Let's play swap the location...

[stcommodore]

I believe after working urban EMS for 1 1/2 yrs that besides the protocals, and logisics of the system you could do the job in any city. I think that in a disaster/nims sense its been tested and would love to see what you all think.

I may not know the radio lingo, streets of your city or hospitals but drop me in NYC with my partner, my truck, a good map/gps program, and field guide to the hospitals and we could go to work.

[Timmy]

And the point of this is?

[scubanurse]

I don't get it either?

I think the idea that with NIMS it should be possible to go anywhere and work? But that is not really the point of NIMS..its for inter-agency cooperation and structure I believe... did you have a question? Or was that just a statement of fact?

[FireMedic65]

I think the point is taking one ambulance from one area, and putting it in another area. Say ambulance A is on a long distance transport because of weather or something. Ambulance B gets called into ambulance A's area to cover a call. Ambulance C covers B. There is an accident, and 5 ambulances are needed. Now they are all coming to an area they aren't familiar with.

That being said, in Pennsylvania, even if an ambulance takes a call into a different region where the scope/standing orders are different, they still act under the guidelines from which they came. They do not have to change everything just because they crossed a line.

[stcommodore]

Sorry if my late night ramblings didn't make sense. Basically I feel urban ems is so similar that it doesn't matter what city your in you could function. Along those lines there wouldn't be the same sucess in suburban or rural to urban.

[Kiwiology]

Depending on your current system you might find it a bit difficult working in my city, our system has no online medical control to speak of and no particular desire to change.

.... and we don't have to transport everybody!

[scubanurse]

Sorry if my late night ramblings didn't make sense. Basically I feel urban ems is so similar that it doesn't matter what city your in you could function. Along those lines there wouldn't be the same sucess in suburban or rural to urban.

EMS is EMS... you will still treat someone with chest pains the same way regardless if you are rural or urban. Protocol is protocol. Now if you're super rural you will have more time with the patient so it may seem like you are providing different care, but you're still following the same chest pain protocols. Nitro, Oxygen, ASA, Morphine, Monitoring... You will still treat a trauma patient the same way, ABC's, spinal precautions, etc... so I really don't see where you are trying to go with this whole urban vs. suburban vs. rural...

And quite possibly I could be wrong, but I've worked urban and suburban and wilderness and I used the same knowledge in all three, just a few modifications for location and distance from a hospital...

[HERBIE1]

I disagree about this. Treating the patient wouldn't be the problem, but every area has hazards unique to them and you need at least someone familiar with these issues. Known drug houses, areas with active gang wars going on, hazards of drug houses, meth labs, drug farms, farm machinery incidents., etc.

Would a rural medic understand about a kill zone when knocking on a door of a house in a ghetto area? Would a city medic understand about how a combine works if you had a person entrapped in that machine?

Obviously you learn these things, but simply treating the patient is only part of the equation here. Scene safety and situational awareness is only as good as your knowledge of what the potential hazards may be.

[fireflymedic]

I'm with Herbie - every place has it's own unique challenges. I took you into some of the areas I worked and you'd be lucky to get the people to say two words to you once you opened your mouth because they knew you weren't from there. I love rural EMS for a number of reasons and I have no desire to move out of it any time in the near future, but I did flip sides of the fence to urban for a year just for kicks and giggles to see how I'd like it and how different it was. Boy was I in for an eye opener - big difference there ! Going from 45 min to do what's needed to 5 min to the hospital is a different animal. I didn't care much for it, but I've had people from the city come ride with us and they can't stand it. it's just a different animal.

Good thing we have all different types of people because otherwise we wouldn't have all areas covered. I encourage students to ride in both rural and urban just to see what the differences are and what is a good fit for them. Makes you appreciate your own more when out of your comfort zone, but makes you grow both personally and professionally.

[FireMedic65]

I disagree about this. Treating the patient wouldn't be the problem, but every area has hazards unique to them and you need at least someone familiar with these issues. Known drug houses, areas with active gang wars going on, hazards of drug houses, meth labs, drug farms, farm machinery incidents., etc.

Would a rural medic understand about a kill zone when knocking on a door of a house in a ghetto area? Would a city medic understand about how a combine works if you had a person entrapped in that machine?

Obviously you learn these things, but simply treating the patient is only part of the equation here. Scene safety and situational awareness is only as good as your knowledge of what the potential hazards may be.

Very true. But every provider should know about the "kill zone". You should always approach the entry from the side, and not right in front of it. Pretty sure they still teach that.

As for combines, or any other machinery/equipment. No one should attempt to mess with them unless they are familiar. Just because you are from the city, doesn't mean you are oblivious to how things work outside of a car/truck. It is mostly common sense on how to turn such equipment off.

The other things, I do agree with though. Knowing your area makes it safer for everyone.

There was a time when I had to transport a patient to a different hospital, and on the way, the highway was blocked off because of a house fire. The firefighters drug the 5inch across the road. Dispatch knew there was a fire, they knew we were going that way but nothing was said. Thankfully my driver knew a back way around the incident and we made it to the hospital before the patient stopped breathing and flooded the ambulance with sweat (his mostly). If there had been a different driver, we could have been screwed. No one directing traffic, no one doing the detour crap. Now with GPS for those who have it, that wouldn't have been too much of a problem other than being annoyed by other peoples ignorance. Just an example of how knowing your area will greatly benefit your patient.