# Rural vs. Metro...



## siefersl (Jan 11, 2008)

I will admit that the pot has been stirred up here in Kansas. I am in no way saying that Kansas has the best EMS services in the nation, but my blood was boiling. Now I'm biased so for the time being I will not say anything, just wanted to know what fellow EMS participants thought.

These are the first two of a series of articles that is being published by the Salina Journal of Kansas,

The first one:

http://www.saljournal.com/rdnews/story/EMS_series_Part_I__for_Wednesday

While I am not up to date on all the rules about posting online but the KBEMS's reply was not written online, It was a public letter sent to services

It reads as thus,

Kansas Emergency Medical Services (EMS) has a proud history in Kansas. The dedicated EMS attendants, educators and services provide a vital role in serving their communities during the greatest times of need. However, the recent article written by the Kansas Health Foundation's information service to policy makers (the Kansas Health Institute (KHI)), casts a very negative and less than complete view of pre-hospital care provided by Kansas EMS.

The Kansas Board of Emergency Medical Services does not wish to engage KHI or the Health Foundation in a negative campaign of content correction before the citizens of the state, policy makers, or the media at large. Rather, let us challenge both the Kansas Health Foundation and Health Institute to broaden their lack of knowledge of the history, complexities, issues, and operations of Emergency medical services. However, the context and scope of the article needs to be addressed. The article maintains that...

"In the state's more sparsely populated areas, the emergency medical technician called to help might be a volunteer summoned from home or work. They are less likely to be well-equipped and trained than their urban counterparts and probably travel greater distances and take more time to reach those in need."

The article fails to recognize that the majority of Kansas is rural and frontier. Statistically, according to the 2006 Kansas Population Density Peer Groups (2004 census), 90 of the 105 counties in Kansas would be considered frontier, rural, or semi-rural. Therefore, to insinutate that care provided outside of a metropolitan area is inadequate and deficient is both disturbing and false. Statutorily, whether an attendant provides pre-hospital care in Morton county or in Johnson county, the educational standards, training, and regulatory overview (audits, investigations, authorized activities) are identical. EMS is made up of volunteer, part-time, and full-time personnel who answer the call of pre-hospital care 24 hours a day, 365 days a year. As with our brothers and sisters in law enforcement, firefighting, and emergency management, the rigors and dedication to serve are a sacrifice attendants personally make. KBEMS would like assist KHI (its writers and organization) in increasing its knowledge of EMS operations and aid in bolstering the Kansas Health Foundation's dedication to the field of health.

The National Highway Traffic Safety Administration (NHTSA) assessment was not requested by NHTSA or any other federal or state organization, but by the KBEMS. With support from the Driving Force Group and funding provided through federal transportation dollars (Kansas Department of Transportaion), the assessment was requested to allow Kansas EMS the opportunity to evaluate and improve the system of care and operations, in order to continue to provide quality out-of-hospital care, as per our mission. Dr. Jermyn, Missouri (MO) Medical Director for the Department of Health and Human Services, and one of the national experts who participated in the NHTSA assessment, explained to the writers of the article that the issues and concerns detailed by the assessors in the report were addressed by the Board during a retreat in September. However, to our dismay, there was an apparent misunderstanding between the writers regarding the inclusion of comments made by Dr. Jermyn. Those were unfortunately excluded from the article. By that account, if KHI were to accurately and Completely evaluate the response to the Assessment by the Board, KHI would have found that many of the issues addressed within the article concerning the status of the Assessment had been clarified, addressed, or are pending action.

It is not a lack of commitment or professionalism of attendants in rural/frontier Kansas that adversely effects rural and frontier citizens, but demography, economics and geography. Operating in sparsely populated areas, transportaion distance between the emergency event and initial hospital care is generally longer, and the time and distance from the first hospital to a Level I trauma center may be several hundred miles. Unlike other public safety agencies, EMS is funded not only through taxes (in come communities), but through insurance reimbursement, direct costs, and occasionally ...a bake sale. Yes, bake sales. In some communities, the EMS service direcotr and attendants participate in bake sales or other fund raising activities to purchase the equipment and provide funds for training to maintain the level of pre-hospital care which is expected. The statement is not made for effect, but to provide a current and true assessment of Kansas EMS ...an assessment that the article neither provides nor addresses. To those attendants who have dedicated their lives serving and providing pre-hospital care, the article is the equivalent of a "Slap in the face" and in effect, discounts the service EMS attendants provide voluntarily and on a full or part-time basis.

KBEMS would like to offer our services, staff, and knowledge to the Kansas Health Foundation and Kansas Health Institute to bridge the divide between the inaccuracies of the article and the true concerns and issues facing EMS. EMS serves as a link btween both public safety and the health industry. As such, KBEMS and EMS services can be a valued asset to KHI, as your organization continues to work toward its vision of "_Healthier Kansans through informed policy that addresses the many factors influencing health_".

We look forward to a healthy and long-lasting pertnership.

