Improving Emergency Medical Response

  In 2004, the National Cooperative Highway ResearchProgram (NCRHP) completed their StrategicHighway Safety Plan. The third section of this plan focused on Rural Emergency Medical Services in conjunction with the high number of rural traffic fatalities each year. Their report showed that rural areas not only suffer from a large number of traffic fatalities but also a larger degree of fatal car crashes per vehicle miles traveled (see the two graphs above).  Furthermore, these areas also have a significantly slower EMS response time. This, in particular, is cause for 

worry since there is a direct correlation between length of response time and increase in the severity of an injury. As shown in the figure on the right, the average EMS response times in rural areas are approximately 17 min longer than those in urban areas. This, as the safety plan suggested, can be attributed to many different factors including the increased distance between the accident and the closest first responders. Another cause for delay, as Stacy Vogel discussed in her article, is the fact that many rural responders are volunteers and they must first travel to the station before heading out to the scene.  While these delays are unavoidable, there are other ways to help reduce response-to-treatment time which, in turn, will also help to reduce the progression of more serious injuries.

“CodeHeartSends Real-time Emergency Vitals from Ambulances to Physicians”

   Last week, Washington Hospital Center announced a mobile application which has the potential to significantly improve patient care. This secure device has the ability to stream real-time audio and video from moving ambulances to their emergency center destination. This, as Potts explains, will allow trauma personnel to gather basic information while the patient is in transit as opposed to waiting until the patient is already in the hospital emergency room. This would then allow doctors to start treatment immediately, thereby reducing the time between injury and treatment. Although the device is not widely available and is only being used to help cardiac patients in route to the hospital, Washington Hospital Center hopes that, in the future, the device will become widely utilized and can then be used to start evaluating trauma cases. Although CodeHeart is not yet a viable option for many rural areas, the promise of such a device offers hope at improving the current standards of rural medicine, particularly response time.

Breast Cancer in Rural America

   This month, thousands of Americans have joined together in the annual fight against breast cancer, one of the most common cancers among women in the United States. National Breast Cancer Awareness Month (NBCAM) has been widely supported by family and friends of both the survivors and those newly diagnosed. When October began, the color pink became a staple of our consumer culture. People across the country have donned pink t-shirts, wristbands, and ribbons. The National Football League has incorporated the color pink into all aspects of media including their website graphics as well as other advertisements. Professional sports players have added pink accents to their uniforms. As the days have passed, people have joined in walks while others are encouraged to donate toward breast cancer research. October has become a time when people are made aware or reminded of this disease; they are encouraged to be proactive and to take every possible step toward disease prevention.

"MU Research Shows Breast Cancer Patients Still Need Post-Treatment Support"

   Last October, journalist Daniel Longar interviewed a woman from rural Missouri who was battling breast cancer at the time. For her, it was important to find the necessary support that she needed to make it through the treatments. While interviewing an assistant professor of health psychology at Missouri University, Longar found that cancer patients and survivors in rural areas are at a disadvantage to those living in a more urban setting. According to Stephanie Reid-Arndt,

“Rural areas have a lot of social interaction and community support, but they have less access to services, such as a mental health facilities [sic].”

   In addition to not having a variety of specialist options, those with cancer in rural America do not have access to other professional help. Although having support from family and friends is necessary, it is also important to have access to therapists who can help you make sense of what is happening and come to terms with your situation. Furthermore, as Reid-Arndt mentioned, support from family and friends typically diminishes once a patient has entered remission or has completed treatment. This is the point where therapy or other support groups can help a patient continue and help others even after the cancer is gone.
   For the past 26 years, Americans have been joining together to raise awareness and research funds for breast cancer. Each October, survivors join together with current patients and share their experiences and stories. One cancer survivor that Longar interviewed commented on the fact that breast cancer never really leaves a person – even if the cancer is gone, the memory and the experiences will never be. Men and women in rural America are already at a disadvantage when it comes to prevention of this cancer. Yearly mammograms as well as self-testing are important but many rural Americans do not have access to such tests and specialists as do those living in an urban area. What is possibly even worse is that many rural cancer patients and survivors do not have access to treatment “after” cancer. So, even though it is very important to work to better the medical care in rural areas, it is equally (if not more) important to better the psychological care one can receive either during or after a particular treatment.

Cultural Barriers in the Rural U.S.

