title: Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Stanford University School of Medicine.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lindquist
authors.affiliation: Department of Emergency Medicine, Stanford University School of Medicine.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Strehlow
authors.affiliation: Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute.
authors.forename: G V Ramana
authors.initials: GV
authors.lastname: Rao
authors.affiliation: Department of Emergency Medicine, Stanford University School of Medicine.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Newberry
keywords: ems; global health; international medicine; prehospital emergency care