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Rural County EMS System--Scares me


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I have yet to work in a urban setting except for my clinicals. I have though worked in a rural setting. There is alot of differences in the two.

This was my life in rural EMS. I worked for a hospital that had the 911 phone in the ER and Nurses station. The ER had two beds in it and if the floor had more than 5 patients then the nurse was freaking out. There was 2 emts in the hospital, 1 Rn and 1 LPN and that was it unless the doctor happen to be there. Me and my partner worked fri 7pm to mon 7am . Our unit was the only one in our area. It was bad sometimes. Like we had to help in the ER if it got busy. I know we got woken up many time to start IV's or what ever cause the nurse was lazy. Our response times was from 5 mins to 45 mins. We was instructed to bypass our ER if we thought they needed a CT or any other needs. All our ER had was lab and normal Xrays. The nearest ER that had up to date things was 30 to 40 mins away.

I think it was a good experince to have and glad I done it. I kind of like rural ems for the fact that it is usually you and your partner against the world. In urban you have fire to help.

Brock

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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.

Okay, I understand what you are saying, but... really what is the difference of staying 15 to 30 minutes and treating and what we will do in ER ? I can assure you for the first thirty minutes, it is the same if not more aggressive treatment.. since they are the only patient getting treated.

Ten minute scene times.. heck, that is just barely the ability of "load & go" if you don't have to carry anyone.. I can see trauma scene time <15 minutes possible, since there is really no advantages of staying and most of that (what little treatment there is for trauma) can be done enroute.

I understand each system requirements (ability of units, call volume, and limited scope of practice for Paramedics) but, of one can actually do the intent of EMS ...stabilize for transport"... why not? Yes, be sure that IV is patent, yes, tx with CPAP, NTG, and Lasix.. so when they do arrive, the initial treatment has been performed... now, even studies are proving decrease intubations/vents, decrease ICU admits and decrease hospital stays...so yes there is no difference from 3 blocks and 30 miles.. If I can treat I will, at least I will know they received the appropriate treatment in a timely manner.

R/r 911

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I see several laughable things about the entire urban vs rural BLS debate.

1st. Skills. Congrats, you can put on a splint. Personally, I'm much more concerned about making sure I understand what my medical assessments are telling me about the patient then my ability to stabilize a possible fx.

2nd. Time. So you can do what as a basic. Put the patient on O2, put in an appropraite position, and... drive or "assist" with meds? Let's be honest with ourselves here. BLS is not rocket science. You actually have to try to hurt the patient. 90% of the drugs we "administer" have to be prescribed by the PMD and supplied by the patient.

3. Call volume/call makeup. Rural=longer transport times=more chance to see changes in the patient. Urban/suburban=generally shorter transport times with more calls=wider exposure to different diseases and patient presentations

Overall, I'd call this a wash. It's almost as sad as trying to compare IFT basics (taxi for nursing homes) to 911 basics (taxi for anyone with a cell phone).

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Whit-

Do you have to have a seperate rig to carry your ego? What level of EMS provider are you? I would put alot of rural providers up against urban providers any day. Why? Because most rural responders have a commitment to their community and not to the number of calls they answer. When I did my clinicals, I ran 30 calls in 24 hours. That has absolutely nothing to do with the skill of the provider. I recently ran on a call where a rural provider, off duty, ran across the town square to stabilize a patient until we got there. If it was not for her expert ALS level of care, there is no doubt that when we got there, all we could have done was call the coroner. You sure have a set of brass ones on you bashing rural responders. The number of calls in shift is meaningless in terms of level of care. Perhaps in your urban area you might deal with more gsw calls or drug calls, but do you know how to disentangle someone from farm equipment? Would you even know where to begin to treat a patient for inhalation of anhydrous ammonia. Get over yourself. Tell you what...if you are ever vacationing in a rural area, and need ALS or even BLS care, you go ahead and turn away the rural responders to wait for the urban crew. I would imagine that the only thing that rivals the size of your ego is the amount of crap you carry on your belt. What a nob.

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Someone has read FAR to much into anothers post. I suggest you check your own ego first mate.

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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.

I made the transition from a rural setting to an urban setting. I didn't have a problem

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I think that you should only be able to transfer between urban and rural (and vice versa) after a suitable time in the suburbs. Kinda along the lines of B before I before P thing.

