Street/Urban EMS -VS- Wilderness/Rural EMS

[jordanfstop]

Who here has experience in both of these fields? Which did you like more? Which was more challenging? Trauma wise, what were the repetitive type of jobs? What were the biggest challenges of both types of areas?

I ride for a fairly busy Community Ambulance Corps (5k calls out of one station per year[busiest in the county]) suburban area of New York City (about thirty miles northwest in Rockland county[directly above Bergen Co., NJ].) It's a fairly suburban area here (about 1750 residents/sq mile.) I have never worked either of them, however they both highly intrigue me as they may be equally challenging so I was looking for some insights you may have to share.

 

[reaper]

Rural is more challenging. You are on your own and have longer transport times. This means you must use more skills to keep your pt stable during transport.

Urban is faster paced. I work urban now, due to 12 hr vs 24 hr shifts. I like being busy for 12 hrs, then go home.

I think you have more BS calls in the urban areas. But, they are part of the job.

 

[firecoins]

Since I work in Rockland County and do medic rotations in NYC, Ill chime in.

Spring Hill see alot of B.S. calls, sometimes just as many as Manhattan rigs do. Spring Valley results in most of the B.S. calls as you know. There are more intox calls, minor medical problems and carrying people down 5 flights of staris because there is no elevator.

Rockland County gets better MVAs and other trauma with longer tranasport times. More rural areas further upstate will see more MVAs and much more serious ones than most FDNY units will see. In Manhattan, there is usually too much traffic for major MVAs. Oter types of traumas are more frequent like consruction accidents and cyclists injuries. A city trauma center is never more than a 5 minute trip. No need to call for Stat flight.

Your are likely to not have cops show on the scene of a call. Scene safety is a big issue.

 

[firetender]

In broad strokes, City work gets you weird stuff, Country work gets you weird stuff.

A 350 lb. woman wedged between a tub and toilet can happen anywhere, as can a man having an arm ripped off by a machine. As has been said before, certain extenuating circumstances come in to play that are defined by the environment. Rural -- 45 minute response times; Urban 45 minutes to travel 15 miles to the hospital Code 3 in Rush Hour traffic.

In this business, Murphy's Law prevails, and you just adapt, wherever you find yourself. All that's left is your decision where to subject yourself to it.

The key word to consider is probably volume, regardless the location. Your shelf life as a (sane) medic is inversely proportional to the volume of calls you run.

Just look at this site!

 

[Ridryder911]

I have worked all. It is a strangem mixture of where rural area may not have a lot of call, but a true Paramedic will work their arses off one single call. Where urban is a mixture, and metro one is busy, but does not perform much treatment.

Each has its selling points and disadvantages.

p.s. if your town is running 5k calls a year, why is it volunteer?

R/r 911

 

[firecoins]

.

p.s. if your town is running 5k calls a year, why is it volunteer?

R/r 911

They have paid staff. Many of the vollie corps. in our area do.

 

[jordanfstop]

p.s. if your town is running 5k calls a year, why is it volunteer?

As my fellow county resident Brian/firecoins said... Our weekday 5a-7p crew is paid as well as our weekday 7a-7p crew (two crews during the days and one at night/weekends)... the nights and weekends are vollie. I figured out that all of the "volunteer" EMS corps in my county are only 58% volunteer (98hrs vol. & 70hrs paid a week) which is why most of them still tag "Volunteer" onto their names.

However, then you have some paid days like our annual dinner at night is paid, then our holidays are paid I believe. So it equals out to like 55% vollie, which still is "more vollie than not." For some reason, my corps hasn't been known as "Spring Hill Volunteer Ambulance Corps" in quite a few years, actually, as opposed to most of the other ambulance corps in this county...

Also it's only just a part of our town.. We have four(five) EMS corps in this town alone (The county has five towns.) We're the busiest in the town/county, then another corps in this town is right behind us with 3,500/yr. The other two get like 300/yr and 700/yr. The fifth one I was talking about is Hatzolah, we cover a lot of the same area (I'd say about two or three square miles of our area is actually theirs because of the residency.) They do quite a bit of calls (4500/yr,) however, they're usually not included in the stats as they're not 911.

 

[jordanfstop]

They have paid staff. Many of the vollie corps. in our area do.

Not one single corps in Rockland County is 100% vollie..Even Hatzolah has paid non-Jewish drivers on Holidays/The Sabbath!

 

[jordanfstop]

Since I work in Rockland County and do medic rotations in NYC, Ill chime in.

Spring Hill see alot of B.S. calls, sometimes just as many as Manhattan rigs do. Spring Valley results in most of the B.S. calls as you know. There are more intox calls, minor medical problems and carrying people down 5 flights of staris because there is no elevator.

Rockland County gets better MVAs and other trauma with longer tranasport times.

Yeah, we do get our fair share of "Why-are-we-even-here-and-why-the-hell-didn't-you-call-the-taxi-or-go-with-your-family-who-is-going-to-follow-the-ambulance-in-the-car?" type of calls. Sometimes it balances out when we get the occasional gang activity though (stabbing, shooting, assault.) The shootings have for sure gone down though. Working the majority of "B.S." calls can really affect you sometimes, because once you have that hot job you're out of shape with your skills and mentality. Also, the occasional "119" (intox.) or "113" (EDP) can be quite humorous . Spring Hill also gets a few good jobs for the little bit of Palisades Interstate Parkway we do, too. In Nyack you guys get those water jobs, TZ Bridge jobs, and bar fights though! With a five minute max txp time, too!