   Health care, as well as the aging process in general, is grossly dependent upon cultural diversity. Various cultures all experience aging in their own way - most of which is dependent upon a particular group’s cumulative advantage or disadvantage. This, in turn, leads to a variety of health disparities between groups. Most of the literature on the subject of aging compares groups of people based on race or on religious affiliation. Even though this is an important point of analysis, it is also important to analyze cultural differences within races. A large majority of the United States, for instance, is Caucasian and, within this single race, there is still a great deal of cultural diversity. Unfortunately, many people, including physicians, do not realize the importance of rural culture. Life is different in rural America and, because of this, people behave and process things differently than other areas of the country would. While this is not unique to rural areas of the United States, it does create a noticeable difference when paired with the severe shortage of physicians who practice rural medicine.

“Learning to Speak Iowan”

   This particular article, which was published in the Wall Street Journal earlier this month, provided an interesting analysis of how understanding Iowan culture is essential to the practice of medicine in the area. The primary focus was on Mercy Medical Center in Mason City, which requires “foreign” medical residents to attend two cultural workshops in order to better learn about Iowan culture as well as dialect. After all, if you are not from the area, it is hard to understand how important football and college rivalries are or even how much rural life revolves around the farm and the harvest cycle. The majority of people in rural areas either farm or have a family member who does. And, as the article explained, many patients will refuse to accept bed rest or to even have surgery until after the harvest season is over. Others will ignore an injury or recuperation time in order to push themselves further in sports.

   Another problem arises from the language barrier. Even though the physician and the patient may both be fluent in English, a different dialect exists in various parts of the country. Not knowing and, even worse, not understanding an area’s particular dialect can lead to confusion and miscommunication. The article noted that 63 percent of the counties in Iowa have a shortage of physicians which, when combined with cultural ignorance, adds to a poor degree of health care in many rural areas. But, most importantly, one cannot make ill-construed presumptions of
a person just based on their culture. As the article stated: 

“An Iowa farmer can be university educated, worth millions of dollars and know all about grain futures. But a rural, small-town feel permeates the culture. It's a place where patients are used to knowing their doctors well, down to the pew their families occupy in church on Sundays…” 

   This is an important note because many people do tend to associate rural, small-towns with under-educated “hicks.” This presumption and potential lack of small-town understanding can lead to a poor doctor-patient relationship. As the above quote explained, this relationship is dependent upon both parties. Not only must the doctor work hard to understand the patient’s culture, but the patient must also be willing to accept “outside” doctors and their respective cultures. Just as in every relationship, it takes both parties to make it work. And, as always, it is important to learn about others’ backgrounds and cultures and to not prejudge those who we do not yet know.

Watson: The Next Advancement in Healthcare

   Medicine is one of the fastest changing professions in today’s society. Being a part of the medical profession requires the ability to adapt as well as the ability to constantly learn. Every day, biomedical engineering firms are creating new designs and testing new products in order to better the quality of health care. What was once a profession based solely on a physician’s mind and ability, is now one which has become heavily reliant upon technology – pieces of equipment that help the doctor do his/her job.

   Earlier this month, WellPoint Inc. announced the hiring of IBM’s supercomputer, Watson. According to reports, Watson will be able to sift through patient data, as well as medical literature, and output a “probable diagnosis and treatment options.” If WellPoint is successful in developing applications based on the Watson technology, the potential impact could possibly far exceed that of any other recent medical development.

Watson, IBM's supercomputer, will pair with
WellPoint Inc. in developing a state-of-the-art
healthcare application.

   Rural areas have the most to gain from the success of this Watson technology. As it stands, there is a severe shortage of physicians in rural areas. Being short staffed not only affects the workload of the doctors’ practices, but it also affects the care that a patient will receive. Even though rural physicians are often committed to each of their patients on a personal level, this inevitably leads to a degree of emotional attachment, potentially causing effects in one’s medical judgment. Watson technology could help fix both of these issues. Not only would doctors get help by having an application suggest probable diagnoses, it would also help physicians think more objectively about a particular case.

   While many are worried that these doctor-assistant applications will take away jobs from hard-working citizens, there is no substitute for personal contact. It is important that health care professionals see this as a tool and not as a diagnostician. Another issue is availability. As nextgov.com mentioned, WellPoint will be able to spread the potentially successful technology among 14 states, including California and New York. Although this is a good start, it is the rural, highly populated areas of the Midwest who have the most to gain from this technology. Currently, the focus is on improving health care instead of improving the sectors that already lack quality health care.
   While it is true that Watson technology will potentially improve diagnosis and treatment across the nation, it also has the ability to change the culture of rural medicine. It is important to realize that most members that live in rural communities are at a severe health care disadvantage. The physician-to-patient ratio is particularly low. Furthermore, most physicians in rural areas are family practitioners and many of their patients are not able to afford multiple visits to specialists on a regular basis. This is where Watson can make a difference. And, hopefully, its potential will become a reality within the next few years.