Evaluation of a Model for Improving Emergency Medical and Trauma Services for Children in Rural Areas

Study objective: To evaluate the effectiveness of a rural emergency medical and trauma services project in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. Methods: This prospective, quasi-experimental study used an untreated control group design with pretest and posttest of prehospital and hospital-based emergency care personnel in two rural counties in central Ohio. Project evaluation compared 50 emergency care providers from the intervention county with 43 emergency care providers from the control county. Changes in knowledge and confidence of these personnel in the assessment and management of pediatric emergencies were compared. Results: Providers in the intervention county demonstrated a significantly greater increase in test scores regarding knowledge of pediatric emergencies than did providers in the control county (P=.001). Significantly greater improvement was also seen when comparisons of test scores were made for field (P=.02) and hospital (P=.03) emergency care personnel separately. Self-reports on a visual analog scale indicated that providers in the project intervention county had a significantly greater decrease in anxiety than did control subjects when presented a scenario of a child experiencing a respiratory arrest (P=.01). On the basis of scores from a five-point Likert scale, emergency personnel in the intervention county had a greater increase in confidence regarding management of the pediatric airway (P=.0003) and a greater increase in the belief that they had adequate pediatric training (P=.000001) after participating in the project than emergency personnel in the control county. Conclusion: The rural pediatric emergency medical and trauma services project was effective in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. This project offers a model that can be replicated in other rural areas nationally. [Smith GA, Thompson JD, Shields BJ, Manley LK, Haley KJ: Evaluation of a model for improving emergency medical and trauma services for children in rural areas. Ann Emerg Med April 1997; 29:504-510.]