BOX 5-1

Participant-Identified Challenges Facing Rural Healthcare Systems

Potential problems with a regional approach to response

  • Geographic barriers (e.g., mountains)

  • Infrastructure (e.g., lack of roads connecting areas in the region)

  • Disparities across the region in funding, weather, population density, and seasonality (i.e., seasonal influx of tourists)

  • Fear among departments that regionalization will result in something being taken from them (e.g., control, resources)

Planning and response hurdles

  • Level of staffing does not allow personnel to take time away from day-to-day responsibilities

  • Costs associated with training, lack of funding for travel to training

  • Emphasis on cost containment in health care affects surge capacity (e.g., lack of beds)

  • People working in rural healthcare and EMS wear multiple hats, cover multiple responsibilities

  • Lack of integration with emergency management and public health

  • A pervasive attitude in communities that “it is not going to happen to us” negatively impacts the ability to gather all of the stakeholders for proactive planning

  • “Defensive medicine” (costs associated with conduct of unnecessary advanced imaging or other expensive procedures on patients with minimal or vague complaints)

tion and information network that can provide standardized, real-time information to all involved in an MCI response. The ultimate goal of regionalization is to improve patient outcomes through the best, most efficient use of collective resources. Regionalization should strengthen, rather than detract from, individual EMS preparedness as it provides a framework for immediate and streamlined assistance should a locality be overwhelmed.

Regional coalitions can be informal cooperatives or structured, formal hierarchies. Participants suggested that regional coalitions are successful in improving integration and collaboration by what they view as common priorities and goals, rather than how they specifically accomplish them. Panelists discussed models within a broad spectrum, from EMS systems and volunteer first response agencies aggregated under one umbrella with a single director for an entire county, to loose coalitions that revolve around the coordination of a few prominent organization directors. Workshop participants highlighted that especially in rural settings, a one-size-fits-all regional model is not feasible. Emblematic of this concept was the initial vocalization by some participants that in rural areas, small incidents can be

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