Urban v. Suburban

[Double-E]

i can imagine the differences between working in the two environments but i curious what any of you have to say about the matter.

any personal experiences to share? reasons you favor one over the other?

 

[vquintessence]

It goes deeper than just the populations.

Income brackets, unemployment, racial demographics, average education level, drug/alcohol abuse, etc etc. Hell, even the service that provides the care will have a dramatic effect.

 

[firecoins]

It goes deeper than just the populations.

Income brackets, unemployment, racial demographics, average education level, drug/alcohol abuse, etc etc. Hell, even the service that provides the care will have a dramatic effect.

yep. Your equipment will be older and more abused in an urban environment.

 

[mikeN]

yep. Your equipment will be older and more abused in an urban environment.

I don't know about that. Boston EMS has new equipment, granted, it is a city service.

 

[Ridryder911]

Some of your larger services will place emphasis of the money in the trucks and equipment over people as the equipment makes the money and can be depreciated.

R/r 911

 

[NolaRabbit]

I work at an urban service in a city of nearly half a million and I wouldn't trade it. Sure, it can be frustrating dealing with the challenges that go along with working in the urban environment, but I love the range and unpredictable nature of the calls I go on.

I did half of my precepting shifts at a suburban service, and while I'm glad to have experienced the difference, I'm also glad that I have the opportunity to work where I do. I'm not going to say one type of service is better than another, but for me, I truly enjoy the urban EMS environment.

Oh, and our equipment isn't old and run-down, either.

 

[johnrsemt]

I worked for 10 years in an urban service; both Private, full time; and fire department based, part time (at the same time).
We had good equipment, great training and large variety of runs (very busy).

Now I work in a rural setting: on a military base where we have a work day population of approx 5000; and a night weekend of 1500. plus we cover a large off base rural area that includes alot of 4 wheel drive/ATV terrain.
We have good equipment, good training (which is getting better), variety of runs, but very slow (21 patients in 11 months, and I am the busiest medic in the section).
we are 45 min from front gate to level III hospital. 1h 20m to level I trauma centers. we fly anything that is serious.

 

[djmedic913]

I don't know about that. Boston EMS has new equipment, granted, it is a city service.

Buffalo, NY EMS is a lot of used and abused trucks and equipment...

by the nature of urban EMS equals more calls, shorter transport times equals more wear and tear on a vehicle...

I used to work in Buffalo and now work in Nashua, NH and our stuff is used and abused...

 

[djmedic913]

I have actually worked in all 3 areas of EMS-->urban, suburban, and rural...

each has their advantages and disadvantages...

Urban-->high call volume, more violent trauma, increase in "scrote" patients.

Suburban-->less calls, less violent trauma, more true medical calls.

Rural-->much longer transport times (this can be a plus and minus), more trauma from MVA's (higher rates of speed than urban)

I liked working for a company that covered all 3 types and gave me the opportunity to hone my skills for each area...because each area does have a unique skill set. for example working a code in a city is usually a 5-10 minute transport so you are lucky if you ever make it to your 3rd round of meds, as compared to rural where your transport time could be 30-60 minutes (even hot) so you will get much deeper into your code meds...

[and yes I know that if you have a transport time of over 30 mins in a code it becomes extremely pointless...sometimes you start it and and call med control before arriving at the hospital. at least the illusion of "everything that can be done is being done" is being maintained for the family]

 

[46Young]

Same here, as in DJ's post. Also, statistically speaking, urban areas will have a higher # of nonsense calls. They'll call for EVERYTHING. I have a fever, sore throat, I slammed my hand in the door, I ran out of albuterol, he done caught a seizure and fell out, she got the sugars, I feel sick and just want to be checked out, my baby has a fever for three hours... no, I haven't given any children's motrin or anything, I was discharged from the hosp six hours ago and my prescription isn't working yet. Oftentimes the pt's family would follow behind in a car! I guess when Medicaid gives you a 100% free ride, why call a taxi or waste your own gas? I had a guy that worked as a security guard across the street from the hosp. He would call for the "asthma attack", get his Tx, sign out AMA at the ER, and go to work. Those living in surburban areas would typically have cars, commercial insurance, and some common sense. There would be less nonsense calls, as they would be driven to the hosp. When people call 911 to aviod the waiting room crowd, I like explaining them, after having waited several hours already, why they were shuttled to the waiting room as if they went via POV. The feel me bads just aren't as important as someone with cardiac issues, resp distress, GSW, stroke, you know, things that an ambulance should be called for.

