Training emergency medical services (EMS) workforce is challenging in rural and remote settings. Moreover, critical access hospitals (CAHs) struggle to ensure continuing medical education for their emergency department (ED) staff. This project collected information from EMS and ED providers across Nebraska to identify gaps in their skills, knowledge, and abilities and thus inform curriculum development for the mobile simulation-based training program.

The needs assessment used a three-step process:

1. Four facilitated focus group sessions were conducted in distinct geographical locations across Nebraska to identify participants' perceived training gaps;

2. Based on the findings from the focus group, a needs assessment survey was constructed and sent to all EMS and ED staff in Nebraska; and

3. 1395 surveys were completed and analyzed.

Thematic areas of training gaps included cardiopulmonary conditions, diabetes management, mass casualty incidents (MCI), maternal health and child delivery, patient assessment, pediatric care (PC), and respiratory emergency care. Gaps in non-clinical skills were related to crisis management such as maintaining effective teamwork.

Participants frequently identified cardiopulmonary care, PC, and MCI as highly needed training. Other needs included life support-related retaining courses, sessions informing protocol updates, the availability of retraining tailored for rural areas, substance use-related emergencies, and farming-related injuries.

Skill gaps and training needs

EMS and ED staff identified several skill gaps and training needs in the provision of emergency services in rural communities. These results allow for the development of customized training curricula and, with the help of an on-site simulation-based program, can identify gaps in health professionals' skills, knowledge, and abilities and thus help them respond to acute healthcare needs of rural communities.

Few prior studies have undertaken a needs assessment of emergency services providers in predominantly rural states. In Nebraska, many EMT providers are volunteers and have limited access to resources, experience in applications of skills, and training opportunities to maintain or improve their clinical and non-clinical skills.

Similarly, many rural ED staff may not receive many opportunities to address complex or challenging cases requiring emergent care. The inferences from focus group discussions and survey highlight a clear need for clinical and non-clinical training to ensure the effectiveness of the emergency services workforce.

The findings of our study are not just limited to rural Nebraska but might also be applicable to other rural areas in the USA as well as the world. These results provided the basis to develop customized training curricula for EMT and ED staff in rural areas delivered through an on-site state-of-the-art mobile simulation-based program.

Such method of delivery might be a model for colleges and other training programs to build capacity and be responsive to ongoing and unique needs of the healthcare workforce in rural communities.