In rural Alaska during a medical emergency, rescue squads use any mode of transportation necessary to get the patient to medical care, whether it's by dog sled, snow machine or air ambulance. Even when road travel is possible, it's often many, many miles to the nearest major medical center.
While dog sleds may be uniquely Alaskan, throughout rural American, and particularly in the Northwest, small, sparsely populated communities face extra obstacles due to their distance from trauma centers and medical specialists.
While it's true everywhere that trained Emergency Medical Services (EMS) providers can mean the difference between life and death, it is especially true in remote and rural regions.
Yet more than 80% of rural EMS providers are volunteers. In addition to their regular jobs, these small town heroes serve their communities while continually studying and learning so that at the next emergency, whether they're called from work, from a family dinner or from bed in the middle of the night, they can rush to the scene knowing what to do.
With little to no funding, just maintaining this life saving certification can become a burden. Taking time off work to travel and attend classes is not only expensive; it pulls providers away from the communities that need them should an emergency occur.
"One of the main barriers to continuing education is the distance," says Kas Healy, a nurse practitioner in McGrath, Alaska. "We don't have a lot of centers and big hospitals are few and far between."
That's where EMS Live@Nite comes in. To lessen the training burden for rural communities throughout the Northwest, in 2003 Inland Northwest Health Services (INHS) partnered with Spokane County EMS to use technology so rural providers can access EMS education right in their own communities.
In 2004, INHS received a grant from the Office of Rural Health Policy's Rural Emergency Medical Services Program for three years to enhance EMS Live to include 6 states. But when that grant ended a year early in 2005, rather than shutter the program, INHS decided the need was too great and has been sponsoring it ever since, still in partnership with Spokane County EMS.
On the second Tuesday of each month an instructor who specializes in a relevant topic delivers continuing medical education via a live, interactive video conferencing from Spokane. The program is now offered to 108 rural locations in Washington, Oregon, Idaho, Montana, Alaska and Wyoming with an average of 250 EMS professionals attending who receive continuing medical education (CME) credit to maintain their state and/or federal certification.
"There is little to no funding available for rural EMS education. Eighty-five percent of these people are volunteers that have to have mandated continuing educating to remain certified," says program director Renée Anderson. "For the past 5 years the program has been funded by INHS. It's impressive for an organization to do this for so many people in 6 states. It makes me proud to work here."
Two of the program's most valued volunteers are longtime partners Dr. James Nania, medical program director for Spokane County EMS, and Raymond Tansy, Jr., administrator for Spokane County EMS. Both men volunteer every month and have been instrumental in ensuring participants receive certification credit for the classes, even though the program serves multiple states with different requirements.
The program, says Nania, "has been one of INHS' nicest community contributions. It fills a much needed void for EMS providers and reaches an audience that is hard to reach by virtue of geography and population. In one shot we are able to reach a large regional audience."
Not only do participants take the free classes and test on the material for continuing medical education credits toward their certification, they also have the opportunity to ask questions and discuss scenarios with both the instructor and other participants, sharing and pooling knowledge.
"They are using people from very high skilled medical centers to offer this kind of education. So you are getting leading edge information and education," says Healy, who was instrumental in getting the Eastern Aleutian Tribes' (EAT) nine clinics connected to the program. "It feels like you are there even though you are not. It has been positive. It has been supportive. It offers great peer to peer interaction. It has been a great educational experience."
On top of those benefits, Healy says the program "gives monster cost savings." She describes how the EAT covers a geographical area that spans a greater distance than the continental United States. To travel for EMS education required 400 to 1500 round trip miles on a plane plus hotel stays. Now they don't need to leave the community.
It's a benefit that resonates with most of the participants.
"We are very rural. Most classes we would have to go 80 miles to attend. Now we go 7 miles," says Colleen Rodrigues, the EMS training coordinator for Jefferson Healthcare in Port Townsend, Washington. "It is always nice to be able to have educated instructors to bring topics we don't normally learn about. We learn from the other organizations. It continues to educate us. We are staying current. It has impacted us hugely in a positive way."
Rodrigues says she's had as many as 20 people attend one of the monthly classes, including nurses and department of health case workers who do home visits to elderly residents. Sometimes she's even had spouses and other community members sit-in for the educational opportunity. "They don't take the test or get the CME credit but they learn something."
"We have to have so many extra hours of training . . . it allows us to have different avenues to meet training requirements," says Toni Halloran, Deputy Chief of EMS for Newman Lake Fire and Rescue. "Agencies that aren't using it are missing out. There are a lot of good things offered through that program."
A key strength of EMS Live@Nite, say participants, is the vast expertise and timely topics covered. Classes have covered the gamut from head trauma, burns or cardiac arrest to meth, hazardous materials and gun wound emergencies. And most of the topics, says Nania, are selected from recommendations by participants, ensuring classes will be relevant.
All of the instructors, adds Anderson, are experts, certified and experienced in the field that they are teaching. Additionally, INHS has utilized the expertise in its air ambulance division, NW MedStar, to provide classes with case scenarios that give participants practical knowledge from professionals who experience the worst traumas every day.
"Many instructors have come from Northwest MedStar," says Nania. "It's a wealth of teaching talent."
Participants echo this praise.
"I was an EMT for about 7 years and went through as many of the nighttime programs I could go to," says Lynn Haugh, who recently retired from the Newman Lake Fire and Rescue. "I felt I was current and could face anything that was thrown at me. It gave me information I couldn't get locally from an expert. They always had real experts talk. They had been on the front line and they knew what they were talking about."
Gary Anderson, with Chinook Volunteer Ambulance in Montana, says "having EMS@Nite allows for people to get qualified instructors with good quality information that can be passed on to them without having to travel. It is saving a lot of time and a lot of money. . . What keeps us current is the current training."
Yet, not every rural community has a hospital, clinic, fire station or school with the technology to access the classes. To help meet this need, INHS provides DVD recordings of the classes at cost.
Of course, with additional funding, those involved with the program say they could do so much more. "If we had funding we would include more states, do it two nights a week, separate for time zones," says Renée Anderson, adding that it is natural to want to expand a program that has been so cost efficient and successful for the health and safety of rural communities. "People should know the quality of the emergency care they receive when on vacation or traveling is dependant on the education of volunteers there to help them. We need to figure out how to fund the education for these people. It is serious hole in the system."
But until that hole is recognized and filled from available funding, INHS will stay focused on stepping into the gap.
"The original vision was to fund a program that wasn't being funded and to expand it. To have live video conferencing you can reach such a large number of people. If tomorrow North Dakota wanted to participate, it wouldn't cost a lot more money, just more resources, says Anderson. "The way the technology is, it is a very cost effective way to offer continuing education. They can stay at home and go home to their families at night. It just makes more sense."
It also makes sense to make sure those first responders have the support to continue serving their communities.
"They are making a contribution of their own time to treat their neighbors and protect them," says Nania. "The audience we are talking to is the best kind of EMS motivated people you could hope for. They don't have easy access to education. To travel to the big cities to get education is expensive. The potential to impact patient care and help people is enormous. It is one of the best things INHS does and the best audience you could hope to talk to."