 

[firecoins]

Yeah, we do get our fair share of "Why-are-we-even-here-and-why-the-hell-didn't-you-call-the-taxi-or-go-with-your-family-who-is-going-to-follow-the-ambulance-in-the-car?" type of calls. Sometimes it balances out when we get the occasional gang activity though (stabbing, shooting, assault.) The shootings have for sure gone down though. Working the majority of "B.S." calls can really affect you sometimes, because once you have that hot job you're out of shape with your skills and mentality. Also, the occasional "119" (intox.) or "113" (EDP) can be quite humorous . Spring Hill also gets a few good jobs for the little bit of Palisades Interstate Parkway we do, too. In Nyack you guys get those water jobs, TZ Bridge jobs, and bar fights though! With a five minute max txp time, too!

In Nyack, we get our fair shair of intoxes, alcohol relates assaults, gang activity, the Palisades Center in all its glory as well as the bridge and thruway. Palisades Center is all b.s.

 

[jordanfstop]

In Nyack, we get our fair shair of intoxes, alcohol relates assaults, gang activity, the Palisades Center in all its glory as well as the bridge and thruway. Palisades Center is all b.s.

how often do you go to the palisades center?

 

[wolfwyndd]

I've actually run both. I USED to run with Laurel Vol. Rescue Squad in Laurel, MD for about 8 months before I moved out to Laura, OH. Personally, I liked running with LVRS better then I like running with Union Township Life Squad (covers Union Township, OH, which has West Milton, OH, Laura, OH, and Ludlow Falls, OH). LVRS did approx. 7K calls a year. UTLS was both fire and EMS while UTLS just does EMS and only about 900 calls per year.

Both had advantages and disadvantages for me. I really enjoyed doing 6, 8, 10 calls per night on a 12 hour shift even though the furthest run for us was a 6 minute transport. There's not a whole lot of interventions you can do with a 3 or 4 minute transport. On the other hand, I'm more challenged with running with UTLS because our closest facility is 25 minutes away. It's not uncommon for us to have a 45 minute transport either. The disadvantage (for me) is that on a BUSY night I have two calls. Most nights I sit there and twiddle my thumbs. I don't like being idle.

I also disagree with you, Reaper. I had just as many BS calls when I ran for LVRS as I do now running with UTLS. UTLS just posted our numbers for Sept., Oct., and Nov and the largest call we had was 70 calls for 'help I've fallen and I can't get up.' They had 'call type' graphed out and it was, by far, the largest of any of our calls.

 

[firecoins]

how often do you go to the palisades center?

I think it represents 25% of Nyack's calls. I was there Friday night for 12 year old who fell on the ice at the ice rink and incurred a small laceration from the blade of someone else's skate. The mother RMAed to take the kid to the hospital on their own.

 

[firecoins]

. I figured out that all of the "volunteer" EMS corps in my county are only 58% volunteer (98hrs vol. & 70hrs paid a week) which is why most of them still tag "Volunteer" onto their names.

I don't know. Nyack, New City and Congers are alot more than 58% volunteer. I worked at Congers. At most they had 3 employees working Mondays and Fridays day shifts. New City pays only some days. Nyack need more emplyees. I do paid shifts at Haverstraw. They pay 2 people during weekdays and that is it.

 

[BossyCow]

In broad strokes, City work gets you weird stuff, Country work gets you weird stuff.

A 350 lb. woman wedged between a tub and toilet can happen anywhere,
QUOTE]

But the 350 lb woman wedged between a stump and a boulder, 3 feet from a raging river is a whole different kettle of fish.

 

[catskills]

I am volunteer EMT-B and I am also an Outdoor Emergency Care (OEC) instructor with the National Ski Patrol. As a volunteer EMT-B with local Fire and Rescue, medics are usually no more than 5 minutes away. As a ski patroller, patients can be up to 2 miles from the nearest road and medics are up to 30 minutes away. Ski patrolling gives me the opportunity to use a lot more BLS trauma skills. As an EMT-B with local Fire and Rescue agency, I get to use more BLS medical emergencies skills.

 

[jordanfstop]

Nyack need more employees.

I'm (hopefully) getting my cert this Thursday. I'm doing on-site, too. I have about 400 calls under my belt... I was thinking of trying to get a paid shift over in Nyack with it.

 

[firecoins]

I'm (hopefully) getting my cert this Thursday. I'm doing on-site, too. I have about 400 calls under my belt... I was thinking of trying to get a paid shift over in Nyack with it.

do it. New City also need employees. Ill put a good word in for you.

 

[BossyCow]

I love both the more urban (okay rural) of the regular service and the wilderness med. Urban is a great way to sharpen your skills due to the repetition and volume of pts seen. But, the challenges of packing someone out from the backcountry involve sometimes days of monitoring the walking wounded, that can suddenly turn into a more serious situation.

I think I prefer the wilderness situation because its so much more involved. But I would think it would have to be a pretty busy system to avoid getting bored.