Blame this
25 July 2008It’s no secret that health care often isn’t as good in rural areas as it is in urban and suburban areas, and that’s probably doubly true of emergency care. You can point all the fingers you want, but it’s just a result of many small factors coming together rather than one large one. However, that doesn’t mean all of the finger-pointing going on is correct: according to one review, the latest group to look at stroke care in rural areas found that
inferior rural stroke care begins with the paramedics, who tend to be older and less educated than urban paramedics, and are often volunteers. “They have, in general, less training, less experience, and fewer learning opportunities to achieve the proficiency of their urban counterparts,” says the team.
While I agree that rural providers don’t get the patient volume or training opportunities of their subruban and urban counterparts, I can’t call EMS providers part of the problem with rural stroke care. Part of this is that there isn’t really anything you can do for a stroke in the field besides transport to a hospital. The other part is that despite the apparent reduced experience of rural medics, at least one study has shown their knowledge of stroke symptoms and risk factors to be just as good as non-rural medics (or, depending on how you look at the numbers, just as poor):
There were no significant differences between frontier and urban EMS respondents’ ability to correctly identify 4 or more stroke warning signs (58% vs 61%), 4 or more stroke risk factors (46% vs 43%), or the 3-hour recombinant tissue plasminogen activator (rt-PA) treatment window (56% vs 57%).
Someday, I’ll actually be able to get a copy of that article to find out how they came up with these numbers. It frightens me to think that a third of EMS providers couldn’t come up with 4 stroke symptoms or the t-PA window–maybe the methodology was poor.
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