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AAP: Pediatricians in rural areas valuable resources in emergencies
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In the United States, more than 40% of community hospitals are considered rural, and 42% of the US population lives in nonmetropolitan areas, 25% of which are rural.
Pediatricians can play a key role in the development, implementation and ongoing supervision of emergency medical services for children (EMSC) because pediatricians may represent the sole source of pediatric expertise for a large region, according to a recent AAP policy statement.
The AAP said pediatricians can develop strategies for outreach to rural areas and assist with organization of pediatric emergency care. Members of the AAP Committee on Emergency Medicine, led by Brian Moore, MD, and Robert Sapien, MD, included in the policy statement four primary actions for rural area pediatricians. First is to advocate for legislative initiatives that support EMSC that meet the needs of children and pediatricians, especially trauma services. Second is to participate in and work cooperatively with local EMS agencies responsible for local system design and development. Third is to provide guidance regarding recruitment and retention of EMS providers and primary health care professionals of all types who have pediatric training. The fourth action recommended in the policy statement is for pediatricians to develop awareness of rural EMSC issues for American Indian/Alaska Native communities.
“Pediatricians can play valuable roles in ensuring access to high-quality and comprehensive care for children in rural communities,” the policy statement read.
Perspective
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William T. Gerson, MD
Keeping abreast of AAP policy statements is a full time job. While I am sure that I am not alone in carefully reading only a fraction of these reports published monthly in Pediatrics, the policy statement from the Committee on Emergency Medicine of the AAP on the role of the pediatrician in rural emergency services for children is exceptional.
Pointing out the unique expertise of pediatricians, the report outlines both the challenges of urgent care of children in rural areas, including care in Native communities, and the opportunities where community-based pediatricians can provide leadership roles at the community and regional levels. Placing the pediatrician in his or her critical position as both a provider of direct care and advocate for all children, while at the same time acknowledging their special skills and knowledge, the report sets an agenda for an enhanced model of health care that applies not only to the field of emergency care. This is the correct strategy at the right time and in the best way forward as an attempt to enhance the well-being of rural children in our nation. Living in a rural state, I can attest to both the special nature of rural emergency health care needs – from the differing nature of trauma, distances to and capabilities of rural emergency services, and to the key leadership role of local pediatricians and regional institutions.
Leveraging the expertise of regional children’s hospitals, utilizing telemedicine, enhanced techniques for EMS and local and regional transport of critically ill and injured children, and advocating at all levels for such investment is an important step in a comprehensive effort to raise the level of attention for a children’s agenda.
The current report not only clearly identifies the issues, the key players, and the systems needed to move forward, it also provides the data and supporting documentation to in fact carry forward a potentially better practice model for rural emergency care. I applaud the careful and well-crafted report particularly its grounding on a community-up solution.
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