Rural vs Urban EMS

[mycrofft]

Knowledge is good, but careful about earning a cert your state doesn't recognize. Sort of like fighting roosters; can't fight 'em, but you can raise as many as you like and make thousands off people who buy them....get the parallel?.

 

[CentralCalEMT]

I love Rural EMS. While I see fewer patients, I feel I still get adequate experience because I am with my patients for so long. I have areas in my coverage area that are a 2 hour drive from a hospital. Almost everything we do is based on protocol and standing orders which is good because we have huge areas we cover with no cell or radio reception. I also believe rural EMS, especially in the mountains where I work, causes us to think outside the box and face challenges not faced by our urban brothers and sisters. I have definitely had to hike in several miles in the middle of the night in order to even find my patient and then wait several hours until we could get a hoist rescue. All our units are 4WD because many of our calls are down poor dirt roads or even on trails in the forest. We also have more medications not typically carried on ambulances in other California counties (Verapamil, Mag, Pitocin, etc) and can do procedures many other California counties do not allow (NG tubes, gastric suction, peds intubation, etc) Having worked urban EMS as an EMT before I became a medic, I have tremendous respect for our urban counterparts and how they get absolutely run into the ground, but I think many times rural EMS does not get the respect it deserves.

 

[mycrofft]

Where are all you people practicing?

Just asking, general region, or county/state....

 

[mycrofft]

I love Rural EMS. While I see fewer patients, I feel I still get adequate experience because I am with my patients for so long. I have areas in my coverage area that are a 2 hour drive from a hospital. Almost everything we do is based on protocol and standing orders which is good because we have huge areas we cover with no cell or radio reception. I also believe rural EMS, especially in the mountains where I work, causes us to think outside the box and face challenges not faced by our urban brothers and sisters. I have definitely had to hike in several miles in the middle of the night in order to even find my patient and then wait several hours until we could get a hoist rescue. All our units are 4WD because many of our calls are down poor dirt roads or even on trails in the forest. We also have more medications not typically carried on ambulances in other California counties (Verapamil, Mag, Pitocin, etc) and can do procedures many other California counties do not allow (NG tubes, gastric suction, peds intubation, etc) Having worked urban EMS as an EMT before I became a medic, I have tremendous respect for our urban counterparts and how they get absolutely run into the ground, but I think many times rural EMS does not get the respect it deserves.

Are your protocols in accordance with (IAW) the federal suggestions/guidelines or has your EMS gone above and beyond?

 

[WuLabsWuTecH]

Just asking, general region, or county/state....

Southern-ish Ohio. We're not as dry in terms of resources as say, south-eastern ohio where you can have one medic for 3 counties, but we are pretty close to that area...

 

[JDallas]

Just asking, general region, or county/state....

Stationed in Trona, CA, in San Bernardino County, approximately 3 feet from Inyo County. Response area includes the Town of Trona (pop. 1800), the road to Death Valley (45 miles and a large gold mine), and the road towards Victorville/ San Bernardino (scattered houses = pop 100, approximately 30 miles of highway) and Spangler Hills Off-Highway-Vehicle park, the largest such park in America

Hospital is anywhere from 10-50 miles away, and ALS ambulance is located near the hospital for running Intercepts.

 

[TheLocalMedic]

I'm in a rural bit of northern California. I've been working in a rural setting for years, although I've also worked in urban areas. Altogether, I vastly enjoy the rural setting for a number of reasons.

As Clare said, in rural or wilderness areas people wind up needing EMS for reasons that urban EMS will never see; i.e. the tractor rollover or someone dropping a tree on their non-lumberjack selves.

One of the perks of my region is that there are many protocols that have "In the event of extended transport" clauses which allow us to implement treatment algorithms that urban EMS never get to use.

Being in a rural area, we also tend to be more friendly to the "stay and play" mentality as the extra minutes spent on scene don't matter much when your nearest hospital is 30-60 minutes away. It allows us to really see how our interventions affect a patient and in some ways we play the GP role by making house calls to administer care to patients who don't necessarily require transport.

