Basic care early or better care later?

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Capt.Hook

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This thread is an offshoot from an earlier that I have always hoped to post. May you be forwarned: I will be using the "rural" and "volley" cards here. In fact, they are the basis of my posts. :)

My area uses a volley FD/FR department. We are a pretty good group that works well together and also with our closest neighbors. The nearest ALS/BLS response is 20 mins. away from station. That company uses primarily Paramedics but at times runs I or B trucks.

Our FR's are considered "advanced" by WI standards, thereby protocols state we can use combitube, the KED, and assist with epi-pens, along with the other basic first-aid skills. The towns closest to us also use FR's and are serviced by the same ALS provider. Other towns in the county have BLS rigs that seem pretty busy for both 911 and transports.

I wonder how some folks think towns like mine should have EMS providing. There just isn't enough of us to warrant even a BLS rig at this point in town. While I 100% understand a Basic or FR is no where near ALS or Critical Care, we have to be able to provide what we can. Basic and FR are glorified first-aid, I agree. Fortunately (or un-) it is the FIRST aid these folks get!

I hope to get some input from both ALS and BLS folks. Appreciate whatever comes.
 
give us some numbers. ie ____ number of people in our town which is ___ number of minutes away from a bigger town with ____ number of people.
 
Numbers:
I live in a village of 800. Our coverage area reaches 122 sq. miles, the furthest response from our station roughly 12 mins. in perfect conditions. The ALS provider comes from a 60,000 pop. city. They stage from 5 ambulance stations and travel roughly 40 miles in every direction. I would guess there are 10 units staffed with on call available.

We are 15 mins from their closest station to ours in a 10-39 response. That said, there could be a 20 to 30 minute travel time for them to arrive at patients door, depending on location.

This provider also is in danger of losing the city's EMS business, as the city is considering staffing it's own rigs via the FD. More than likely, they will work out an agreement, but there is the possibilty of our rural areas losing the ALS coverage.

Our nearest town is 10 mins away with a pop. of 2200. They are in some rough shape as EMS providers, as the FR is seperate from FD and poorly financed. Last count they had a volly staff of 9. Some calls don't get a response. Our ALS provider also staffs one ALS rig and a BLS rig in a town with a hospital 10 mins from them.
 
wow, that's a pretty unique situation you got there. If I were you, I'd push for a bls ambulance that could rendezvous with als down the road and know when to call a helicopter. I will be eagerly awaiting other viewpoints though.
 
I don't think the number really matter in regards to quality of patient care. The numbers have to do with economics. ANY competent care is better than no care at all. As stated, if a BLS unit can rendezvous with an ALS unit enroute to transfer care then the quality of care given to the client exceeds that if the BLS unit was not available and the client had to wait 20 minutes longer for the ALS unit.
 
My agency is volly, rural, currently operating without power and water due to a big windstorm (going on day 3 wheeee!)

We are 52 square miles, about 1200 people, closest ALS is 30 miles away at a city of about 17,000. The ALS is provided from a local private ambulance service which also does fill in with the civil/ff/ALS rig for the city and out of the area transports. The private ambulance service covers the entire county, which is filled in with volly districts providing BLS. As a result, our ALS support may or may not be available every time we need it. A lot of our area is timberland and we border and transport for a large National Park and Wilderness area. We have salt water to the North and West and tons of rivers (currently below flood stage!!!!! Whooo Hoooo!)

We do a rendezvous with ALS, which is sometimes coming from 50 miles away. Very often a load and go like heck is preferable to waiting for ALS. We can sometimes be at the hospital before they can reach us. We can use Airlift but the LZ's are few and far between. The helo comes from Seattle and generally meets us at the hospital. There is only one hospital available to us and it is 30 miles east.

We are a BLS agency and have in the past had some EMT-I's. Currently we have three candidates for EMT-I waiting for a class to be offered. Issue with that is OTEP's and training are not available in our county. So basically, we have to challenge the test every 3 years which I don't necessarily see as a bad thing. If we can't pass the test, we don't know what we are doing and shouldn't be certified..

We do have a permissive MPD who will allow us on a case by case basis to do some interventions as needed. Nitro for someone who doesn't have a current prescription, Albuterol neb treatments etc. These must be done under the supervision of the MPD and with constant contact. Our system also allows us to do glucometer checks, combi-tube, and to 'assist in the administration of a pt's prescribed meds'

We work well with our ALS support though in the past have been beaten up for calling ALS out for BLS calls. Some of our EMT's will see every anxiety pt as a cardiac. The reason we are encouraged to be judicious with our ALS calls is when we call ALS we take a unit out of service from a more densely populated area. ALS is the one that will complain about having to come 'all the way out there' for a BLS pt.

So its interesting to me to hear of ALS providers saying they should be called out more rather than less. We are told the exact opposite from our ALS provider.

Not saying this is the way things should be, just the way they are in my system. My husband is a Medic in the civil department so I understand the value of ALS and the vast differences between the two levels of care. Just not available to my district.
 
I am applying for my field ride along time with a service in Northern Wisconsin. They are hospital based ALS with 40 - 45 minute transport times. They have a reputation for only taking the very best for ride alongs and then hiring the best of those. Admittedly I lack experience, but it seems to me that hospital based EMS for rural areas is the way to go.
 
Our situation is very similar to BossyCow's (especially since we're in the same state). We cover approximately 240 sq. miles with a documented population of about 3000-4500 people. We are 45-60 minutes from any hospital in any direction. The hospitals that we transport to include a Level 3, two hospitals that rotate their trauma team so they alternate being a Level 3, two other hospitals that rotate their trauma team so the alternate being a Level 3, five Level 4 hospitals, and three Level 5 hospitals. We have 5 ALS services in 3 different directions that we can call, but it is a 30 minute transport to meet them. The helo comes out of Richland, when available, and has a call to scene time of 37 minutes. We are 2.5 hours to the nearest Level 2, and 3.5 hours to a Level 1 hospital.

We are a BLS agency with the majority of our people at the intermediate level. We have 4 EMT-ILS, 5 EMT-IV's, 2 EMT-B's, 2 EMT-FR, and 4 students that are waiting for their state test results to come in to become EMT-B's.
 
The town I come from in ky has a population of about 600 people with the county having around 5000.The service there is provided by the fire dept.It started as volly and now is a combination.They are licensed for five ambulances.The usually have five staffed during the day.One being als.Granted 3 of the 5 are gone most of the day then they cut down to two during the night.As much as I hate a fire dept doing transports it is a neccesary evil for that department to supply that kind of staffing levels.Sometimes that get lucky and aren't on transports and then you have more help than you know what to do with.Has your town thought about this route to go.
 
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