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How far to the ER?


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Hey folks

Over the past year I have been working at stations that are extremely rural, as in buried at the end of a road that has no exit. Some of these are in communities that nominally have hospitals with ERs, but they are not designated trauma centres by any stretch, and one of the stations is in a community with no hospital, no Doc, no clinic, and is 150 kms away from the nearest hospital. Very few of the roads are paved, and northern gumbo is nasty stuff.

As a result, transport times are often in the 2 hour range, and every call is a minimum of three hours unless there is a refusal or DOA.If the pt requires higher level care, we are often on the road for ten hours or more per call.

I am curious if there are other places besides Northern Alberta with similar conditions. and how you deal with this, including the boredom in the back for the attendant and the patient, or the stress of treating/transporting a red or a yellow in a BLS unit for that length of time.

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I am curious if there are other places besides Northern Alberta with similar conditions. and how you deal with this, including the boredom in the back for the attendant and the patient, or the stress of treating/transporting a red or a yellow in a BLS unit for that length of time.

MedicNorth, you are not alone. I work for a rural service in a county that is 950 sq miles (I'll let you do the conversion) with 4 stations. Within our county we have a couple of small ERs, but none that would be indicative of a Trauma I here in the states. To get to the closest apporpriate trauma center is somewhere around 90 miles (or around your 150 km). So, you see, we are in the same boat in regards to the transport time.

How do we deal with this? Well, we fly them if we can and we drive them if we can't. If this patient is requiring transport to a trauma facility, then there is no opportunity for boredom. We usually have our hands full. But, we do have a paramedic in the back and an EMT driving, so we just treat/transport to the best of our abilities. Any "down" time is spent on doing the patient care report so that we have a good handoff upon arrival as well just getting the paperwork done before we return to county. (We have a short report that is handwritten for the receiving facility and then the long report is done on the mobile computer.)

Toni

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Take turns with driving vrs attending is one thing you can do if you are both qualified.

Assuming this is a critical patient, would there be a need during a 2 hour drive?

Also, how would you do the paperwork? I'm under the mindset that if I start with the patent, I should end with the patient.

Not to mention...how do you explain to the non-critical patient, "I'm bored and will now be switching with my partner. It's been fun, though."

Toni

Edited by tcripp
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Not to mention...how do you explain to the non-critical patient, "I'm bored and will now be switching with my partner. It's been fun, though."

Tell them it's the law. Thanks to the news, most people are accustomed to there being legal limitations on professional drivers, pilots, train motormen, etc... They'll be glad you're being careful.

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Tell them it's the law. Thanks to the news, most people are accustomed to there being legal limitations on professional drivers, pilots, train motormen, etc... They'll be glad you're being careful.

But, the OP only asked about being bored in the back. He implied nothing about the length of drive on the driver...which he stated was a 2 hour drive. One would think the exchange in driving would occur on the return trip.

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Most of our transports are 15-20 minutes, a few are half an hour, but a couple of the rural stations have transport times of 45 minutes. The total call including scene time, transport, triage generally runs 90 minutes. These calls aren't generally problematic. In the event of boredom: do paperwork, make small talk, or if they want to rest let them sleep, dim the lights and enjoy the quiet yourself.

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At my rural post, if the helicopter can't fly, we are 1.5 to 2 hrs from the level 1 hospital. There is a band aid hospital down the street from the station and two level 3 hospitals within 30 to 45 minutes.

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Medevac is sometimes a possibility, but it is rather difficult to justify fixed or rotary for every call, or we would need an aircraft posted at the station.... I guess a case in point is that uyesterday I went 16 hours straight out, drove almost 900 kms, all for three calls! During this time the other crew ran 3 more, so there would have been 6 flights out of here in less than one day. Ground is likely going to continue to be the main process, I would imagine.

I have considered bringing my portable DVD player and mounting it in the unit so the pts, especially some of the peds ones, can watch something during the trip. While it might not be acceptable to the "big guys", it would possibly help with patient comfort and happiness!

Edited by MedicNorth
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