Rural County EMS System--Scares me

[bbbrammer]

Very common where I work. I figure that is just something that people who live out in the middle of nowhere take on when they move there. Like not being able to just make a quick run to the grocery store and the like. Its understood.

[dzmohr]

I visited the county my Mother lives in over the Thanksgiving weekend. I am considering moving back there so I made a few inquires about the EMS system, and was scared by what I heard. The EMS system is run by the county and all ambulances stage out of the hospital. This could result in a25-30 min or longer response time to some areas of the county. I was told there are volunteer first responders throughout the county who will POV to scene to be there until ambulance arrives.

I know an EMT is not much above a FR, and I am not sure if the county ambulances are all ALS or a mix of ALS/BLS, but at least there is more equipment on the ambulance. I am a volunteer EMT, but at least in my county when you call 911 you will get an ambulance with at least an EMT on it within a reasonable response time.

Has anyone ever known of a similar system? Just curious to see what your thoughts are.

Sarge

Well now, THAT was an interesting read ( the whole thread, not any ONE post in particular)!!! Thru it all I never saw anybody answer your question, maybe I am not reading it right....but in case I am reading it right, here are some things to think about.... not knowing which County you speak of I will be general.

If the area is VERY rural with the low call volume that comes with that, ALS skill deterioration can be a problem. The more procedures you do, the more diagnostic experience you have, the better you will be, that is what experience is all about.(That is why I find rural trauma centers, often, laughable --- you need to have a volume of experience impossible for most small and even many large hospitals but that is an entirely different thread) So often hospital systems will use medics and EMTs to work in the ER ( plus they are cheaper then nurses) and often throughout the hospital. They might assist with deliveries in the OB unit ( then assist with deliveries in the shipping and receiving department.) They might get to tube in the OR, start IVs in the ER and on the floor...

Some hospitals base all their units at the hospital and respond out, though it makes more sense to me to rotate units so that some are out deeper in the county for response time and get rotated in to bone up on clinical skills. ( But remember, slave labor is cheap! So many keep ALL the units at base and working when not working.)

As for first responders, don't know the specifics of your County...some first responders ARE EMTs, some are even paramedics, the term MAY just mean they respond before the arrival of the medics.... others , as you note, are trained below the EMT level and, while I wish they would make the investment in time and resources to upgrade in many places that just does not happen for any number of reasons ( most that we would not like.)

The ONLY thing I will say about the urban vs rural responder, and it has NOTHING ( well not much anyway) to do with the silliness I have read in this thread is that I also have experienced both worlds and my hat is off to the rural first responder!! You guys ( and gals) do some AMAZING stuff with limited resources ( and sometimes resources that make me jealous, I am AMAZED by some of the monster medic units (Freightliners and beyond!!!) and equipment you guys have, shows how much the community loves you!!) I have to agree with Anatomy Girl ( yes I actually AM sucking up to her, I like the mental picture I have in my mind when I read her posts -- that is MY right as an American chauvinist!) -that in the rurals you have time to do more ... I may have run 22 calls per 24 hour shift average in San Diego, but I hardly ever had time to get a traction splint on while working a major trauma patient and the level of assessments you guys had time to do was pretty nice for me!

And I have read enough in other threads not to talk about the times we would do, out of necessity, things that would stroke out some of the medics I have read comments from here ( exceeding scope and all...did I say that??)

[dzmohr]

I visited the county my Mother lives in over the Thanksgiving weekend. I am considering moving back there so I made a few inquires about the EMS system, and was scared by what I heard. The EMS system is run by the county and all ambulances stage out of the hospital. This could result in a25-30 min or longer response time to some areas of the county. I was told there are volunteer first responders throughout the county who will POV to scene to be there until ambulance arrives.

I know an EMT is not much above a FR, and I am not sure if the county ambulances are all ALS or a mix of ALS/BLS, but at least there is more equipment on the ambulance. I am a volunteer EMT, but at least in my county when you call 911 you will get an ambulance with at least an EMT on it within a reasonable response time.

Has anyone ever known of a similar system? Just curious to see what your thoughts are.

Sarge

By the way, in the 80s and I believe up to the early 90s Denver General staged all their units out of the hospital ...hardly a rural system! ( Not that I ever understod the logic to it.)

[Dustdevil]

By the way, in the 80s and I believe up to the early 90s Denver General staged all their units out of the hospital ...hardly a rural system! ( Not that I ever understod the logic to it.)

Ah, but you DID understand the logic of it! In fact, you touched upon the logic in your last post when you talked of using slave labour to save money. Now, using that same logic, how much money do you think DGH saved by posting all their ambos at the hospital, as opposed to paying to establish stations around the city, or paying for the fuel to keep them on the road constantly? Pretty shrewd business logic right there. Stupid, but shrewd.

[dzmohr]

Ah, but you DID understand the logic of it! In fact, you touched upon the logic in your last post when you talked of using slave labour to save money. Now, using that same logic, how much money do you think DGH saved by posting all their ambos at the hospital, as opposed to paying to establish stations around the city, or paying for the fuel to keep them on the road constantly? Pretty shrewd business logic right there. Stupid, but shrewd.

Exactly!

[zippyRN]

That statement was not meant to offend any rural EMS providers.

The hospital does not care if your transport time was 2 hours or 10 minutes if the situation warrants the treatment, they are going to expect it to be performed.

utter grot

" we could get here quicker than it would take to do it on scene " is always an excuse for not doing somethign in thefield - as long as you genuinely mean it ...

[spenac]

We have areas that it atakes an hour or more to reach if we're at the station. if we're out and the mutual aid is available they have to wait more than two hours. And even with the 911 system we still have to get directions such as turn at the barking dog.

[EMT*Sweet]

I think I lost the meaning in all this....

I work as an EMT-I in an industrial plant.. I also work for a paid service(urban) and I volunteer with a Fire/EMS (rural) dept. Does it matter?? Not in the least!! I agree that there are differences in call volumes, scenarios, tempraments, Levels of training etc...but in the end we are all out there for the same reason. We all have our roles in the scenes we are called too and we all started out in the same place as Basics..

[spenac]

I think I lost the meaning in all this....

The OP was trying to help people understand just how scary rural EMS is. Honestly if more people understood that they actually will not get an ambulance within 5 minutes like they do in the city and that they may have a very long ride to get to the hospital they would either move or be willing to spend money to improve. But most choose to live in the fantasy that they will never have an emergency so things stay the same.

[captainstandup]

There is more to life than sitting around worrying about about how long it will take an ambulance to get to where you are. I have two kids and wouldn't dare consider moving nearer to a city. I realize response times are very important but the trade-off is often unacceptable. Why give up the beautiful places in the country in favor of getting an ambulance in 5 minutes when you have to live in fear of some jackass killing your kids. Robbery, gangs, drugs noise, filth present risks to your health too. We live in a rural area approx 40 miles from a small city and about 90 miles from a metropolitan area. Our county is roughly 550 square miles of mostly mountainous terrain. A great deal of national park land is in our county. The local EMS has 6 paramedic units and their average response time to 90% of the county is 6min 11 sec. There are, like a previous contributor mentioned, areas of our county that take over an hour to get to. As you would imagine there not many residents living in those areas. My point in all this, and I should have made it earlier, is that to apply a negative connotation to "rural EMS" isn't fair or accurate. The men and women in our EMS system are among the best trained clinicians in America. They are uniquely qualified to care for patients in an extended fashion and are quite successful in doing so.