Urban & Rural rotations for students?

[mobey]

Hey all thought this could be a interesting topic.

In my Intermediate class the instructor asked "what is the main difference between BLS & ALS? One of the urban PCP's answered "as BLS we don't have direct resoncibility for our pt because we always have a ICP or medic with us. I was very quick to correct his in the box thinking by informing him of this thing we call "rural EMS". I invited him to come take a call in my service where you are paired up with an EMR who considers themselves a driver only, no ALS for 120 miles, no hospital for at least 1.5 hr dry road driving, yada, yada, yada. So this person who claims to be on top of his game because he works for one of the busiest services in this province, has never had full responcibility for a patient!!

I think it should be manditory in the clinical portion of EMS training to do a rotation in a rural service. I would like this kid to pull out of town all alone with a flash pulmonary edema at 3:00am knowing he is at least 1hr away from Ventolin, Lasix, Nitro, or anything else his patient "really" needs :shock: .

So there you go, thats my thought of the hour... What do you all think?

[Mastabattas]

Interesting thought. And well timed as I narrow down my top 5 choices for my practicum for EMT school.

There is often the debate of which way to go for practicum. Common conceptions of either option are:

Urban = higher call volume, greater diversity in type of calls, guaranteed to be working with Paramedics and so being exposed to skills out of our scope but highly interesting...here in Alberta the chance to witness thrombolytics.

Rural = greater lengths of time with the patient regardless of what level of care you are in a position to give (ALS versus BLS), although longer time required to complete practicum requirements...slower pace to possibly build stronger skills.

I did ride alongs with both an ALS and BLS rural service and found it very interesting. I have another run of rides with an ALS rural service this weekend. What stands out the most to me is the exposure of ALS in a rural setting as compared to an urban setting. I haven't yet ridden with Edmonton's EMS (need certain certifications first) but what I have heard is that there are some limitations to scope here because transport times are so short compared to those that are hours away.

I think any exposure a student can get to the different kinds of EMS services in their region is good. Is it the schools responsibility to provide that? Maybe in a perfect world it would be nice. But like so many of the veterans on here will remind us newbs and students: our education is what we make of it.

My program is one year in length...6 months school and up to 4 months practicum depending where you are placed. I work full time while going through the didactic portion too. And have zero on car experience outside of my ride alongs. BUT I have taken every initiative to get exposure (even in just the ride along setting) wherever I can and even that has helped cement concepts from school. It'd be nice if they had certain exposure worked into the curriculum, but sometimes resources both time and money...can make it an unreasonable expectation. Especially if you consider how challenging it is in a market such as Alberta.

Still interesting thoughts. I like where you are going with your thoughts... perhaps the initiative taken on the student's part to gain such exposure on their own time will help them along the way in their career. It will "separate the men from the boys".

[Dustdevil]

I think it should be manditory in the clinical portion of EMS training to do a rotation in a rural service. I would like this kid to pull out of town all alone with a flash pulmonary edema at 3:00am knowing he is at least 1hr away from Ventolin, Lasix, Nitro, or anything else his patient "really" needs :shock: .

So there you go, thats my thought of the hour... What do you all think?

I think your thinking is back asswards.

Why should we dumb it down to the lowest common denominator?

Wouldn't a better solution be to require that those rural services upgrade to at least the 20th century standard?

[mobey]

I think your thinking is back asswards.

Why should we dumb it down to the lowest common denominator?

Wouldn't a better solution be to require that those rural services upgrade to at least the 20th century standard?

Lowest common denominator?? Did you read my post? You honestly believe that those people who spend 15min with thier patients with a medic "babysitting" them are of a higher quality than us in the rural?

You have to understand some communities cannot afford to staff an ALS car. I may be hours from a hospital but we only have a low call volume, what paramedic is going to sit around in the sticks waiting for his calls when he could be in the cities banging out calls and bossing around some BLS kid? and who's going to foot the bill for him to sit around? The Gov't :roll: like it or not there are some areas of the world where a BLS services make sence.

[EmergencyMedicalTigger]

Lowest common denominator?? Did you read my post? You honestly believe that those people who spend 15min with thier patients with a medic "babysitting" them are of a higher quality than us in the rural?

You have to understand some communities cannot afford to staff an ALS car. I may be hours from a hospital but we only have a low call volume, what paramedic is going to sit around in the sticks waiting for his calls when he could be in the cities banging out calls and bossing around some BLS kid? and who's going to foot the bill for him to sit around? The Gov't :roll: like it or not there are some areas of the world where a BLS services make sence.

I working in a diverse county system where you can work a fast-paced urbanized setting one shift and be bumped out to po-dunk the next. I personally hate working rural-for the most part it sucks. However, some of our worst calls are in the rural parts, so when a bad call comes in, it's very bad. I don't think there is any EMS that can justify not having a paramedic on staff-they'd be crazy to do that. Billy Bob out in the sticks can have MIs too-what is BLS going to do about that?

[Dustdevil]

Lowest common denominator?? Did you read my post? You honestly believe that those people who spend 15min with thier patients with a medic "babysitting" them are of a higher quality than us in the rural?

Nope. But that is not the scenario you presented. This is no longer about urban vs. rural. This is about ALS vs. BLS. And I don't care how long you are performing BLS, whether it be 5 minutes or one hour, it is still the lowest common denominator.

After the first fifteen minutes of BLS, you have done it all anyhow. What other experiential value is there to now staring at your patient and doing nothing for him for the next half hour? None. All it does is show you that really, in the grande scheme of things, you bring nothing to the table as a BLS provider, especially in rural EMS.

Go ALS or go home. Quit screwing your community.

[BushyFromOz]

The Gov't like it or not there are some areas of the world where a BLS services make sence.

Oh whinge whinge whinge......

For once id like to see an argument where a US BLS'er tries to justify having ALS instead of justifying why not to have it. BLS NEVER makes sense on its own, and failing to recognise its limitations by arguing against an ALS alternative is as mad as an irish women who takes to pills "To be sure to be sure" :?

[mobey]

Dust & Bushy: You are right I worded that poorly, I meant that a BLS is all that is practicle. I do agree that every service should be staffed ALS, unfortunatly some communities such as mine can't afford it. I did not mean to turn this into BLS vs ALS, there is no question.

Every ambulance should be ALS staffed, every hospital should have competent RN's, unfortunatly in a province with a Population of 1 mil (approx same Pop as Calgary) we do what we can with the little funds available.

Hopefully I have been more clear in this post.

BTW you will notice I am upgrading to ALS... :wink: