New Medic Starting In Small Town

[jrodrgr]

Hello this is my first post here. I have only been a paramedic for about a year now and during this course in time I have only worked at a hospital. I am taking a job at a VERY small town and will be one of seven paramedics. I grew up in the Dallas area and we are looking to get out of the city so that is why I am taking this job. I am nervous about my new adventure and would love to hear some advice (especially from small town medics). What should material should I review while I'm working and I would also love to become a 12 lead guru so what are some helpful books to grow my knowledge in 12 leads.

Thanks in advance!

 

[NomadicMedic]

Sick and injured people are the same in small towns and big cities. The big difference is, in a small town, everyone knows everyone. They know each others kids, doctors and medical history. They know each other husbands and wives, what car they drive and where they work. Hell, chances are they're related.

Best advice about small town EMS? Don't say anything about anyone that you wouldn't say to their face. It takes a while to be accepted, but once you are you'll love small town life.

 

[cruiseforever]

I have found that alot of people from rural areas and small towns delay calling 911, hoping they will get better on thier own. So they tend to be more ill.

 

[91Bravo]

Same boat. Everyone knows everyone.......... and might be related. I only did hospital and clinics before getting Paramedic too. Don't pick up bad habits. Beware of the, "been doing this 25years EMT" who's more interested in telling you they know what they're doing than working under your license and/or in their place on the team and forgot about being new a long time ago. You're not only the new guy/gal, you also didn't go to elementary school with your supervisor's/chief's kids. I don't like small town ways (granted this little town is beyond disorganized, you'll get keys before you get an orientation or protocols to look over).

Grudges are old and deep in small towns, don't waste your time trying to figure it out.

 

[NomadicMedic]

All of those things are absolutely true. I work with a lot of EMTs that have "20 years of experience" when really it's one year of experience repeated 20 times. There's lots of bad habits, lots of good old boy baggage to deal with, and everybody knows everybody.

 

[Tigger]

As others have said, being anonymous is challenging. I don't live in the area I work in but it seems like every time I head up there (pretty mountain town), I recognize a patient or (god forbid) they recognize me. People stop you in the grocery store just to talk about what you do, things like that. I certainly don't mind, but you do have to be careful what you say as you just don't know who knows who. In a small town, it doesn't take long for a seemingly off handed comment to make it to your boss's ears and odds are they are not going to have interpreted it like you meant.

 

[CentralCalEMT]

I grew up in Los Angeles so I am a city transplant like yourself. I have only worked in rural areas since I became a paramedic 3 years ago. Prior to that I worked in a large city for 6 years as an EMT so I have seen both worlds. Like the above posters said, in a small town everyone knows everyone so watch what you say. Chances the patient's family knows your supervisor. A patient is a patient no matter where you go. A CVA, MI or trauma is the same in a small down as it is in a big city. That being said, some of the things I wish I had known about working in a small town before I started were:

Depending on where your specialty centers (Trauma, STEMI, etc.) are, review whatever local policies are on air transport. In big cities, air transport is not a factor. Also, know the landing zones where the helo will actually go to and the ETA of a helicopter to them. Many air medical agencies have pre designated landing zones and it is up to the paramedic to pick the closest one.

Know your local resources and be prepared to do more with less. For example, in a large city, a MVA with 5 patients might get 3 ambulances. In a rural area, you might not have three ambulances in the entire county. Definitely do not be scared to call for the appropriate resources, but be aware they might be coming from a distance or not available at all. I was first on to a MVA with multiple ejections once and my 2nd in unit was coming from 15 miles away, and the 3rd in was even further out.

Country folk do not like calling 911 as a general rule. They are rugged and independent. Many times if they call you, they desperately need you. I have seen compound open fractures and arterial bleeds come into the ER via private vehicle because the patient said "ambulances are for emergencies only." (For a comparison, often country folk take about as long to call 911 as some SNFs do and usually wait until they are as sick as a SNF dos.) Be prepared to run some serious calls where the patient has been deteriorating for awhile.

Know your first in area, including local terminology for locations. Some locations are hard to find and mapping can be an issue in the small towns. Instead of 123 Main street you will hear "the patient is down a dirt road 1/2 mile north of the old railroad bridge near the old stage route." There is a definitely a learning curve when it comes to navigation. Hopefully your partner will be able to orient you to the area.

Maintain a high level of professionalism with your local hospital, fire department, law enforcement, etc. You will probably be on a first name basis with all of them fairly quickly. You do not want to develop a bad reputation because those are hard to shake in small towns. You can not simply lay low if you irritate someone like you can in larger cities.

You will be part of the community. People will wave at you. Children will come up and want to see the ambulance. People will come up to you and make conversation in the stores and on the street. At least where I work, EMS personnel are respected members of the community. Embrace that, even if it seems strange at first. A little PR goes a long way. When there are big public community events, if we do not have a dedicated standby unit, I will usually stay in service but attend the street fair, parade, graduation, etc. The public likes to see their local EMS being a part of the community, and simply being there and walking around gives a good impression.

Also, when you run a tragic call, be prepared for people in town to ask you about it. Word travels quickly and chances are the person all ready knows about it but wants to hear about it from someone who was there. If it was a fatality chances are they knew the person that died or their family from school, church, work, 4H, FFA, etc. Remember to keep yourself tight lipped and HIPPA compliant. You will know anything and everything that happens in the town. Every roadside memorial you will know the backstory to and will probably have been at that scene. That can trigger a wide range of emotions. It seems in small towns as if we feel the communities pain every time something bad happens.

