The Myth of Rural EMS = long transports

[RocketMedic]

So I've heard a lot of times, both in person and online, that urban EMS is basically five-minute rides and every rural call is hours long. I've worked both. Truth is, most "urban" calls run at least ten-fifteen minutes at least of transport, and most rural calls are quite close to the rural hospital. Just food for thought.

 

[Colt45]

Yeah I agree for the most part. Where im at there are parts of the state that have hour and a half ground transports to the nearest hospital.

 

[akflightmedic]

Hmmmm, yes and no. There is everything from hours to mere minutes to get ambo from its parked spot on scene to the ER. And there are systems which reflect that as well, from the do as little as possible/load and go cause we are so close to the systems which say proximity to the ER should not be a factor in your clinician skills/assessment/care and treatment.

And within those systems there are those who abuse it or take advantage of it, depending on which side of the bed they woke that day.

I am unsure what exactly your point was or which direction you want to go with your post, but there are way more dynamics to how long a scene or transport should take within all rural or urban environments than simply assessing the way the crow flies.

Where I live part time of the year (rural) if the roads are dry, weather is fair, and traffic is light....I can be at the ER within 30-40 minutes. Other times of the year the trip could take 1-2 hours due to inclement weather, snow, bad roads, etc.

I also live where a 4 mile section of road easily takes 25 minutes to drive due to pot holes, switchbacks, hills, and many other interesting obstacles most urbanites would never think about. On the flip side, I typically do not have 3 level walk ups on narrow dark stairwells to navigate along with every busy body either inquiring about what is going on or trying "to help".

Again, just far too many dynamics which we could probably write about for days on end, however I think the more important time factors are response to scene and then scene time. Short of a significant trauma, Stroke Alert or Cardiac Alert....I can handle everything else and am quite happy to take all the time needed to do so and could care less about the "transport" time.

Edit: I can handle the above mentioned things...just not in the way their condition warrants. Did not want it to sound like I was lost on those, lol. Was trying to stress the time factor, but even knowing time is essential, I will not jeopardize myself or my partner and take short cuts or unnecessary risks. I will do all I can for the patient within reason and what is, shall be.

 

[chriscemt]

So I've heard a lot of times, both in person and online, that urban EMS is basically five-minute rides and every rural call is hours long. I've worked both. Truth is, most "urban" calls run at least ten-fifteen minutes at least of transport, and most rural calls are quite close to the rural hospital. Just food for thought.

I haven't worked both, but some counties in Kansas don't even have hospitals, making the basic transport time run at least (at a minimum) 45 minutes. Unclear how rural EMS transport times are some kind of myth.

 

[NomadicMedic]

Agreed. I work in a primary rural area and it’s an average of 40 miles to a stroke/PCI/trauma center. We do have a critical access hospital, but the anticipated clinical course usually precludes transport there for all but the most innocuous cases.

Long transports are certainly no myth in my neck of the woods.

 

[TransportJockey]

When i was in nm our shortest transport was 35 minutes. We didnt have a hospital in our county. In Pecos if we were in town we were 5 to 10 from the hospital, but that hospital could only handle minor,stable patients. Anyone serious and we either had to drive 70 miles to odessa or skip the hospital and wait for a fixed wing or rotor. Out in tbe county it might take an hour just to get to scene.
I do think generally scene time will be less in rural areas because we get proficient at doing things on the move with little help. I know my scene times here in Galveston tend to be longer than equivalent calls in nm

 

[Summit]

Sure if the call was in town, I had 2 minute transports.

But most of my calls working a rural ambulance were 20-60 minutes to the local 3 bed ED where they'd stabilize the pt (and sometimes we'd stay and help out) then they'd call us back for a 1.5-2.5 hour IFT.

I've never worked urban EMS

 

[EpiEMS]

This sounds like something that could be answered with NEMSIS data.
Response times are definitely longer in rural areas...http://newsroom.acep.org/2017-07-19-Rural-Patients-Wait-Longest-for-EMS

 

[Tigger]

The true statement here is that urban EMS is not just five minute transport times. Who knows how long on scene plus traffic can easily be a half hour call.

But as they say, if you’ve seen one system, you’ve seen one system. My FT service is has an average dispatch to clear time of 178 minutes. 50% of our calls are within 15 minutes of the local CAH. Yet we can transport 15% of our patients there. 20% of our transports are from said CAH which is a 40 minute transport (never mind total call time) to real hospitals. There are parts of our district with a ground time of 2 hours to a real hospital and we do it regularly. We aren’t calling for helicopters outside of actually time sensitive conditions.

