Problem Addressed: Rural Emergency Medical Services Access

Healthy People 2010 Objective: 1-11

Web Address: www.citmt.org

SNAPSHOT

Providing continuing education opportunities, training, and improved communication are challenges to the provision of emergency medical services across the nation, but they are particularly challenging in remote areas. The TENKIDS EMS Computer Network was established to address this challenge in Montana. The three primary objectives of the network are to provide educational opportunities for remote and volunteer emergency medical services (EMS) providers, to improve patient record keeping and the aggregation of those data for epidemiologic and administrative purposes, and also, and to improve the communication among and between the providers and state-level authorities. The project covers the entire state of Montana, where extremes in weather, terrain, and travel distances to continuing education opportunities isolate many providers.

THE MODEL

Blueprint: A number of organizations contribute to the success of this network. The Critical Illness and Trauma Foundation (CIT) provides leadership, oversight, equipment acquisition, and some technical assistance. Burns Telecommunications Center at Montana State University aids in distance learning, technical assistance, and software support. The Emergency Medical Services and Injury Prevention Section of the Montana Department of Public Health and Human Services helps in equipment upgrade and software support. Finally, there are 123 emergency medical services agencies with over 4,000 members (85 percent of whom are volunteer) serving communities across the state. The network primarily targets EMS providers across the state of Montana, particularly those in the most remote areas. The providers use the information and technology to improve patient care.

The network provides asynchronous learning opportunities via interactive CD-ROM, web-based curricula, and web-cam interaction to responders in the field. The needs of the patient data collection system are met by providing a platform and necessary software. And, finally, an Internet-accessible bulletin board dedicated to Montana EMS issues helps to alleviate many communications challenges.

The backbone of the system is a multi-media personal computer placed at each ambulance service administrative office in the state. These individual computers are networked together by the Internet, and specific software and programs are provided for data collection and EMS education. The training and communications intervention occurs at the ambulance station, or in some cases, on the individual EMS provider’s home computer. The data collection intervention occurs only on the computer at the ambulance station.

Making a Difference: More than 3,000 EMS providers have participated in some form of training using the TENKIDS infrastructure. Data collection processes have begun, and dozens of providers each week utilize the TENKIDS bulletin board system as a routine communications venue. The TENKIDS network has been featured in the premier EMS trade journal, and two peer-reviewed articles have confirmed the efficacy of the project.

Beginnings: In 1995, the Office of Rural Health Policy awarded the Critical Illness and Trauma Foundation with a half million-dollar grant, while the Montana EMS and Injury Prevention Section also received funding. The problems to be addressed were identified through focus groups at various EMS conferences and through feedback provided to the state EMS office and CIT. Working together, project leaders built the infrastructure of the TENKIDS electronic community, installing computer hardware and software in every licensed ambulance service in the state. The Burns Telecommunications Center at Montana State University – Bozeman made access to the electronic bulletin board possible, therefore allowing for the exchange of on-line information. Continuing education is achieved through the development of interactive CD-ROM programs, with electronic patient care records making up the final component of the system. The installation of data collection software allows for ambulance services to analyze local patient care information, as well as to share data that will provide the first statewide information about pre-hospital emergency care.

Challenges and Solutions: High turnover rates among volunteer EMS personnel make the need for ongoing training and technical support ever-present. This has been overcome by periodic “circuit rider” events where technology training is taken to the local level so as many EMS providers as possible are aware of and able to use the network. A second challenge is keeping the network technologically up-to-date. This has been accomplished by building support for the system into a myriad of grant applications and other opportunities. Currently, the network is on its third generation of desk-top computers, and more than a dozen EMS-specific training programs have been developed and delivered over the network.

Other than technology updates and the need for ongoing technology training, both of which are supported through external funding resources, the overall maintenance of the system has been relatively inexpensive to maintain. Program staffing is provided via one paid and one donated staff member (each 50 percent time) and six to 10 volunteer staff. National and state publications, feature articles for various levels of media, professional meeting presentations, and “circuit rider” technology training all serve as a means to promote the network and increase awareness of it. The network has also received national recognition through the Peter F. Drucker Foundation for its non-profit leadership and internationally through the Stockholm Challenge for innovative technological applications.

PROGRAM CONTACT INFORMATION

Nels D. Sanddal, MS, REMT-B

Critical Illness and Trauma Foundation

300 N. Wilson Ave., Suite 3002

Bozeman, MT 59715

Phone: (406) 585-2659

Fax: (406) 585-2741