I love rural EMS and would not trade it for anything. However, those are just some of the things I wish I had been told before I started. Good luck!!!!!

 

[johnrsemt]

As DeMedic said: 20 years experience doesn't mean much when it is 5 runs a year (but good luck getting them to listen to you anyway).

Call for help early; Put a bird in the air as soon as you THINK you might need one. Even before you get on scene sometimes. the closest bird may be 30 minutes by air, or out on another flight and it will be 15-30 longer than normal. You can always cancel them when you get on scene. Same with ground units: we have 3 locally, but the next ground unit is 45 minutes away if we are lucky.

Rural calls usually ARE as bad as dispatch says they are: Not only do they wait to call, but they are pretty accurate when they do.

call for help from local Fire Departments, they like to help when they can. In turn, as you find out how the patient is that they helped with let them know; AND go back and thank them for their help.

You will probably get more odd injuries: horse threw patient and kicked or stomped them when they were down: hay baler accident, etc. Never got those in Indianapolis, but have had friends out here that have been hurt that way.

Be visible: be in parades, volunteer to read to the elementary school kids.

Go back and check on your patients after they are released from the hospital. Try to answer questions for them and their family members: (get the answer from the Hospital if needed); they are usually more willing to ask you (since you live/work locally) than they are to ask the doctor or nurse at the 'busy' office or hospital

 

[NYBLS]

What are your transport times like? Working in a small town will be different if you are a hop skip and a jump away from hospital or an hour away from one and my advice will vary accordingly.

 

[TransportJockey]

Most of my career has been spent in rural areas (high volume minimum 45 minute transfers at first, low volume huge coverage area later) and if anything it has taught me to be an aggressive medic. You'll get bad calls, have the patient for longer periods of time, fly out a ton, and use your guidelines to their fullest extent.

 

[RocketMedic]

I grew up in Los Angeles so I am a city transplant like yourself. I have only worked in rural areas since I became a paramedic 3 years ago. Prior to that I worked in a large city for 6 years as an EMT so I have seen both worlds. Like the above posters said, in a small town everyone knows everyone so watch what you say. Chances the patient's family knows your supervisor. A patient is a patient no matter where you go. A CVA, MI or trauma is the same in a small down as it is in a big city. That being said, some of the things I wish I had known about working in a small town before I started were:

Depending on where your specialty centers (Trauma, STEMI, etc.) are, review whatever local policies are on air transport. In big cities, air transport is not a factor. Also, know the landing zones where the helo will actually go to and the ETA of a helicopter to them. Many air medical agencies have pre designated landing zones and it is up to the paramedic to pick the closest one.

Know your local resources and be prepared to do more with less. For example, in a large city, a MVA with 5 patients might get 3 ambulances. In a rural area, you might not have three ambulances in the entire county. Definitely do not be scared to call for the appropriate resources, but be aware they might be coming from a distance or not available at all. I was first on to a MVA with multiple ejections once and my 2nd in unit was coming from 15 miles away, and the 3rd in was even further out.

Country folk do not like calling 911 as a general rule. They are rugged and independent. Many times if they call you, they desperately need you. I have seen compound open fractures and arterial bleeds come into the ER via private vehicle because the patient said "ambulances are for emergencies only." (For a comparison, often country folk take about as long to call 911 as some SNFs do and usually wait until they are as sick as a SNF dos.) Be prepared to run some serious calls where the patient has been deteriorating for awhile.

Know your first in area, including local terminology for locations. Some locations are hard to find and mapping can be an issue in the small towns. Instead of 123 Main street you will hear "the patient is down a dirt road 1/2 mile north of the old railroad bridge near the old stage route." There is a definitely a learning curve when it comes to navigation. Hopefully your partner will be able to orient you to the area.

Maintain a high level of professionalism with your local hospital, fire department, law enforcement, etc. You will probably be on a first name basis with all of them fairly quickly. You do not want to develop a bad reputation because those are hard to shake in small towns. You can not simply lay low if you irritate someone like you can in larger cities.

You will be part of the community. People will wave at you. Children will come up and want to see the ambulance. People will come up to you and make conversation in the stores and on the street. At least where I work, EMS personnel are respected members of the community. Embrace that, even if it seems strange at first. A little PR goes a long way. When there are big public community events, if we do not have a dedicated standby unit, I will usually stay in service but attend the street fair, parade, graduation, etc. The public likes to see their local EMS being a part of the community, and simply being there and walking around gives a good impression.

Also, when you run a tragic call, be prepared for people in town to ask you about it. Word travels quickly and chances are the person all ready knows about it but wants to hear about it from someone who was there. If it was a fatality chances are they knew the person that died or their family from school, church, work, 4H, FFA, etc. Remember to keep yourself tight lipped and HIPPA compliant. You will know anything and everything that happens in the town. Every roadside memorial you will know the backstory to and will probably have been at that scene. That can trigger a wide range of emotions. It seems in small towns as if we feel the communities pain every time something bad happens.

I love rural EMS and would not trade it for anything. However, those are just some of the things I wish I had been told before I started. Good luck!!!!!

Are you still in Ridgecrest?

 

[CentralCalEMT]

Are you still in Ridgecrest?

I work in Tulare County now. I like the schedule better up here and the pay is higher.