Experiences of patients with peripheral intravenous catheter insertion and care in an Australian emergency department: A CFIR-guided qualitative study.

Rural sexual assault survivors face barriers to accessing trauma-informed care (TIC), including shortages of sexual assault nurse examiners (SANEs) and limited resources, leading to retraumatization and poorer outcomes. To improve TIC knowledge among SANE-competent nurses in a rural Midwestern emergency department and assess effects on advocacy service use. A quasi-experimental, mixed-methods design that included 12 SANE-competent nurses who completed the Attitudes Related to Trauma-Informed Care-10 Scale (ARTIC-10) pre/post and a 16-minute TIC and advocacy video. ARTIC-10 scores increased significantly, indicating improvement in TIC attitudes and competencies. Qualitative findings showed greater empathy, empowerment, and communication. Advocacy center calls doubled post-intervention. Brief, targeted TIC training show promise to improve competencies and advocacy utilization. A concise microlearning module can strengthen TIC and advocacy collaboration among rural SANE-competent nurses, offering a scalable model for underserved communities.

ABSTRACT OBJECTIVES Paramedics in rural and wilderness environments often face prolonged transport intervals and limited resources, increasing the value of diagnostic tools like point-of-care ultrasound (POCUS). This is a prospective, quasi-experimental study with a one-group pretest-posttest design to assess the feasibility and utility of implementing extended focused assessment with sonography in trauma (eFAST) and limited cardiac ultrasound exams in these austere settings. METHODS Twenty-four paramedics from a National Park Service unit and a local emergency medical services (EMS) agency underwent a blended POCUS training program, including asynchronous modules and hands-on instruction. Knowledge, attitudes, and practices (KAP) were assessed via pre/post-training surveys and tests, with a delayed knowledge test administered at four months. Scan utility was evaluated via post-scan hand-off surveys. RESULTS Participants demonstrated a 44% increase in knowledge scores immediately post-training (p < 0.0001), with good knowledge retention at four months post-training. Although KAP scores showed minimal change, qualitative feedback reflected strong enthusiasm for and perceived utility of prehospital POCUS. Twenty-two scans were performed during routine patient care. Four scans (18.2%) were deemed clinically meaningful by receiving physicians, influencing diagnosis and transport decisions. CONCLUSIONS Point of care ultrasound training for paramedics in rural and wilderness EMS settings is feasible, well-received, and results in successful use of POCUS for patient care and transport decision-making. Broader implementation and research may provide further insight to EMS clinician satisfaction, diagnostic accuracy and impact on patient outcomes in austere environments.

Language has a profound impact on communication and thought for human beings. It has been instrumental in the dissemination of disaster warning and rescue information during emergencies. Due to the decline in language abilities and the physiological and social disadvantages of not keeping pace with the speed of information technology development, elderly individuals have become a vulnerable group on the linguistic level. Based on field surveys, this paper focuses on the elderly population in rural China and discusses the language barriers faced by this group in emergencies and the emergency language services they received. The research found: (1) The rural elderly’s individual language abilities are so poor that they are less able to cope with emergencies. (2) There is a pronounced barrier for the rural elderly in terms of communication and information acquisition. (3) Current rural emergency language services face issues such as limited service content, lack of professional service teams, insufficient service awareness, and an incomplete service mechanism. Based on these issues, rural emergency language services should provide differentiated services according to the linguistic characteristics of the elderly population and the actual conditions of rural communities. This involves forming specialized, localized emergency language service teams, extending the breadth and depth of emergency language services, and establishing a long-term mechanism to better protect the linguistic rights and emergency needs of the elderly.

