The industry conversation about healthcare disparities in rural areas is an entrenched one. We all know the barriers at this point – the provider shortages, the difficulty in obtaining specialty care, the transportation burden that falls on patients who need to drive three hours to an appointment. Receiving skilled critical care at a tribal facility is an ongoing challenge.

But that’s the patient side. What doesn’t get acknowledged as much are the immense burdens shouldered by the facility staff.

Imagine you work as a Registered Nurse or Respiratory Therapist at a rural hospital or Indian Health Services (IHS) facility. Chances are, your unit is short-staffed, saddling you with long and arduous shifts. Every day brings new patients with critical needs. Some of them need treatment beyond your skillset, so your facility transfers them to other facilities. You’d like to update your skills with clinical training; you would welcome hands-on learning as you work side by side with top experts in your field. But that would require travel – possibly a day’s drive or even a flight to a distant teaching hospital. You’d have to leave your team even more shorthanded while covering childcare or eldercare. In short, it’s a tough barrier to get past.

Educational Barriers, Limited Treatment

This is a depressingly common scenario and the consequences are abysmal. The surrounding community loses faith in their hospital. Patients resent transfers to hospitals too far away for their families to visit. Medical staff lose confidence in their own abilities even as they exhaust themselves providing the best treatment they can to critically ill patients.

One obvious solution is bringing in locum tenens staff with advanced skills, but that’s a stopgap measure. A more constructive solution – the kind that drives lasting change – is onsite critical care training.

Here’s how onsite clinical education plays out at a hypothetical tribal facility treating COVID-19 patients. A Critical Care Response Team (CCRT) arrives at the facility and provides reference guides, protocols, care checklists, and hands-on training.  This begins with admission criteria and then moves into the protocols for patients who require oxygen therapy and patients who don’t. Staff learn how to perform intubations, administer COVID-19 medications, assess and treat hypoxia, manage patients on ventilators, and administer Monoclonal Antibody Therapies.

Patients with COVID-19 receive top-notch care – not just while the visiting team is in residence, but after they leave. The facility staff learn new care delivery methods and feel more confident in their abilities. Patients receive care in their own communities and develop deeper trust in their local healthcare resources. Over time, the hospital improves its quality initiative metrics.

From Critical Care Training to Sustainable Transformation

As you might have guessed, Tribal EM CCRT teams are transforming IHS and 638 facilities with the exact scenarios described above. Tribal facilities asked us at the start of the COVID-19 pandemic to send out teams who could conduct hands-on instruction for their front-line professionals. Our healthcare staff include faculty who have taught in medical schools, teaching hospitals, military deployments, and the U.S. Peace Corps, so we immediately pulled together world-class critical care teams.

After we began flying out those teams to sites across the country, the demand rose sharply. Our CCRT teams increase staff competencies in treating critically ill patients, and they provide competency checklists, treatment protocols and reference guides to create an onsite critical care library. Currently we’re launching similar training programs in emergency medicine, behavioral care, family medicine, and other disciplines.

In short, these educational efforts with IHS and federal staff make transformation a reality – not a buzzword. By implementing new protocols that benefit patients and providers, we help connect tribal communities to advanced medical expertise. It’s been incredible to watch the hard-working staff at IHS and federal facilities learn new clinical skills and then turn that professional development into life-saving, compassionate care. Native American care disparities won’t be solved today or tomorrow, but these healthcare pros are determined to get there – and we’re determined to help in any way we can.