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Usually, it is perfectly clear when we have a true emergency. But sometimes we may have chest pain, assume (or hope) that it’s heartburn, take an antacid and wait to see if it gets better. To quote an Archie Campbell “Hee-Haw” line, “DON’T DO THAT!!” Because, if it’s not heartburn but a heart attack, that decision could be your last, so call 911!

When you call 911 and report chest pain, our Emergency Medical Services (EMS) system is activated, and that is what we will talk about today. Occasionally we may take these dedicated people (our neighbors) for granted; but, believe me when I say that they have a hard job, face real obstacles and truly need and deserve our attention, support and serious involvement in the work for which they have such profound passion. A crucial obstacle that merits mention up front is that financing for EMS is much less favorable for rural areas than for urban settings, resulting in continual financial and resource issues.

In the hospital-centric world of health care quality improvement, some huge determinants of quality in rural communities are largely ignored. These include: time to contact, care during transportation, and transfer of care from one setting and professional to another (in our opening example, home to ambulance to emergency room to helicopter to heart center). If we just look at quality in the heart center, for example, we miss most of the factors that determine how well the person actually does after the illness. So clearly EMS plays a critical role in health care quality and effectiveness.

What are the factors that determine the quality of EMS in Lincoln County? To name a few, we must include speed, people, training, equipment, communication, collaboration and integration with the emergency department. Note that most of these factors require adequate financial resources, which we identified earlier as a major problem for rural EMS services. It follows, then, that the enemies of high quality of EMS services include inadequate reimbursement, not enough people, barriers to good training, inability to afford the best equipment (medical, transportation and communication), ineffective communication among caregivers, and insufficient integration with the rest of the health care community such as emergency departments. And, oh yes, let’s not forget that four-letter word TURF, that blocks collaboration.

This “enemies” list comes from national studies of rural EMS over the past several years, not from any assessment of our Lincoln County systems. In fact, EMS stakeholders are meeting to discuss these issues and to assure that we are being the best we can be for the health of everyone in Lincoln County, that we are continuously improving, that we are applying available resources in the most effective and efficient manner possible, that we are ready for a disaster and fully prepared for an effective trauma system.

So, what is your role, citizen of Lincoln County? First, call 911 in case of true emergency including chest pain. But beyond that, be aware of these issues! Be friends of your EMS system and people; help with staffing, training, equipment and resources. Actively and knowledgeably support them—your life may depend on it!

Dr. Calico is Director of the UK Center of Excellence in Rural Health—Danville. He resides in Lincoln County.

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