The rural emergency department: an overlooked learning opportunity for pre-clerkship medical students

Small bowel obstruction (SBO) is a common surgical emergency that can lead to significant morbidity, mortality, and healthcare costs, particularly when diagnosis is delayed. In rural and resource-limited emergency settings, advanced imaging techniques like computed tomography (CT) may not be readily available. As a result, clinicians often rely on physical examinations and plain radiographs which can be unreliable. Point-of-care ultrasound (POCUS) provides a rapid, radiation-free and cost-effective diagnostic alternative that can be performed directly at the bedside. We conducted a systematic review of published literature evaluating the diagnostic accuracy and clinical utility of POCUS in identifying SBO on the following databases PubMed, Web of Science,Cochrane Library and Google Scholar databases from January 2000 to December 2024. Studies were screened and selected based on the inclusion and exclusion criteria adhering to PRISMA 2020 guidelines. The sensitivity of POCUS for SBO ranged from 85.0 to 100%, while specificity ranged from 54.0 to 100%. Diagnostic accuracy remained high across a broad range of expertise overcoming operator dependence. Examination durations are approximately 10-11min, which is markedly shorter than 45-min to 3-h by CT. POCUS presents as a practical, scalable and cost-saving tool for diagnosing SBO in rural emergency care, addressing significant gaps where CT is not available and also facilitates faster diagnosis by timely identification of specific features. Future efforts should focus on developing validated algorithms for resource-limited settings allowing immediate care management.

Timely access to emergency surgical care is a key metric for health system development and performance. To mitigate the risks of rural hospital closures in the United States, the 2021 Consolidated Appropriations Act introduced the rural emergency hospital (REH) designation, which promotes closure of inpatient units in small hospitals in favor of emergency and outpatient services via supplemental funding and reimbursement. We investigated trauma and emergency general surgery volumes at REH-eligible hospitals to evaluate the potential impact of REH designation on trauma and emergency general surgery care. We used the 2021 Healthcare Cost and Utilization Project from five geographically diverse states (California, Florida, Iowa, Maryland, and Wisconsin) to select encounters where adult patients were treated for acute injuries or emergency general surgery conditions. We then identified REH-eligible hospitals (critical access hospitals or rural hospitals with <50 inpatient beds), comparing case volumes and patient populations at REH-eligible and -ineligible hospitals. We analyzed 2.1 million encounters. Trauma and emergency general surgery encounters at REH-eligible hospitals demonstrated substantial interstate variation, comprising 2% to 37% of statewide hospitalizations and up to 17% of statewide inpatient days, with rural states showing the highest proportions. Compared with ineligible hospitals, REH-eligible hospitals treated a higher proportion of patients who were White (85% vs. 55%), were living in rural areas (79% vs. 8%), and had lower incomes; treated fewer patients operatively (2% vs. 11%); and transferred more patients (5% vs. 3%) (all p < 0.001). Hospitals eligible for REH designation contribute substantially to the care of injured and emergency general surgery patients, although this is variable across states. While this policy may preserve emergency services in rural areas, the substantial variation in REH-eligible hospital utilization and the vulnerable populations served necessitate systematic evaluation of impacts on surgical access, transfer protocols, and regional care capacity given the irreversible structural changes inherent in this designation. Epidemiological; Level III.

BackgroundApproximately 20% of the U.S. population resides in rural areas where health care access is limited by physician shortages. This presents a disparity in emergency general surgery where timely intervention is essential. This study aims to evaluate the impact of rurality on outcomes of emergency general surgery patients transferred to a metropolitan center.MethodsA retrospective single-center cohort study of 1189 patients who underwent non-traumatic emergent exploratory laparotomies. Patient rurality was determined by Rural-Urban Commuting Area (RUCA) codes which categorize patients as metropolitan, micropolitan, small town, or rural. The primary outcome was in-hospital mortality.ResultsRural (n = 369) and small-town (n = 135) patients had similar preoperative comorbidities, Physiological Emergency Surgery Acuity Scores (PESAS), utilization of damage control laparotomies, ICU metrics, and outcomes compared to those that presented to a metropolitan center (n = 508). In contrast, micropolitan (n = 177) patients had higher PESAS scores (5 vs 3, P < 0.0001) and underwent more damage control laparotomies (62% vs 40%-49%, P < 0.0001) with higher use of intraoperative vasopressors (57% vs 37%-39%, P < 0.001) and higher overall mortality (23% vs 13%-15%, P = 0.027).DiscussionOur findings suggest that a mature and centralized transfer system promotes equity of outcomes between rural and metropolitan emergency general surgery patients. Micropolitan patients were more acuity ill than patients of other degrees of rurality, which suggests that low acuity micropolitan patients were more likely to be managed within their own communities.

Implementing an emergency nursing framework improves the quality of clinical handover: A stepped-wedge cluster randomised control trial.