 

[DrParasite]

I've done urban and suburban. never done rural, never really wanted to. I've get too bored, or frustrated because we would take a taxi run on a 40 minute transport while a truely sick patient call came in. In the cities we can often do a quick turnaround.

I happen to like the high volume shifts (even the taxi runs), and despite a lot of calls being simple taxi runs, you do see some sick people. and by sick, I mean really really sick. and when you have a taxi run, they walk to the truck, very having to carry every single patient.

I also like the fact that if I need backup (PD, FD, more EMS resources), they are usually there in a short amount of time. We don't always have an ALS unit available (they cover multiple towns, and are regional based), so we will often load and go to the ER and give them a heads up as to what we are brining so they have a bed waiting for us.

We don't get PD on every call (which has it's ups and downs), but we are definitely given more respect by other emergency services agencies than our rural and suburban counterparts. And we definitely get more major traumas in the cities than in the burbs (although rural does get some weird *** :censored::censored::censored::censored.

btw, I like working FT in urban EMS, and part time in the suburbs. The slowness is a welcome change from the fast paced environment, and it's nice to get a long nap during the downtime (along with the lack of an on duty supervisor breathing down my neck over every stupid thing).

 

[mycrofft]

I'm in a rural bit of northern California. I've been working in a rural setting for years, although I've also worked in urban areas. Altogether, I vastly enjoy the rural setting for a number of reasons.

As Clare said, in rural or wilderness areas people wind up needing EMS for reasons that urban EMS will never see; i.e. the tractor rollover or someone dropping a tree on their non-lumberjack selves.

One of the perks of my region is that there are many protocols that have "In the event of extended transport" clauses which allow us to implement treatment algorithms that urban EMS never get to use.

Being in a rural area, we also tend to be more friendly to the "stay and play" mentality as the extra minutes spent on scene don't matter much when your nearest hospital is 30-60 minutes away. It allows us to really see how our interventions affect a patient and in some ways we play the GP role by making house calls to administer care to patients who don't necessarily require transport.

This could be the intro to a book.

 

[mycrofft]

Forgot myself.
Omaha civilian, mostly urban.

Civilian, in Lincoln NE we did urban/suburban AND rural, the interface was a little steep (urban to rural in three miles or less back then).

Military, either on-base (Guard base without hospital, co-located with again no base hospital), or field exercise (ironically, sometimes these had a base hospital, but at Crow's Landing and Beale AFB we had to go to local civilian facility).

 

[WuLabsWuTecH]

Being in a rural area, we also tend to be more friendly to the "stay and play" mentality as the extra minutes spent on scene don't matter much when your nearest hospital is 30-60 minutes away. It allows us to really see how our interventions affect a patient and in some ways we play the GP role by making house calls to administer care to patients who don't necessarily require transport.

Interesting, I've actually found the opposite myself in a rural area. All interventions tend to get done in the back of the medic which not only reduces transport time but also reduces out of service time. The first time I was with someone starting an IV and I made the call-out, I got a weird look because these rural medics start IVs over railroad tracks all the time!

I also like the fact that if I need backup (PD, FD, more EMS resources), they are usually there in a short amount of time. We don't always have an ALS unit available (they cover multiple towns, and are regional based), so we will often load and go to the ER and give them a heads up as to what we are brining so they have a bed waiting for us.

We don't get PD on every call (which has it's ups and downs), but we are definitely given more respect by other emergency services agencies than our rural and suburban counterparts. And we definitely get more major traumas in the cities than in the burbs (although rural does get some weird *** :censored::censored::censored::censored.

When we're within the limits of small little towns and villages, we usually get PD on every call and I personally think that's a pro. I've never had PD be detrimental on any scene and they can only help in my experience. Even if they are just a flashlight stand, it's still something. Plus in the small towns everyone knows the cops and the cops know everyone so they townspeople feel their tax dollars are being well spent and we get heads-ups before we got on scene for potential problems.

The not having backup in a rural setting through really pushes you to be on top of your stuff!