Cordiallr

Robert Waller
Chief Administrator


The second article published in the Salina Journal:
http://www.salina.com/rdnews/story/EMS_Part_II__for_Thursday


I Will repost if any other articles are posted.


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## JPINFV (Jan 12, 2008)

> "In the state's more sparsely populated areas, the emergency medical technician called to help might be a volunteer summoned from home or work. They are less likely to be well-equipped and trained than their urban counterparts and probably travel greater distances and take more time to reach those in need."
> ...
> Statutorily, whether an attendant provides pre-hospital care in Morton county or in Johnson county, the educational standards, training, and regulatory overview (audits, investigations, authorized activities) are identical.



I really hate to burst anyone's bubble here, but if the city is getting the majority of their EMS calls responded to by paramedics while the rural areas are having the majority of their calls being responded to by basics (albeit, who has the option of calling for paramedics), then the newspaper article is 100% correct in their assessment. If you honestly think that basics provide the same level of care as paramedics, then you are obviously confused about the differences in the level of care provided. 



> EMS is made up of volunteer, part-time, and full-time personnel who answer the call of pre-hospital care 24 hours a day, 365 days a year. As with our brothers and sisters in law enforcement, firefighting, and emergency management, the rigors and dedication to serve are a sacrifice attendants personally make.



All of the sacrifices and "brotherhood" (the merits of this term should be reserved for another thread) in the world does not change the facts that the care given by basics is drastically lower (due to, sorry to say, the rather pitifully low level of education required of basics. This is a nationwide problem though) than the care given by paramedics. Furthermore, a response time that consists of "receive call, get out to POV, respond to ambulance bay, start ambulance, respond to scene" is going to be longer than "receive call, start ambulance, respond to scene" is going to be longer. 



> Operating in sparsely populated areas, transportaion distance between the emergency event and initial hospital care is generally longer, and the time and distance from the first hospital to a Level I trauma center may be several hundred miles.



Well, this sounds like a perfect reason to pay to have paramedics standing by. Maybe then the isolated trauma patient will be able to have some pain control during their long trip to the hospital. Maybe then a cardiac patient will receive proper care instead of "oxygen and pretty, flashy lights." 



> KBEMS would like to offer our services, staff, and knowledge to the Kansas Health Foundation and Kansas Health Institute to bridge the divide between the inaccuracies of the article and the true concerns and issues facing EMS. EMS serves as a link btween both public safety and the health industry. As such, KBEMS and EMS services can be a valued asset to KHI, as your organization continues to work toward its vision of "Healthier Kansans through informed policy that addresses the many factors influencing health".


Actually, it looks like the newspaper printed a pretty accurate description of what is happening. It just seems like KBEMS isn't pleased that said description paints rural services in a poor light.


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## skyemt (Jan 12, 2008)

I am a volunteer basic who works in a rural area... we have access when needed to ALS at the paramedic level, with short response times.

do i think our system works? yes it does, and rather well.

if i was having the emergency and needed help, would i want basics with access to ALS, or two paramedics standing by, who do this for a living every single day...

hands down, you know who wins every time... 

i'm not knocking our system, i happen to think highly of it...

but, i am not naive enough to compare it to a paramedic rig standing by 24/7...

try not to take things personally... i've learned not to, and then you can be a tad more objective...


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## triemal04 (Jan 12, 2008)

So let's recap.  The article says that volunteers may take longer to get to a patient...true.  It says that volunteers are generally not trained as well as those who work in cities...true.  (even ignoring the difference between a basic and a medic, still true)  It says that the number of people volunteering is going down...true (national issue too).  Not seeing anything wrong or innacurate there, but I can see how it would piss of KBEMS.

It then goes on to talk about how there is no leadership at the state board, how no changes have been implemented since a 1994 study found deficiences, how there is no continuity between areas...basically, saying that KBEMS really isn't doing it's job.  Oops.


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## siefersl (Jan 16, 2008)

Did a single person stop to think and ask them selves if the way it is explained in the articles is actually how it it???


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## JPINFV (Jan 16, 2008)

siefersl said:


> Did a single person stop to think and ask them selves if the way it is explained in the articles is actually how it it???


You must be new to EMS because you obviously haven't gotten the memo that no one involved with EMS policy and delivery is allowed to think at any time. 


/me notes that the above post is laced with sarcasm.


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## Flight-LP (Jan 17, 2008)

siefersl said:


> Did a single person stop to think and ask them selves if the way it is explained in the articles is actually how it it???



Sorry bud, but the article accurately represents a lot of rural America, not just Kansas. Comparatively speaking, I believe it was written better than most media writings pertaining to EMS..............


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## BossyCow (Jan 18, 2008)

Flight-LP said:


> Sorry bud, but the article accurately represents a lot of rural America, not just Kansas. Comparatively speaking, I believe it was written better than most media writings pertaining to EMS..............



Did you mean to say that we're not just in Kansas anymore Toto?


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