RURAL ERS BETTER IN QUEBEC THAN ONTARIO

Rural emergency departments in Ontario have dramatically fewer CT scans, specialists and nearby intensive-care units than those in Quebec, suggests a new study that adds to evidence of wide quality gaps in Canada’s emergency health care.

The findings parallel a similar disparity the researchers discovered earlier between rural ERs in British Columbia and Quebec.

They are now studying whether that lack of specialists and equipment affects the number of non-urban Canadians who die from trauma, stroke, heart attack and severe infection. The early results are “concerning,” said Richard Fleet, a Laval University emergency-medicine professor who co-authored the newest research.

“In a rural emergency department, people actually save lives by working as teams,” said Dr. Fleet, who practised in a small-town B.C. emergency department before heading to Quebec. “For emergencies … it’s really good to have these backup systems in house.”

One prominent rural ER physician in Ontario rejected the notion that his province’s departments are inferior, saying the focus is more on sending the sickest patients to big trauma centres.

Across the country, however, wide variations in emergencydepartment standards definitely do exit, said Alan Drummond, a spokesman for the Canadian Association of Emergency Physicians.

“It’s a crapshoot, when you go to any hospital in this country, in terms of what you’re going to get in the type and quality of care,” he said. “We have national variability and for 23 per cent of Canadians (who live outside cities), that’s unacceptable.”

About 6 million Canadians live in rural areas, tend to be older on average, have greater health needs, and are more likely to suffer traumatic injury, partly due to the prominence of dangerous professions like farming and logging.

Fleet became interested in the relative quality of emergency service after cutbacks meant his former hospital in Nelson, B.C., could offer only “bare-bones services to a high-risk population.” He lobbied for additional funding, but realized there were no published data comparing different Canadian emergency departments.

In the most recent study, just published in the journal PlosOne, he and colleagues looked at rural departments with 24/7 service and an ability to admit patients to acute-care beds in their hospitals — 26 facilities in Quebec and 62 in Ontario.

If anything, the Ontario ERs appeared more isolated on average, with a greater percentage of them being at least 300 kilometres from a trauma centre.

Yet 92 per cent of the Quebec emergency departments had a local intensive-care unit, compared to 31 per cent of the Ontario ones. Just over 80 per cent of the Quebec ERs had a general surgeon available on call, versus a third of the Ontario emergency departments.

Fleet said he is not sure why Quebec’s rural ERs are better equipped, given the provinces’ spending on health care is similar per capita. It may relate to the fact its rural hospitals have fewer foreign-trained doctors, who may feel less empowered to demand better facilities.

But Drummond said Ontario has a different protocol that ensures rural ER physicians are well-trained to provide basic emergency services — such as treating shock and blocked airways — and emphasizes funnelling critically ill patients to trauma centres in larger cities. The province’s CritiCall system helps rural hospitals find facilities that can take their patients.

However, he agreed that having a CT scanner is now crucial to emergency departments anywhere making accurate diagnoses; the one his hospital in Perth, Ont., acquired five years ago “changed the way we practice.”

Just nine of 62 full-time rural Ontario departments had a CT scanner, according to the new study.