Abstract
Background: Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India.Methods: A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion.Results: 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week.Conclusion: This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.
Highlights
Emergency medical care is receiving growing attention in low- and middle-income countries (LMICs) as acute conditions, such as road traffic accidents, continue to rise as leading causes of mortality [1]
Recommendations for emphasizing standing orders over online medical direction are based on United States (US) studies where paramedics have significantly more training than emergency medical technicians (EMTs) or other prehospital healthcare providers operating in most LMICs
Research assistants collected a total sample of 108 EMTs (9.1%), out of 1180 total EMTs in Gujarat, with 100% response rate and no refusals to participate
Summary
Emergency medical care is receiving growing attention in low- and middle-income countries (LMICs) as acute conditions, such as road traffic accidents, continue to rise as leading causes of mortality [1]. In some countries such as India, cellular phones are used to provide real-time physician medical direction to the prehospital care providers and improve the quality of prehospital emergency care [3,4,5]. Recommendations for emphasizing standing orders over online medical direction are based on US studies where paramedics have significantly more training than EMTs or other prehospital healthcare providers operating in most LMICs. Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting.
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