Getting used to the Rural Setting

[redhead_emt2luv_angel]

I am not used to a rural setting. This is all new to me. I am used to bigger cities and running strictly als trucks. Rural settings are soooooo different. We are an hour either way you go to the closest hospital. And were we live we have winding curvey roads so the accidents here are not the BS you usually see in the big cities 75% of the time. They are BAD accidents so we do a lot of fly outs. My husband is stationed is this LITTLE BITTY town that know one knows of with not even a Wal- Mart. SO that ought to tell you just how little this place is.

[Arizonaffcep]

I have always preferred rural EMS over city EMS. Longer contact time, greater skills usage (when called for), greater need to think on your feet, be creative, etc etc. None of this, "well, just transport and let the hospital figure it out" crap you see in the cities all too often. You really want a fun time? Work for a long distance interfacility transport company. Wow...when I was part time for one, I can't tell you how many times we got REALLY SICK Pts that needed to go to Tucson for higher level of care (ICU/Trauma, runny nose, whatever, we were stationed about 2.5 hrs SW of Tucson). We had one guy who was shot multiple times in the chest, post traumatic arrest (Sierra Vista managed to get a pulse back). It was monsoon season and the helicopters were all grounded at the time, so flight=not an option. The guy managed to code again south of Benson (still about an hour & 15 or so from UMC-area Level 1). Well...needless to say, he didn't fare well . But it was fun...and quite a test of skills.

[Dustdevil]

Red, regardless of your education, it is time to seriously elevate it. As you have discovered, remote rural practice is not the same as urban, just longer. It is a whole 'nother game. It's no longer acceptable to just label every belly ache as "abd pain", give them an IV and O[sub:bbd9f5591c]2[/sub:bbd9f5591c], and then stare at them for the next two minutes. When you've got half an hour to two hours at a patients' side, you should expect a lot more from yourself. You need to be doing a much more thorough history and physical assessment in that time than you did five blocks from the hospital, and coming up with more accurate and relevant diagnoses. This is imperative, because you have to make intelligent and informed decisions on who gets flown out and who will do just fine at the local community hospital. If you fly someone who didn't need it, because you did a cookbook urban medic assessment on them, and that bird goes down, you've got the blood of four lives on your hands.

The purpose of EMS is more than transportation and CPR. The purpose of EMS is to bring the hospital to the patient. We don't do that in urban practice, nor is it usually necessary. But in your new position, you are going to literally forget almost everything you thought was correct, and totally reinvent your practice standards in order to do it competently. The best way to do that is to start with education. That means if you do not already have a degree, you need to immediately start working on those classes that lead to one. Those classes are not just a bunch of basket-weaving, as those idiots who are afraid of education often claim. They are the scientific foundation for medical practice that every medic should have before ever spending day one in paramedic school, just like every other medical profession in the country does. All that A&P and microbiology and chemistry and psychology gives you the intellectual tools to elevate your practice standards from a technical level to a professional level. If you do have your degree, there are still plenty of other courses that will contribute to your professional knowledge base to be had, both college and continuing ed. Take them. Urban EMS is not the "big time". Remote rural practice is the "big time" of EMS. It requires the most education, knowledge, and experience to perform competently. Much more so than urban practice. So please do not assume that you've paid your dues in urban EMS and that now is the time to relax and rest on your laurels. If you do nothing but continue to practice the way you always did in urban EMS, you will suck. But from what you have posted here, I feel confident that you recognise that and will rise to the occasion. Good luck, and welcome aboard!

EDIT: Okay, I just saw in the other thread that you are only an EMT. :shock: Since you said you were used to running only ALS trucks, I assumed that meant only ALS personnel, meaning you were a medic. If you are working rural as an EMT, with no medics around, that would explain why you are flying so many patients out. I certainly hope that you plan to change your educational status very soon. EMT is not a career. And ambulance drivers are not enough for people over an hour from the nearest hospital. I hope it is your personal desire and goal to give your community the very best that you can offer them. And that means getting a professional education, starting today. Again, best of luck in your new position!

[sirduke]

WTF? Dust and I agree on something again???? Holy Dog Strudel Batman !!!

Yep, Rural EMS is where the rubber meets the road. Longer time to the hospital means more time spent treating your patient, instead of tossing them in the truck and running around the corner to the ER.

I would rather slit my wrist, strap on dynamite and walk into an embassy than work urban EMS, but hey, thats just me.

The first and foremost importance is to continue your education, become the best you can possibly be, and use what you learn to provide quality care for your patient. Don't stop at the EMT level, be it Basic or Intermediate, because unless you are just in it for the lights and sirens, you will quickly become frustrated at both your lack of knowledge and lack of ability to treat your patient.

And that is exactly what you should be in this profession for, the patient, because the money damn sure isn't the attraction.

Anyway, welcome to the City.

Peace

Out

[defib_wizard]

sirduke wrote

because unless you are just in it for the lights and sirens,

Hopefully you lose that in your 2nd or 3rd 45minute response to the middle freaking nowhere at Oh dark-thirty

[rock_shoes]

sirduke wrote

Hopefully you lose that in your 2nd or 3rd 45minute response to the middle freaking nowhere at Oh dark-thirty

I lost that on the first one. A two hour L/S transfer is grating as all hell to drive. I'd much rather be in the back in those circumstances.

[Dustdevil]

Yeah, the only time I use the siren in a rural system is when going past cows.

Gotta take entertainment where you can find it in rural EMS!

[mstovall]

The sirens also do a good job of scaring away deer. You just have to watch out for the suicidal ones. The ones that go straight away from you and then turn 90 degrees into the side of your truck.

[firedoc5]

I started out in a rural area. About three years ago moved back to that same little town. It's got one gas station, one grocery, two diners, no traffic lights. The pop. here is about 350, including cat's and dog's. There's only one BLS ambulance covering the entire north end of on of the largest counties in IL. So a lot of road time. Many "bad" MVA's and farm accidents around here.

You do have to think on your own. Luckily there are a few EMT-A's scattered around that can be used as First Responders and that helps a lot.

It can get old after a while, I know that. They may get 300 calls a year. I know if someone goes from a busier system/ area it can be a culture shock.

Right now they are advertising for drivers and EMT's. I told them I'd be interested in driving, but they never got back to me. I guess they don't want someone with my experience to come in. Maybe they are paranoid that I'd take over or something. It's the same service I was first an EMT with. Who knows in these little bitty towns.

[rock_shoes]

Yeah, the only time I use the siren in a rural system is when going past cows.

Gotta take entertainment where you can find it in rural EMS!

I wish I had that choice. For us if the lights are on the siren must also be on. No exceptions. The siren controls get pretty hot by the end of it. Overall I like working rural. There is lot's of time to do a really thorough assessment and actually understand what's going on with your patients. The flip side is low call volume and hours of waiting for calls to come in. You need to be vigilant to stay on your game.