Reducing inpatient deterioration and improving patient safety in emergency departments with a standardised nursing framework: A stepped-wedge cluster randomised controlled trial.

PurposeRural hospitals face persistent financial challenges that often threaten their survival. To address this, the 2023 “Rural Emergency Hospital” (REH) designation offers Critical Access Hospitals and hospitals with fewer than 50 beds enhanced Medicare reimbursement and annual facility payments if they discontinue inpatient services while maintaining outpatient care and a 24‐hour emergency department. This study evaluates the characteristics of hospitals that choose REH conversion and examines the perceived community impact of the change.MethodsWe analyze Centers for Medicare & Medicaid Services cost report data to compare converting hospitals to eligible nonconverting hospitals. We also conduct a content analysis of 33 news articles and phone interviews with local rural residents to assess how REH conversions are presented in the media and perceived in communities.FindingsHospitals that converted to REH status had low inpatient volumes, occupancy rates, and revenues, suggesting they were positioned to benefit financially from eliminating inpatient services. Content analysis revealed that news articles were primarily neutral in tone (54.5%), with most (90%) describing the financial benefits of conversion. Interviews with rural residents highlighted negative perceptions of local health care and revealed that many preferred not to use their local REH even when available.ConclusionsREH designation may provide financial lifelines to rural hospitals with declining inpatient demand, but community skepticism and limited willingness to use REHs may constrain their role in sustaining health care access. The long‐term effectiveness of this policy may depend on addressing both financial viability and community trust in rural health care delivery.

Erratum: Can implementation of in situ simulation support rural emergency provider self confidence and improve patient safety? A mixed methods study.

Letter to the editor concerning 'can implementation of in situ simulation support rural emergency provider self-confidence and improve patient safety? A mixed-methods study'.

Abstract -This project presents the design and development of a cost-effective IoT-based smart ventilator system that provides real-time monitoring of respiratory parameters such as airflow, oxygen saturation, humidity, and temperature. The system uses an ESP32 microcontroller, medical sensors, and cloud connectivity to continuously measure patient health data and display it on a mobile app or web dashboard. The ventilator also includes safety mechanisms such as automatic alerts during abnormal breathing patterns, low oxygen levels, or system failure. The main aim of this project is to support patients who require assisted breathing by ensuring reliability, portability, and real-time remote monitoring. This prototype offers a low-cost alternative suitable for rural healthcare centers and emergency situations. Key Words: IoT, ESP32, Smart Ventilator, Oxygen Monitoring, Cloud, Alert System.

Neurologists Fear Rural Emergency Rooms Closures Will Put Patients at Risk for Dire Consequences

ObjectivesDespite data showing many opportunities for emergency medicine (EM) physicians to practice in rural settings, only 8% of EM graduates are exposed to rural environments during training.5 The authors of this study noted a curricular gap in their EM training program and developed a 4-week rural elective for PGY-2 and PGY-3 EM residents. While prior literature has focused on the logistics of a rural rotation and associated procedural experiences, to our knowledge, no previous studies have focused on resident perceptions of the rural experience or preparedness for a future career in rural EM. This qualitative study aimed to gain a rich understanding of the residents’ experiences and the impact of those experiences on the 2 study aims.MethodsBetween June 2019 and May 2020, upper-level residents (PGY-2/3) completing a rural EM rotation participated in semistructured interviews exploring their perceptions of a rural EM rotation, and data was analyzed using inductive thematic analysis. Codes were informed by social cognitive theory, and a constant comparative approach was applied, with data collection concluding upon reaching thematic saturation.ResultsFour overarching themes were established. Rural EM electives provide (1) understanding of differing patient presentations in a rural emergency department, (2) exposure to differing approaches to patient care when compared to academic settings, (3) appreciation of the transport logistics associated with transferring patients to higher level care, and (4) understanding of the perceived benefits of the rural experience on EM resident training and preparedness for rural EM practice.ConclusionExposure to a rural EM elective provides residents with unique experiences on rural EM, which enhances a deeper understanding of care provided in a rural environment and leads to a sense of preparedness for practice in rural EM.