/IBTL

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I grew up in a very rural setting. I live and work now in a very urban setting. A person who has work experience in an urban setting perhaps will have to make some adjustmants working in a rural setting, but believe me, give me someone from rural america and send them up into the projects to treat a woman who speaks Pashtun who is having an MI, that'll take a lot of getting used to.

Secondly JP, I'm not sure exactly what treatment tricks are up your sleeve for someone suffering from exposure to anhydrous ammonia is, but I'm guessing its along the lines of High flow 02 and transport. Am I close?

You guys really need to get over yourselves already. Oh, and BTW, how do you treat a gunshot wound? You say "Boy, that sucks," then you put a bandage on it and drive real fast to the hospital. Oh and put them on a backboard too, and some oxygen for giggles.

Lastly, Intermediate is pretty much a speed bump for those seriously considering a career in EMS. Just go to medic school ASAP and be done with it already.

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Nremt Basic

First, don't get your panties in a bunch. For arguments sake I will review my post for you, obviously you didn't read it.

Nremt Basic wrote:

I would put alot of rural providers up against urban providers any day. Why? Because most rural responders have a commitment to their community and not to the number of calls they answer.

Your saying urban providers don't have a commitment to their communities, and I have a brass set. Well my commitment is 100% geared to my community. I even get paid.

and then wrote:

That has absolutely nothing to do with the skill of the provider. I recently ran on a call where a rural provider, off duty, ran across the town square to stabilize a patient until we got there. If it was not for her expert ALS level of care, there is no doubt that when we got there, all we could have done was call the coroner.

Do you call that commitment? We don't run anywhere you are correct, we take an ambulance. Could you please elaborate on that for me, I am interested in knowing why someone would run versus taken an ambulance. And how her expert ALS level of care would matter, Without a freakin ambulance?

You sure have a set of brass ones on you bashing rural responders

Point out where I did that friend.

The number of calls in shift is meaningless in terms of level of care

Ummmm......OK But I will take the medic that has tubed seven or eight people this week, as opposed to 7 or eight in his career.

do you know how to disentangle someone from farm equipment

No, I would hope I would be able to figure it out in a timely fashion, as you would the gunshot victims you speak of.

Would you even know where to begin to treat a patient for inhalation of anhydrous ammonia

We have a HAZMAT team for that. Exposed pts don't enter my ambulance, until they are naked and wet.

Tell you what...if you are ever vacationing in a rural area, and need ALS or even BLS care, you go ahead and turn away the rural responders to wait for the urban crew.

Thank you, but I do not vacation in rural America. If I did and got tangled in some farm equipment and exposed to anhydrous ammonia, you would be the last person I call. If you cant keep your composure in this forum, I would doubt you would be able to keep it in an industrial accident. I am sure you are the exception rather then the rule, as I have met many very competent and committed rural providers.

I would imagine that the only thing that rivals the size of your ego is the amount of crap you carry on your belt. What a nob.

Friend, I don't carry anything on my belt besides belt loops. My equipment is in the ambulance, which I take on every call. I also don't run around town stabilizing pts. and waiting for ambulances. Then call someone else a knob.

You sound very defensive about your situation, are you trying to convince me or yourself.

Take care.

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Whit-

as far as the als provider running to the scene, she was called after a relative called 911 and an ALS rig was at least 20 minutes out. As far as what she did or could do...ever hear of a jump kit?

You conveniently skipped answering what your level or training is or how long you have been working in EMS?

Do you believe that getting paid makes you better, more skilled?

You brought opened the door about the number of calls answered, saying that you have answer more calls than the other provider in this thread.

You wouldnt let a pt exposed to ammonia in YOUR rig? Neat! You own your own service? If not, it aint your bus unless you paid for it. You may infact have some un-natural attachment to it, but it doesnt belong to you. And since you brought up hazmat and you have an apparent disdain for rural ems, you probably arent aware that most small volly rural ems agencies dont have hazmat capability or resources.

While you are figuring out how to disentangle the pt from a piece of machinery, would you also excersise your super duper urban skills to stop them from bleeding out, or would you stick one needle in your arm and one in theirs and auto transfuse. Or do you carry FFP in YOUR ambulance?

As for having a brass set, I dont doubt it. When one has to flex ones ego as greatly as you do, I can only assume you have no active hormones and so have to prove yourself to be the Uber-Urban..sorry, what was your level again?

Have a great day and dont forget to polish your brass, :D

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