Emergency Medical Services in American Indian Reservations and Communities: Results of a National Survey

Quick, Kathryn; Dufour, Sara; Narváez, Guillermo · 2019 · ROSA P / Roadway Safety Institute

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Summary

This exploratory study investigates the quality of Emergency Medical Services (EMS) response to motor vehicle crashes (MVCs) in American Indian reservations and communities. The research was motivated by the disproportionately high MVC fatality rate among American Indian and Alaska Native (AIAN) populations, with approximately 656 annual fatalities reported in tribal areas. Prior to this study, no systematic research had identified specific EMS deficiencies in these regions, despite tribal transportation professionals raising concerns about slow response times and dispatch issues. The study aimed to scope these challenges to inform future policy interventions and deeper research. The authors conducted a national online survey of 189 transportation safety specialists, including tribal government employees, first responders, and state-tribe transportation liaisons. The survey assessed perceived EMS quality across multiple dimensions: 911 access and dispatch, responder training and equipment, accessibility of crash sites, distance to hospitals, and inter-jurisdictional coordination. Respondents also compared EMS quality in reservations to surrounding non-reservation areas and provided data on response times. Key findings reveal significant bottlenecks in the EMS chain of care. The most critical concern was dispatch; only 42% of respondents agreed that cell phone coverage was adequate to place a 911 call, highlighting a fundamental barrier to initiating response. Regional disparities were statistically significant, with participants from the Pacific Northwest and Alaska expressing greater concern regarding EMS equity and timely access to emergency rooms compared to other regions. Additionally, a distinct perspective gap emerged based on affiliation: respondents working for tribal governments were significantly more optimistic about EMS adequacy, dispatch accuracy, site accessibility, and airlift options than those without tribal affiliation. For instance, 68% of tribal affiliates deemed EMS response adequate, compared to only 40% of non-tribal respondents. The study concludes that EMS response is a high-stakes factor in AIAN roadway safety requiring targeted intervention. The authors recommend prioritizing research on dispatch infrastructure, particularly cell coverage and location pinpointing, as this is the primary failure point. They also suggest focusing on the Pacific Northwest and Alaska due to elevated concerns in these areas and investigating the reasons behind the optimism gap between tribal and non-tribal stakeholders. Finally, the authors emphasize the need for improved inter-jurisdictional coordination and clearer geographic definitions of "American Indian reservations and communities" to enhance data consistency and policy effectiveness.

Key finding

Study participants demonstrated notably low confidence in cell phone coverage for placing 911 calls, with only 42% agreeing that signal was adequate, and respondents from the Pacific Northwest and Alaska reported statistically higher concerns about EMS response times and hospital access compared to other US regions.

Methodology

survey

Sample size: 189

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

Topics

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• post crash care delays
• demographic disparities