Emergency Medical

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Emergency Medical
EM Services in Rural Areas
Frank Douma for Thomas A. Horan, Ph.D. Research
Director Center for Excellence in Rural Safety
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Setting the Stage The Center for Excellence in
Rural Safety
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Overview

• Established by the 2005 federal transportation
  act (SAFETEA-LU).
• Hubert H. Humphrey Institute of Policy Affairs,
  University of Minnesota.
• In collaboration with the Center for
  Transportation Studies (CTS) and the New England
  Transportation Institute.
• Purpose To facilitate research, training, and
  outreach.

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Center Management

• Lee Munnich, Director
• Senior Fellow and Director, State and Local
  Policy Program, Hubert H. Humphrey Institute of
  Public Affairs
• Robert Johns, Director of Outreach and Training
• Director, Center for Transportation Studies
• Thomas Horan, Research Director
• Visiting Scholar, Hubert H. Humphrey Institute
  Associate Professor, Claremont Graduate
  University
• Thomas J. Adler, Technical Advisor and Liaison to
  New England Transportation Institute
• Director, New England Transportation Institute

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Mission

• Provide research, training, and outreach on
  innovative uses of technology to enhance rural
  safety and economic development,
• Assess local community needs to improve access to
  mobile emergency treatment, and
• Develop online and seminar training needs of
  rural transportation practitioners and
  policy-makers
• Section 5309(c)(3) of SAFETEA-LU

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Theme Focus

• Theme Individual-centered improvements to rural
  safety through behavioral, technological and
  policy innovations.
• Focus research, training and outreach on
  behavioral, technological, and policy issues
  relating to rural transportation safety.

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Objectives

• Contribute to research by addressing pressing
  rural safety issues that are affected by
  behavioral, technological and policy factors
• Contribute to practice through outreach
  activities for practitioners and policy-makers so
  that they make more informed transportation
  safety decisions in rural areas
• Contribute to researcher, practitioner and
  citizen training through annual summer institutes
  and related specialty online and face-to-face
  training opportunities
• Contribute to federal and national programs
  though establishment of an advisory committee and
  coordination with DOT and AASHTO.

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Key Stakeholders A Grasstops Approach

• Policy leaders - Governors, legislators, local
  elected officials
• Institutional leaders - FHWA, NHTSA, DOTs, Public
  Safety, Tribes, etc.
• Safety advocacy groups - MADD, Safety Council,
  Toward Zero Deaths, state and regional groups
• Transportation leadership groups - AASHTO, AAA,
  ATA, etc.
• Rural leadership groups - NADO, Rural development
  organizations
• Research leaders - University transportation
  centers, Turner-Fairbanks, other research groups
• Media

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Summer Institute Key Questions to Address

• What are the behavioral, technological, and
  institutional successes, barriers and challenges
  to advancing rural safety public policy?
• What research is needed to address these
  identified barriers and challenges to advancing
  rural safety public policy?
• How does this get translated into pre-crash,
  crash and post crash strategies?

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Center Research

• The Center will conduct policy-oriented research
  to improve rural safety.
• As specified in section 5309(b) of SAFETEA-LU,
  the legislation calls for
• investigation of innovative uses of technology
  to enhance rural safety and economic development,
  
• And assess local community needs to improve
  access to mobile emergency treatment.
• Research will be conducted on these areas and in
  a manner consistent with the research theme of
  citizen-centered improvements to rural safety
  through behavioral, technological and policy
  innovations.

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Behavioral Issues In Rural Safety

• This area focuses on how rural safety approaches
  need to take into consideration the intentions
  and characteristics of distinct citizen/driving
  segments within rural communities, including but
  not limited to young, elderly, and
  part-time-urban segments.

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Technology Issues in Rural Safety

• The focus is on technological developments that
  affect rural safety and the technical and
  non-technical issues surrounding their
  deployment.
• Of particular interest will be how developments
  in the next generation 911-system, as well as
  access to that system, effect rural safety and
  health care.

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Policy Issues in Rural Safety

• A distinctive aspect of the Center is its
  consideration of integrated policy approaches,
  with special attention to citizen-based
  solutions.
• The Center will collaborate with related programs
  on research, evaluation, and outreach initiatives
  that leverage the expertise and resources of
  these programs as well as consider the national
  implications of this research.

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Crosscutting Areas/Federal Areas

• The federal research program has identified a
  number of rural safety issues that require
  research. The Center will facilitate dialogue and
  partnerships for these areas and develop
  collaborative research projects with FHWA and
  other research partners.

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Center Research
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National Accident Statistics

• Approximately 40,000 highway deaths each year
• Most deaths occur within few hours of crash
• 30 of deaths occur within minutes of crash
• 50 of deaths occur prior to arrival at a
  hospital
• 70 of deaths occur within 2 hours of crash
• Accident victims 5-7 times more likely to die if
  arrival to hospital exceeds 30 minutes (NCSA,
  NASEMSD, NASEMSP, Grossman et al. 1997)

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Rural Statistics

• Nation wide vehicle fatalities 60 occur in
  rural areas (Minnesota, 73 Montana, 92
  Wisconsin, 75)
• Time between crash and arrival to hospital
• Urban 34 minutes
• Rural 52 minutes
• MN 2005
• 87,813 traffic crashes were reported to the
  Department of Public Safety
• 161,683 motor vehicles were involved
• 221,835 people were involved
• 559 people died
• 37,686 people were injured
• 1,666,276,000 estimated economic cost to
  Minnesota

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Increasing Public Demand for EMS

• 9-1-1 Calls more than doubled since 1995 from
  24 to over 50 million (FCC, 2006)
• Demand for improved service Performance (IOM,
  2006)
• Reduce disability consequences, save lives
• Reduce response times
• Increase service quality
• Evaluate holistically (across the service)

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Recent Research

• Case Study
• Research on rural emergency response through
  Humphrey Institute and ITS Institute, University
  of Minnesota.
• National Workshop
• Held a National Workshop at Kennedy School of
  Government, Harvard University on Time-Critical
  Information Services (TCIS)

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Brainerd-Baxter Case Study
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Brainerd-Baxter Case Study
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The Silos
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Rural Minnesota Case Study
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(No Transcript)
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Top-Level Findings

• Rural Emergency Response has longer response
  times than urban equivalent urban areas of
  Minnesota
• There are information and technology needs that
  could enhance the performance of rural emergency
  response
• The issue encompasses demographics (behavior),
  technology (ITS), and policy (EMS policy and
  finance).

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TCIS Workshop

• April 2005, Kennedy School of Government, Harvard
  University
• Representatives from NHTSA, IOM, ComCARE, MIT,
  Harvard, Claremont, U. Minnesota, MN/DOT,
  NASEMSD, NRHA, Bentley, County EMS Agencies

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Workshop Findings

• Performance information exists within individual
  organizations, but is not shared or evaluated
  from end-to-end.
• End-to-end service evaluation should focus on
  both timeliness and quality of service.
• Focus on the multiple nested levels of
  inter-organizational linkages from 3
  perspectives operational, organizational, and
  governance.

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A Comprehensive View of Emergency Response
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Challenges Ahead

• Need to understand unique operational,
  organizational, and governance constraints and
  context that surround end-to-end performance in
  rural areas.
• There is a challenge to tracking a patient from
  end-to-end from the time of a 9-1-1 phone call
  through to being released from a hospital and
  this hampers performance improvement.
• There is a need for concepts, methods and systems
  for connecting disparate performance data sets
  from multiple organizations (creating an
  end-to-end performance data set).