use, and increasing funding for ambulance services are crucial temporary solutions.
—Xi Yao Gui, MD
Family Medicine Resident, Department of Family and Community Medicine, University of Toronto
—Eric McMullen, MD
Dermatology Resident, Division of Dermatology, University of Toronto
—Chris Bhatla, MD
Physical Medicine and Rehabilitation Resident, Division of Physical Medicine and Rehabilitation, University of Toronto
—John Siewert, MD
Family Medicine Resident, Division of Medical Sciences, University of Northern BC
—Ramy Melek, MD
Family Medicine Clinical Instructor, Division of Medical Sciences, University of Northern BC
—Jessica Burian, MD
Family Medicine Clinical Instructor, Division of Medical Sciences, University of Northern BC

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References

1.    Fleet R, Poitras J, Maltais-Giguère J, et al. A descriptive study of access to services in a random sample of Canadian rural emergency departments. BMJ Open 2013;3:e003876.

2.    BC Emergency Health Services. Accessed 26 October 2023. www.bcehs.ca.

3.    DeRosa K. Push is on to hire more paramedics in B.C., but some veterans say barriers remain. Vancouver Sun. 4 September 2022. Accessed 27 October 2023. https://vancouversun.com/news/local-news/push-is-on-to-hire-more-paramedics-in-b-c-but-some-veterans-say-barriers-remain.

4.    Office of the Auditor General of British Columbia. Access to emergency health services. 2019. Accessed 27 October 2023. www.bcauditor.com/sites/default/files/publications/reports/OAGBC_EHS_RPT.pdf.

5.    MacKinney C, Mueller KJ, Coburn AF, et al. Characteristics and challenges of rural ambulance agencies: A brief review and policy considerations. RUPRI Health Panel. 2021. Rural Policy Research Institute. Accessed 27 October 2023. https://rupri.org/wp-content/uploads/Characteristics-and-Challenges-of-Rural-Ambulance-Agencies-January-2021.pdf.