Emergency Medical Services in American Indian Reservations and Communities: Results of a National Survey

The focus of this exploratory study is emergency medical response (EMS) for motor vehicle crashes (MVCs) in American Indian reservations and communities. Tribal transportation professionals have raised questions about the role of EMS in the high MVC fatality rate - 656 annually - in these areas. We conducted a national survey (n=189) of tribal governments, first responders, and state-tribe transportation liaisons. They assessed factors in the quality of EMS response in their areas (e.g., 911 access, dispatch, accessibility of MVC locations, responders' training and equipment, distance to hospital; and inter-jurisdictional coordination). We recommend continuing research on MVCs specifically in American Indian reservations and communities. Specifically, more research is needed on dispatch issues (e.g., cell phone coverage and dispatchers' ability to pinpoint MVC sites) because this is study respondents' single highest area of concern, and the whole EMS response hinges on successfully placing a call for help. And, examples of productive inter-jurisdictional coordination need to be identified since tribes report vastly different experiences with this aspect of EMS system functioning. Two statistically significant findings merit further study, namely: a) heightened concern about response times and hospital access among responders from the Pacific Northwest and Alaska (compared with other regions); and b) higher optimism on all aspects of EMS response from study participants who work for tribal governments versus participants without that affiliation. Finally, it is important for researchers to communicate clearly about the geographic areas covered under "American Indian reservations and communities" in order to improve characterization of road safety and EMS issues.