tgulch

No I am in Ohio at the Put in Bay EMS service. The islands are actually the Bass (South Bass, Middle Bass, and North Bass). We have 1 full time paramedic year round on South Bass with support from the Volunteer EMT's. In the Summer we supplement the staff with part time paramedics and EMT's. We run with 2 medics during the day and medic/emt combo at night, on weekends we run with two medic/emt teams on south bass and a 2 EMT (or AEMT) team on Middle Bass. Those are the only two islands with any EMS staffing at all and the only two islands with any EMS equipment on the islands. If we have to respond to any other island, it is by boat and we are pack mule with whatever equipment we think we may need. And I had forgotten, there are 4 islands with year round residents. One island is a Campus for OSU for Marine Biology program used only in the summer, and 3 of the other islands have some people living on them from time to time. There is one island that no one ever lives on. Our practice is actually limited by the Scope of Practice for the State of Ohio. If sutures ever got added to that, I am certain we would be doing those also.

I am the EMS supervisor for a unique island community. During the winter we have MAYBE 300 residents on all 9 islands (We cover 160 something square miles, and only about 7 are land, 9 island only 3 are inhabited year round). During the summer though the population of the island swells to as many as 20,000 on a busy holiday weekend. The island has become known as a party island in the summer. The only way on or off the island in the summer is to take a auto/passenger ferry, a passenger only ferry, personal boat, or airplane. There is also the Air Ambulance for emergent transport off the island. The Airport is a daylight airport only, and the ferries stop running by midnight at the latest and begin again at 6am. In the winter, air is the only way on or off the island. Our run volume is about 500/year, with a majority of runs occurring between May and September. Usually about 50-75 runs outside of those months. We have a very progressive Medial Director, and have incorporated a very progressive medical treatment. A majority of patients are treated and released. Fractures, lacerations, etc are bandaged, steri stripped, and sometimes even non narcotic pain meds given, and the patient is left in care of self or family and friends and told to transport themselves off the island for definitive treatment. Patients that have had too much to drink are given a 2000cc Bolus of NS and if they are responsive able to walk, and alert enough, they are sent home to sleep it off. We regularly clear C-Spine on falls and simple traumas. We fly anyone who has injuries or illnesses that need that transport, and have even transported on a ferry with just the cot to turn care over to a service on the other side. I foresee more EMS entities entering into a system similar to how we run. We even have the right to refuse Air Ambulance transport to patients who are demanding it, but do not have injuries or illnesses to justify an air ambulance.