Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat India.

BACKGROUND: Many low- and middle-income countries depend on emergency medical technicians (EMTs) nurses midwives and layperson community health workers with limited training to provide a majority of emergency medical trauma and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice nations leverage cellular phones and call centers for real-time online medical direction. However there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat India. METHODS: A convenience sample of practicing EMTs in Gujarat India were surveyed regarding the barriers to call initiation and completion. RESULTS: 108 EMTs completed the survey. Overall ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician despite attempts at least once a week. CONCLUSION: This study identified multiple barriers to communication including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.