In the nine years since rural Saskatchewan lost 52 hospitals, volunteer
people trained as first responders have filled in the emergency medical
gap.
But consistency of care can differ. Setting standards so all rural
people get the same level of care, and so it is no different than urban
treatment, is the goal of a new study by the province’s Health Services
Utilization and Research Commission.
HSURC chief executive officer Laurie Thompson said there is “no clear
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evidence of what is the best factor in rural emergency health care
outcomes.”
While the time it takes an ambulance to get to an ill or injured rural
person is an obvious factor in his survival, Thompson said another
issue is how long the person or his family waits before calling for
help.
“Stroke is a good example. Often people endure three to five hours of
symptoms before people realize they need help.”
So HSURC is asking health districts to help it study their rural
emergency services, using case studies and statistics to determine if
there are best practices that can be applied throughout the province.
One person consulted by the researchers is Dennis Nelson, owner of
Crestview Ambulance in Yorkton, Sask.
He agrees that speed in getting to the person is crucial. His
ambulance’s goal for rural service is to send out a first responder to
give medical assistance to the person within two to 15 minutes, and to
get an ambulance on site within 30 minutes.
The volunteers don’t get a lot of calls but are crucial when needed,
Nelson said.
“I think we need to work more with first responders to keep them
confident of and current in their skills.”
While the provincial government has committed to upgrading the training
of ambulance staff, Nelson said transportation fees can be a problem in
rural areas. The basic ambulance fee is low but mileage charges can
quickly raise that cost, especially when moving people between medical
institutions for diagnostic testing, rather than emergencies. He has
seen individual bills as high as $2,000 for such service.
Thompson agrees that rural ambulances tend to be most often used to
transport people for tests between hospitals.
“Is that the best use of resources? Can we do it another way?”
Another issue researchers want to uncover is whether it’s best to have
highly trained people in the ambulance doing complex medical work, or
just “grab and run” with the person to the nearest facility. Thompson
said studies have not proven which way is best.
For Christina Denysek, vice-president of emergency health services for
the East-Central Health District, first responders are “an intricate
part” of rural emergency service and they need more ongoing training.
Upgrading ambulance staff is still a question for her because of the
difficulty in recruiting and retaining personnel. She said the public
also has a role to play in assisting health providers.
“You can have the best ambulance service in the world, but if they
don’t know how to get to your place …”
University of Saskatchewan nursing professor Norma Stewart agrees there
is a problem keeping health staff in the province. Recent statistics
show that one-third of the province’s graduating registered nurses
leave.
Stewart said that is partly due to salary differences. She and three
other academics are working on a cross-Canada project surveying the
country’s 44,000 rural nurses for their attitudes and job satisfaction.
Judith Kulig, a University of Lethbridge professor, said the federally
funded $592,000 project will provide a final report in 2004.
Kulig said nurses also see a need for standardization in emergency
care. She noted one rural nurse told researchers that she laughed when
told “to get the ER team ready” following an accident. The individual
nurse was the entire ER team.
