Emergency Services in Rural Communities

People in most urban areas take it for granted that they can get emergency medical care quickly. Urban areas have become accustomed to quick response times from emergency services in the event of a crisis (NEMSIS, 2015). There are some rural areas in Tennessee where this isn't true, like where I live. Residents of the Willow Grove community, which is located in Clay County's southeast corner, must travel into Overton County in order for emergency responders to reach them. When the police or EMS arrive at a scene of an emergency in Willow Grove, this is a problem. As an alternative to this, rural areas of most counties in the Upper Cumberland Region have placed substations because of the problem of lengthy reaction times (UCEMSDA). An ambulance substation is required to reduce response times for the residents of Willow Grove so that they can receive equal care as the rest of the community.

Dale Hollow Lake separates Celina, where the Clay County Ambulance Service is based, from Clay County's southeast corner. With an average response time of 30 minutes, Overton County EMS handles all emergency calls in southeast Clay County. However, this does not address the issue of providing appropriate care for sick and injured taxpayers in southeast Clay. Both of these response times are unacceptable when dealing with patients who have suffered a traumatic injury or a myocardial infarction (MI) or a stroke, for example, in Overton County. Response times for emergency medical services (EMS) are six minutes on average, according to the National EMS Information System (NES). Residents of Willow Grove face serious danger because of the community's abnormally long response times, which can be up to twenty minutes longer than the national average.

A total of 23,641 trauma patients were treated in trauma centers or Comprehensive Regional Pediatric Centers in Tennessee in 2013, according to the Trauma Care Advisory Council of Tennessee. Approximately 80 percent of trauma patients were transported to trauma centers via ground transportation, while only 20 percent were transported via air (Guillamondegui, Seesholtz, Booker, & Love, 2014). There should be an immediate transfer of patients who have been injured within 60 minutes of their injury. Mortality and morbidity are significantly reduced when patients receive definitive care within the "golden hour" (Rogers & Rittenhouse, 2014).

In other words, time is of the essence when it comes to trauma patients. When it comes to stroke deaths, Tennessee ranks fourth-worst in the United States, according to a new report from Health and Human Services (HHS). Of Tennessee's 95 counties, 63 have no designated stroke center where EMS can transport patients who have suffered an acute stroke. Nearly 40% of the population is between twenty and fifty miles from a stroke center (Hern, Swafford, Winters, & Aldrich).

To avoid irreversible brain damage, patients with stroke should be transported to a comprehensive stroke center within three hours of the onset of the symptoms (McFarland, 2011). A stroke victim's outcome can be improved if he or she receives prompt treatment and is transported to the appropriate medical facility. When a person is having a stroke, time is of the essence in preserving brain tissue (Antevy, McTaggart, & Jayaraman, 2015). To paraphrase what Dr. David French had to say in a JEMS article, "The best chance for a full recovery for the patient is early EMS activation, identification, management, and rapid transport and triage to the most appropriate stroke center."

An individual who is experiencing chest pain is one of the most time-sensitive calls that EMS receives. There is an increasing annual volume of calls for EMS regarding chest pain. Those who use EMS instead of a personal vehicle after a MI have a much better outcome than those who don't (Maziar Zafari, 2015). In the event of a cardiac arrest, EMS personnel are equipped to save a person's life. "Myocardial Infarction Treatment & Management," by Zafari Maziar, MD, PhD, is published on Medscape and explains: Chest pain occurs in approximately one out of every three patients.

A patient being transported to the emergency department by private vehicle suffers a cardiac arrest on the way. According to research, only 23% of patients with a confirmed coronary event used EMS (Maziar Zafari, 2015), even when they have STEMI (S-T segment elevation myocardial infarction), which is the most common type of STEMI.

For example, the chances of surviving a sudden cardiac arrest decrease by one-third for every second that treatment is delayed without the assistance of emergency medical services. Within the first 60 minutes, 65 percent of all deaths due to MI occur, but early defibrillation can prevent most of these deaths (Maziar Zafari, 2015).

In addition, rapid response times may save the patient's life by minimizing damage to the heart muscle.

Requiring more money to pay for raises or new equipment is always met with pushback in the public safety budget. Overton County Emergency Management/911 Director Chris Masiongale says that 1261 emergency calls were made by fire, police, and EMS in Willow Grove area in 2014; this is a common argument against ambulance substations (Masiongale, 2015). There are a slew of grants out there to help small towns boost public safety. Providing an ambulance substation to the Willow Grove Community is the right thing to do, given the grants available and the increasing call volumes year after year.

To save their lives, people in need of emergency pre-hospital care are reliant on well-trained medical personnel to reach them as fast as possible, diagnose their conditions, and administer life-saving treatment. As public servants, it is our duty to ensure that each community has access to the emergency services they need, and to respond as quickly as possible to everyone in need.