 

[Ace 227]

I work in a medium sized city that is surrounded by a lot of rural townships that we also provide coverage for on occasion. I definitely prefer being in the city stations where I'm never more than 8-10 minutes from the ED an additional units are always an option. Out in the rural areas, the transport times are significant and the volly QRS is unreliable at best. Sometimes they won't even acknowledge the call. I prefer to know that city fire will be onscene if I'm going to need man power.

As an example, last week I had a pediatric arrest in one of the housing projects and before we had the patient out the door I had an additional ALS ambulance and a supervisor vehicle onscene giving us a total of 4 paramedics ready to go. Plus fire and PD were available to handle the neighbors, etc.

Comparing that to an arrest I had in a rural trailer park a few weeks ago and all we had was myself, my partner, and a volunteer that drove POV to the scene. After struggling to get the obese pt out of the trailer with just the three of us, my partner was alone in the back for the 25 minute transport. Not ideal.

 

[mycrofft]

Ah, 1979 all over again.

 

[DrParasite]

When we're within the limits of small little towns and villages, we usually get PD on every call and I personally think that's a pro. I've never had PD be detrimental on any scene and they can only help in my experience. Even if they are just a flashlight stand, it's still something. Plus in the small towns everyone knows the cops and the cops know everyone so they townspeople feel their tax dollars are being well spent and we get heads-ups before we got on scene for potential problems.

In most urban areas, PD stands there and looks pretty, gets photographed in the news, rushes in past you and holds a flashlight on what's going on, or gets info so they can write a report.

I actually subscribe to the belief that if it's on fire send a fire engine, if they are sick or injured send an ambulance, and if a crime was committed or if its an unsafe scene, send law enforcement. No need to cross into other areas, just do your jobs well, and towns should give agencies enough funding to do their job well without having to rely on someone else.

there have been many documented cases where LEO complicate scene (hello, every time a fire chief is arrested of threatened with arrest for failing to follow a LEO order), and my personal experience where a LEO will either escalate a situation and then leave the now aggravated or agigatated patient in the hands of EMS. Don't get me wrong, I like many of the cops who work with us, or don't go out of their way to antagonize patients (or us), and am thankful to the ones who have dealt with those unsafe scenes.

let PD deal with the crime stuff, cities usually have enough stuff to keep them busy. if I need them, I will call them and back out. Very similar to the rural areas, where you have one state trooper covering 80 square miles and 6 towns. do you really want to tie them up on an EMS assignment when all they will be doing is write a report and maybe hold a flashlight?

 

[WuLabsWuTecH]

In most urban areas, PD stands there and looks pretty, gets photographed in the news, rushes in past you and holds a flashlight on what's going on, or gets info so they can write a report.

I actually subscribe to the belief that if it's on fire send a fire engine, if they are sick or injured send an ambulance, and if a crime was committed or if its an unsafe scene, send law enforcement. No need to cross into other areas, just do your jobs well, and towns should give agencies enough funding to do their job well without having to rely on someone else.

there have been many documented cases where LEO complicate scene (hello, every time a fire chief is arrested of threatened with arrest for failing to follow a LEO order), and my personal experience where a LEO will either escalate a situation and then leave the now aggravated or agigatated patient in the hands of EMS. Don't get me wrong, I like many of the cops who work with us, or don't go out of their way to antagonize patients (or us), and am thankful to the ones who have dealt with those unsafe scenes.

let PD deal with the crime stuff, cities usually have enough stuff to keep them busy. if I need them, I will call them and back out. Very similar to the rural areas, where you have one state trooper covering 80 square miles and 6 towns. do you really want to tie them up on an EMS assignment when all they will be doing is write a report and maybe hold a flashlight?

There is not nearly enough crime in our area to keep them busy. But since we invite most of them over for dinner on the nights we cook our working relationship is very good with them. And these small little towns have fewer then 500 people in some of them so "tying them up" is tying up the LEO that would otherwise be just driving around anyway. We don't usually get LEO in the unincorporated county or during times when these town's police forces aren't in service. I guess it really depends on the situation you are in. But since I know all of our PD guys by first name and I'll see most of them having dinner or lunch in our station at least once every few months, we get along very well