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Rural County EMS System--Scares me


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PS-

Yes I have responded to GSWs as I do live in an urban area where we have about 3-4 such calls a month. Probably not as exciting as your Metropolis, but yeah, we Basics are trained to deal with gsw...cavitation and all. While we are at it...which is more likely to create the greater and more unpredicatable cavitation...a .22 rim fire or a SigSauer 9mm? While will pitch and yaw more as it makes it way through your patient? If you dont put in a chest tube, how many sides would you afix your occlusive dressing to the patients wound, 3 or 4? You also said you would prefer the medic who has put in 7-8 ETTs recently...what if that isnt available immediately? Are you scared of combitubes? This is so much fun. Lets keep playing. I am not insecure in my skills as a Basic, nor do i feel a need tp prove myself to you. I think we can lock up this thread.

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I spent my years as a basic in a suburban setting, which is really neither urban nor rural.

I spent my first 6 years as a medic in a major metropolitan city. Then I went to rural. I can assure you that, medically and operationally speaking, this transition is MUCH more of a major matter than moving urban from rural. No doubt about it. There's not even the beginnings of a logical argument to be made the other direction. The only major shock for somebody going from rural to urban is that of bureaucracy and politics. Much more bull$hit in an urban system.

In my experience, you can get by an entire career as a substandard medic in an urban system. It's easy to get lost in the crowd. And with close proximity to your facilities, you simply aren't expected to know a lot of serious medicine. You simply fall back on the, "Oh, we're too close to the hospital to worry about that" mantra. You will find a much harder time getting away with that in a rural system. It's a lot easier to tell your patient (and yourself) "we're almost at the hospital" for a five minute ride, while calling in your report and taking vitals than it is to do that for twenty to thirty minutes in a rural system. After the first five minutes, that bluff doesn't fly anymore and you have to start actually doing something for the patient.

Even the quantity argument doesn't fly in this debate. Urban runs more than rural? Well, uhh... yeah! But they do it with exponentially more ambos too! There are urban ambulances all over this country -- in huge cities -- growing cobwebs on their square wheels, just like in rural areas, because they are in low volume districts. And again, quantity of runs simply is irrelevant. It is the quantity of patient contact time that is the significant factor here. And on that number, they really even out.

Anatomy Chick and NREMT-Basic take this round.

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The whole debate just seems kind of silly to me since everyone except Dust seems to be basing their arguments in the pride they have for their job. Pride tends to get in the way of a well reasoned argument. I figure most of you are effective and passionate providers who will give your patients a high level of service, or else you wouldn't be here. So have fun with your little excercise in chest puffing!

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And the original intent of the thread was not to see who was better. It was to discuss the problems related to rural EMS systyems with long response times, etc. Maybe we should look back to the origianl topic and get away from the pissing contest!!!

Sarge

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Thanks Dust for getting my back on this one... you definitely stated it more eloquently than I did.....

I apologize for my part of making this an Urban vs. Rural argument.. that was not my intent. I am glad to have such a varied group here, so that I can see things from both sides.

Jo

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I run in a hospital-based EMS system. We have a station in the city, and we also have a unit based in a VFD in a rural town about 15 miles outside of the city limits. The coverage area of the rural unit is about twice the size of the city, and covers four towns and a wildlife refuge. Granted, there are more calls in the city, but they are rotated between three units during the day, and two at night. The rural unit handles all of the calls in their coverage area, sometimes running more calls than the city units combined in a regular shift.

Since we are all based out of the hospital, there is no difference in protocols, rules, regulations, etc... between the two, plus the EMT's from the rural unit regularly run shifts in the city during their time off.

I agree that the transport times may be longer in the rural areas, but there is always ALS assist available, and the EMT's have the smarts to use the skills they have obtained both in the city, and in the sticks. I would gladly put our rural EMT's up against the city folks any day.

G.

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Guys and gals, let's stop this my epeen is bigger than your epeen.

I could care less how many calls someone has ran or how big their ego is and I sure as heck care less on whether it's a rural responder or a urban responder taking care of me.

Let's stop this Stupid pissing match.

What I want is an ambulance that has all the equipment to take care of me and a provider that is competent in doing their job.

Yes rural providers spend more time on calls that urban providers

Yes urban providers run more calls than rural providers

I knew that this thread would come down to pistols at 30 paces.

For the urban providers who look down their noses at rural providers and for the rural providers who look down their noses at urban providers, Just SHUT UP we all do the same job it's only the environments that are different.

Why do these posts always degenerate down to I'm better than you are. Waaa waaa waaa

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From rural Nebraska: the bigger problem, related to response, is the number of basics we have in town. If we're around our response is excellent. Being a volunteer in a small rural fire department is requiring more and more committment of time, training etc. Its harder and harder to get folks to take the training, clinical time and continuing ed and juggle other committments, family etc. Our response could be pretty bad if we have people out of town etc.

Tough issue, not related to if rural or urban is faster, better trained or more committed; its what we ask of volunteers in today's busy world.

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