 

[djmedic913]

Same here, as in DJ's post. Also, statistically speaking, urban areas will have a higher # of nonsense calls. They'll call for EVERYTHING. I have a fever, sore throat, I slammed my hand in the door, I ran out of albuterol, he done caught a seizure and fell out, she got the sugars, I feel sick and just want to be checked out, my baby has a fever for three hours... no, I haven't given any children's motrin or anything, I was discharged from the hosp six hours ago and my prescription isn't working yet. Oftentimes the pt's family would follow behind in a car! I guess when Medicaid gives you a 100% free ride, why call a taxi or waste your own gas? I had a guy that worked as a security guard across the street from the hosp. He would call for the "asthma attack", get his Tx, sign out AMA at the ER, and go to work. Those living in surburban areas would typically have cars, commercial insurance, and some common sense. There would be less nonsense calls, as they would be driven to the hosp. When people call 911 to aviod the waiting room crowd, I like explaining them, after having waited several hours already, why they were shuttled to the waiting room as if they went via POV. The feel me bads just aren't as important as someone with cardiac issues, resp distress, GSW, stroke, you know, things that an ambulance should be called for.

o wait you also forgot the 'toe pain', the 'high blood', and the 'vomicking'...LMAO...

I have had plenty of patients call from a bus stop on 1 side of the city complaining of something and they won't let you examine they just want to go to a hospital clear across the city and they walk thru the ER and out the door...once I followed 1 of these guys just to see and he went to his buddies house...that same night he called again (someone else transported him) just to go back home...I have even had chief complaint of "I have medicaid take to the hospital"...under 911 law we had to...

generally in urban settings EMS and the ER's are abused...or should we call them 911 taxis?

 

[46Young]

According to an article I read some time ago, Richmond Va 911 dispatchers employed RN's to triage over the phone, and attempt to convince callers of alternate means of txp. It worked well, but they would have to send an ambulance if they still requested one. During the brief time I worked at Charleston County EMS, medics had a "no need for EMS" SOP, which allowed the crew to deny txp for utter nonsense. It was infrequently used, due to liability fears. Extra points for you if you can tell me what these three things mean: peanut butter balls, I've got a ferocious liver, and I'm sick as hell! Sick as HELL!

 

[djmedic913]

Extra points for you if you can tell me what these three things mean: peanut butter balls, I've got a ferocious liver, and I'm sick as hell! Sick as HELL!

peanut butter balls is phenobarbitol. used to have dispatcher in Buffalo who would dispatch that...along with difficulty breeding (breathing), abdomila pain

the I'm sick as hell just sounds like standard IBD [IBD= I be dying]..but I don't know

ferocious liver, I have no clue...sounds like Hep C or Cirrhosis

can you tell what "smiley mighty jesus" is?

 

[46Young]

Spinal meningitis. I've never heard that before, though. That's a new one for me. You're right on the phenobarb and cirrhosis. Sick as hell is sickle cell anemia. With what condition would you typically hear !Ay Ay Ay! !No puedo no puedo no puedo! Hint: we also refer to it as I-Tach (Ay in excess of 200 times/min).

 

[djmedic913]

Spinal meningitis. I've never heard that before, though. That's a new one for me. You're right on the phenobarb and cirrhosis. Sick as hell is sickle cell anemia. With what condition would you typically hear !Ay Ay Ay! !No puedo no puedo no puedo! Hint: we also refer to it as I-Tach (Ay in excess of 200 times/min).

I just smacked my self in the head on sickle cell...I forgot all about that one...lol


ok you got me...not sure of Ay Puedo...

I have not heard of I-tach but have heard of the Tachy-lordies and Brady-lordies...

 

[46Young]

Roughly 40 y.o. female supine on the couch complaining of difficulty breathing, with the family hysterical, and totally eating it up. It's either a panic attack, or an attention getting ploy after a family argument.

 

[djmedic913]

Roughly 40 y.o. female supine on the couch complaining of difficulty breathing, with the family hysterical, and totally eating it up. It's either a panic attack, or an attention getting ploy after a family argument.

ok...never heard of that as I-tach...I like it...

I will add it my list along with IBD, incarceritis, sub-ocular pain upon urination, normazaline, brady-lordies, and tacha-lordies...LMAO

we should start a different thread just for these loving sayings from patients, dispatches and our spins on things...LMAO

 

[46Young]

Good idea, since we already hijacked this one.

 

[reaper]

Nice to know see the quality of medicine being practiced out there. (Lowers head in shame)

 

[mycrofft]

Poll about this dichotomy.

http://www.emtlife.com/showthread.php?t=10984

Urban companies in cities surrounded by underserved people (i.e., Omaha, Rapid City SoDakota, etc) can also see patients under rural conditions.