Introduction: Rural emergency departments (EDs) are important safety nets for 20% of Canadian citizens. In Quebec, the province’s 26 rural EDs treat an average of 19,000 patients/year and are on average 300 km from levels 1 and 2 trauma centers. These distances signify that Emergency Medical Services (EMS) play a considerable role in the care of rural patients. EMS in Quebec province are private local services. There are no published reports on EMS in rural Quebec. As part of a larger study on rural emergency care, this descriptive study aimed at offering a comprehensive portrait of EMS. Methods: We conducted semi-structured interviews with managers of all paramedic services in rural Quebec. Interview questions focused on number of transports, training, availability of telemetry, GPS technologies, and work schedules. Results: Fifty managers of the 51 private companies serving the 26 rural EDs in Quebec were interviewed (response rate 98%). All were primary care paramedics (PCP). In 2010, EMS transported 40,671 patients, with 10,228 emergency transports to the rural EDs. A total of 7956 inter-facility transfers were conducted, 1499 of them emergency. Each ED required between 88 and 700 inter-facility transfers. A total of 60% (n=31/51) had GPS technology, only 25% (n=13/51) had telemetry features. Work schedules varied with 13% (n=7/51) of companies offering shifts of less than 12 hours, 28% (n=14/51) 24/7 weekly shifts, and 56% (n=29/51) a combination. Conclusion: This is the first study to describe rural EMS in Quebec. The finding that Quebec’s rural EDs are served by 51 privately-owned companies is unique in Canada. The considerable number of EMS transports, including inter-facility transfers, may reflect lack of local resources in rural EDs, the vulnerable population served, or the increased trauma risk in rural areas. Future studies should examine inter-facility transport reasons, costs, times and adequate training/scope of EMS practice.

Introduction: Rural emergency departments (EDs) are an important gateway to care for the 20% of Canadians who live in rural areas. We recently reported that fewer than 15% of rural EDs in Canada have access to a CT scanner. Lack of CT scanners in rural hospitals can result in frequent inter-facility transfers and delays in diagnosing and treating life-threatening conditions. No recent study has examined this issue. Objective: With a future larger study in mind, we did a pilot assessment of inter-facility transfers for CT scans from one rural ED and evaluated the quality of the data and feasibility. Methods: This pilot study was part of our province-wide study on rural emergency care. Criteria were having 24/7 physician coverage and acute-care hospitalization beds. The hospital was also selected for its proximity and local interest. Two medical students collected data from hospital databases to determine annual number of ED visits, ED transfers, proportion of transfers for CT scans, reasons for examinations, and transfer times from April 1, 2010 to March 31, 2015. Descriptive statistics were reported as well as data quality and feasibility indicators. Results: For each year from 2010 to 2014, there was an average of 13,341 ED visits, 444 inter-facility transfers, and 125 CT scans. Over the five years an average of 28% of the inter-facility transfers were for CT scans, and the majority were abdominal CT scans. Inter-facility transfer data was 100% accessible through hospital databases but inter-facility transfer times and final diagnoses were not. Conclusion: More than a quarter of inter-facility transfers were for CT imaging. The limited electronic data in this Quebec rural ED precluded analysis of inter-facility times. While further cost-benefit analysis is required, preliminary data suggests local CTs may save time, money and lives.

Introduction: Trauma is the leading cause of death among people under 40. With more than 7 million Canadians living over one hour’s travel from a level 1 or 2 trauma center, access to quality trauma care in Canada is a major concern. We recently reported that more than 40% of rural EDs across Canada were more than 300 km from levels 1 and 2 trauma centers. Direct transportation to trauma centers is therefore unusual and most trauma cases are initially managed in rural EDs. Assistance from trauma centers via telemedicine could thus be valuable in optimizing initial stabilization and inter-facility transfers. Objective: Is telemedicine a potentially effective intervention for improving rural trauma care? Methods: We conducted a literature review to examine the potential impact (number of transfers, transfer times, length of hospital stays and mortality) of telemedicine on rural trauma care. Two reviewers independently searched PubMed, Embase and Cochrane databases with key words / concept combinations: telemedicine, trauma and rural. Articles included in the final review had to address the question with specific methodologies. After duplicate removal, 312 articles were found relevant. After independent review of titles and abstracts, only 25 articles pertained to the specific question. Only three studies met inclusion criteria. Results: These studies reported 187 successful teleconsultations in the context of rural trauma care, 29 of which involved significant interventions (8 interventions potentially lifesaving). Some unnecessary inter-facility transfers were avoided. However, transfer times to trauma centers and length of hospital stays appeared slightly longer with telemedicine. Conclusion: The literature on the efficacy of telemedicine in trauma care is scarce, with only three studies addressing the question. Conclusions generally favor telemedicine, but additional research must should determine its impact and better understand the barriers/facilitators to the implementation of telemedicine for rural trauma care.