Rural County EMS System--Scares me

[Asysin2leads]

I would put most of our rural responders up against "Urban" EMT's any day... the reason? Because of the long wait times for our Ambulances, many times we are out there performing BLS skills that those who work in the City NEVER do.

Would you mind elaborating on which BLS skills you are referring to? BLS is typically done rapidly without regard to wait time for transport.

[AnatomyChick]

Around here, our City Counterparts rarely if ever do things such as traction splinting, EOA / Combitube, etc. I'm thinking that you must think that I'm talking about CPR, et al.... not so... even the City folks can't get out of that!

Jo

[whit72]

Anatomy chick wrote:

I would put most of our rural responders up against "Urban" EMT's any day... the reason? Because of the long wait times for our Ambulances, many times we are out there performing BLS skills that those who work in the City NEVER do.

Are you kidding?

No offense, but I probably have done more calls this week, then you have done in 6 months.

I have a transport time of less then 5 minutes for the most part. In that time I can provide any treatment or skill necessary, that the situation warrants. We can also asses the pt. call for an ALS intercept if need be, receive one, and that provider can also perform any skill he needs to in that specific situation, in the allotted time. Drop a note and still have time to tell me what they did this weekend.

Let me ask you a question. Please answer honestly.

What do you think would be a more difficult transition?

Taken an urban emt or medic and placing them in a rural situation

Taken a rural emt or medic and placing them in a urban situation.

I believe going from a rural to urban situation would be more difficult transition.

[whit72]

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.

[bassnmedic]

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.

You are joking yourself, aren't you? I don't know a medical control or medical director for that matter that wouldn't care if you took 2 hrs to transport your patient because they needed certain interventions performed, especially if you're 5 minutes from the ED. So, basically you would stay on scene with an acute pulmonary edema patient, establishing IV's and CPAP and RXs for 20-30 minutes when you are 3 blocks from definitive care? I don't think so.

Take care,

Todd

[AnatomyChick]

Honestly.....

I think both scenarios presented would be equally difficult to acclimate to.....

I agree that you may run more calls than we do... and that is where my agreement to your post stops.

Just as your post was not meant to offend rural providers, mine was not meant to encite Urban providers... two different animals performing two different functions. Basically what I was trying to say (and may have done so poorly) was that as rural providers we can hold our own.....we spend more time with the patient and often provide care that others may not "waste time on" due to short transport times.

Take Care All,

Jo

[whit72]

Todd, if I might have you referenced my posts above.

[whit72]

I was not saying you "couldnt hold your own". I am sure you are very proficient.

This isn't a competition.

We treat and perform any skill warranted. We don't forgo them because they might be a waste of time or because we are around the block from the hospital. You just become more proficient with the time you have.

[Asysin2leads]

For once, and I think I'm marking this on my calendar, I actually agree with whit. The other thing you have to realize, AnatomyChick, is that just because you are in close proximity to the hospital in an urban environment doesn't necessarily mean you will be grabbing your patient and running. While environments in rural and suburban settings are typically wider and rarely above 3 stories, In an urban environment just getting someone out of their apartment may take as long as traveling a great distance in a rural setting.

The other night I had a cardiac arrest victim who lived about a mile away from the hospital. It took us approximately an hour and forty minutes from the time we arrived until we were at the ED. This was because among other things, she lived on the fifth floor of an apartment building with no elevator and very narrow staircases. Close proximity does not necessarily equal short transport.

[whit72]

bassmedic wrote:

So, basically you would stay on scene with an acute pulmonary edema patient, establishing IV's and CPAP and RXs for 20-30 minutes when you are 3 blocks from definitive care? I don't think so.

Not really interested in what you think. I will however humor you.

What I am saying is that we don't have the luxury to forgo treatment because our transport times are shorter. We just have less time to complete those treatments.

The average 20 minutes we spend with the pt. on scene and transporting is more then enough time to adequately treat the injury or illness.

In closing if a thirty-minute on scene time was beneficial to the outcome of the pt. whatever the predisposing injury or illness is. Yes we would stay on scene.

However most injuries and illness without mitigating circumstances can be effectively treated with minimal on scene time. We have ten minute target times, ALS or BLS. For the most part those times are met.