Best part? CMS classifies us as urban.

 

[johnrsemt]

Must be nice to be close to the hospitals:

FT job is minimum of 42 miles to small hospital. 85 miles to Level I and II's.
PT job is 2 hours (110-125 miles) to any hospital. 8 hour turn around in not abnormal. 2 hours to scene, 2 hours back to town, 2 hours to hospital, 2 hours back to station. Last Christmas turn 6.5 hours to the hospital due to storm (snow and ice and wind) cardiac issues, no way to get a helicopter.

 

[DrParasite]

2 hours to scene

So all of your people are either able to take a taxi (because time isn't of the essence), at deaths door and knocking loudly, and you can't do anything about it, or what?

If you have a two hour response time on a routine basis, than something is really wrong with the system..... or it's super rural, and the thought is a late ambulance is better than no ambulance at all.

 

[TransportJockey]

So all of your people are either able to take a taxi (because time isn't of the essence), at deaths door and knocking loudly, and you can't do anything about it, or what?

If you have a two hour response time on a routine basis, than something is really wrong with the system..... or it's super rural, and the thought is a late ambulance is better than no ambulance at all.

Usually the latter. Or extenuating circumstances like in the middle of the oil patch

 

[EpiEMS]

Who knows how long on scene plus traffic can easily be a half hour call.

This could be as true in an urban setting as in a rural one. Could take 30 minutes to go half a mile, even going lights and sirens, in NYC...

That being said, if I'm going to generalize about calls, it's gonna be this: a more critical patient is going to be a quicker (and cognitively easier) call than a BS call...

 

[NysEms2117]

This could be as true in an urban setting as in a rural one. Could take 30 minutes to go half a mile, even going lights and sirens, in NYC...

That being said, if I'm going to generalize about calls, it's gonna be this: a more critical patient is going to be a quicker (and cognitively easier) call than a BS call...

if i remember correctly the few times i've been into NYC, they get as close as possible, and sling their go bag, and walk, prep the patient and by that time the ambulance would be arriving.

 

[NPO]

So I've heard a lot of times, both in person and online, that urban EMS is basically five-minute rides and every rural call is hours long. I've worked both. Truth is, most "urban" calls run at least ten-fifteen minutes at least of transport, and most rural calls are quite close to the rural hospital. Just food for thought.

Yes an no. When ive worked in a city it could be 2 to 20 minutes to the hospital. Where I work now it's 30-120 minutes to the nearest hospital, which is a level 2 stroke and has basic cardiac capabilities. The nearest trauma center, with more advanced cardiac, and neuro is another 45 minutes.

That said, both present unique challenges.

 

[ThadeusJ]

When I did Int'l Medevac, I spoke with a crew in Corner Brook, Newfoundland who did regular transport runs to St. John's for specialty treatment/diagnostics. One way run was about 7 hours. Made for a long day.

 

[Summit]

In Norway they have ambulance boats for some areas that are not reachable by ground and frequently not by air either.

 

[VFlutter]

I went from a base that had relatively long transport times (20-35mins) to one with very short (3-10mins) and everyone assumes that it is great but in reality it just means you can turn more flights, less time to do what you need, and the same chart regardless. It doesn’t matter if you have a 3min or 30min flight you are held to the same clinical standard and lack of time isn’t an excuse for not getting an OG, blood sugar, or getting them on the Vent.

 

[ThadeusJ]

It doesn’t matter if you have a 3min or 30min flight you are held to the same clinical standard and lack of time isn’t an excuse for not getting an OG, blood sugar, or getting them on the Vent.

I have heard that some large, urban services rejected adopting CPAP for this very reason. I'm pretty sure that it still stands.

 

[Peak]

My rural service is sixty miles to the nearest trauma center/cath lab/ICU/PICU and thirty five from a critical access hopsital that we can swing by to grab drugs, blood, or supplies. This doesn't take into account the time it takes us to get to the patient and get out (usually by ATV). Flight typically isn't an option either due to weather or elevation, and the nearest crew is thirty minutes out if they are available. I'm lucky if I get done with a case in four hours.

We don't staff critical care nurses on our buses at my full time hospital system, but our crews average time for a call from dispatch to bedside is about 30 minutes. This is in a inner city setting with hospitals within a few miles of each other. Their transport times are definitely shorter than mine. vasoactive drip.