Abstract As dementia care evolves to meet the needs of a growing and diverse aging population, innovative strategies are required to improve accessibility, cultural responsiveness, communication, and preparedness. This symposium brings together global perspectives to explore how dementia care can be optimized across different settings and populations. The first presentation provides an updated scoping review of rural palliative dementia care, identifying challenges and strategies to improve person-centered support in resource-limited areas. The second presentation examines culturally adapted interventions for Chinese and Korean American caregivers, showcasing strategies used in the New York University Caregiver Intervention—Enhanced Support (NYUCI-ES) to enhance engagement, support, and care outcomes. The third presentation explores Augmentative and Alternative Communication (AAC) in dementia care, synthesizing research on communication aids and identifying critical gaps in integration and real-world application. The final presentation focuses on disaster preparedness among Chinese American family caregivers, analyzing how caregiving-related characteristics, cultural beliefs, and cognitive appraisals influence emergency planning. This symposium highlights the need for holistic, person-centered, and contextually relevant dementia care models. By addressing rural access barriers, cultural tailoring, communication challenges, and emergency preparedness, these studies provide valuable insights into advancing dementia care across diverse settings. Attendees will gain a deeper understanding of how interdisciplinary, community-driven, and culturally sensitive approaches can enhance dementia caregiving worldwide.

Abstract With recent passage of the One Big Beautiful Bill Act (OBBBA), Medicaid changes are likely to impact older adults. One concern is that hospitals that depend on Medicaid revenue from higher Medicaid patient volumes may be at greater risk of closure. Alabama serves as an example of a state that did not expand Medicaid and provided limited aid to struggling hospitals. Even before the passage of the bill, a majority of Alabama’s hospitals were struggling partially due to a Medicare wage index calculation that underpaid hospitals (AHA, 2014). To better understand potential hospital access gaps in Alabama, we 1) coded media reports of at-risk hospitals in Alabama and hospitals who had reduced services/ converting to a rural emergency hospital (REH) 2) used the percent of Medicaid enrollment/eligibility by county in 2024. We then conducted GIS analyses to map the hospitals that may be at risk of closing or reducing services while examining Medicaid eligibility rates by county in Alabama. GIS analyses results revealed more at-risk hospitals in areas with higher Medicaid enrollment. Health access gaps were most pronounced in the lower half of the state, westernmost side of Alabama, and a pocket of 3 counties in Northeast Alabama. One hospital converted to an REH losing its geriatric psychiatry unit. While conversion to a REH may result in saving a hospital from closure and access to a nearby ER, the result is hardship for older adults depending on nearby inpatient services. Potential solutions to offer quality health care options are discussed.

Patient acceptability and satisfaction with the rural emergency department nurse practitioner model of care (RED-NP MoC).

In rural settings, women with ST-elevation myocardial infarction (STEMI) are less likely to receive timely reperfusion than men. We explore factors that may impact time to reperfusion by sex for patients with STEMI. We conducted a cohort study of adults with STEMI activations from 2016 to 2020 using regional North Carolina STEMI registry data, which included eight rural emergency medical services (EMS) agencies and three percutaneous coronary intervention (PCI) centres. The primary outcome was EMS first medical contact to PCI in ≤90 min. By sex, we evaluated prehospital time intervals (dispatch, response, time-to-ECG, catheterisation laboratory activation, on-scene, transport and total EMS) and door-to-balloon time with clustered Wilcoxon rank-sum tests. We also evaluated agency and patient factors associated with timely reperfusion using generalised estimating equations. Of the 365 patients included, 30.1% (110/365) were female with a mean age of 62.5±12.7. Fewer women received PCI within 90 min compared with men (43.6% vs 67.8%, p<0.001). Women also experienced significantly longer total EMS time (42.5 vs 40.0 min, p=0.049) and door-to-balloon time (48.5 vs 40.0 min, p=0.01). Other time intervals were similar. After adjustment, women without exertional symptoms, with diabetes or with hypercholesterolaemia had lower odds of timely reperfusion. Among men, lower odds of timely reperfusion were observed among those without pain, who had catheterisation lab activation between 17:00 and 07:00, who were older or who had farther transport. In rural settings, women without exertional chest pain and those with comorbid conditions were less likely to have timely reperfusion. Women experienced significantly longer total EMS time and door-to-balloon time than men.