ALS Care in Urban vs Rural areas thoughts?

[wrenEMT]

This questions was posed to me today, "why do we have Paramedics in Urban areas like New York, and LA, and Miami when the closest hospital is 3 minutes away, but when you get out into the sticks you have mostly basic services only. and ALS is miles and miles out? Wouldn't it be better patient care if those areas that have a transport time of 10 + minutes have ALS crew instead of BLS?"

I thought on this and of course I agree that if there was a paramedic on those trucks it would give better patient care. But, there are those times especially out where I am in the sticks that most of the transports to the ER are basic runs but paramedics get sent to them.

Most of the time the only thing a paramedic does around here if on a medical run is start a line, draw labs and possible give some albuterol for those cute lil old people with CHF or possible pneumonia. Drawing the labs is big here in my town. The nurses in the ER are a bit too babied by the paramedics and the basics get yelled at for bringing in a basic patient, without a medic because they wanted labs drawn.

Of course there are those times when there does need to be a paramedic on board sure. We are out in the sticks and we have a patient circling the drain. Of course I'm going to call for help. Which is true for most basic services.

Only thing I would have to say is that Urban or City areas get the same kind of runs as we do but in greater number. But most of the time, you have to think, the paramedic doesn't have time use any of their skills in that short amount of time. I mean unless you count those times the medic stays and plays because of a code patient or just wanting the chance to play with their toys and use some skills.. Very Happy

On the other hand we have more time in the rural areas only because we have less hospitals and more time with our patients. Yet we are without the number of paramedics in our areas as in urban areas.

What are your thoughts on this subject?

PS I'm not sure if I put this in the right area, so if need be just move it to right area

[Ridryder 911]

Anyone that has really studied EMS systems realize that rural area could utilize Paramedics much better and actually is more beneficial than in metro areas. Then really all patients should be initially examined by a Paramedic.

The reason one will not see many Paramedics in the rural area is lack of funding and benefits that are offered at larger services. Sorry, although the interest may be there, when it comes time to paying bills and food for the family, one is going to work where they can make double to triple an hour with benefits.

It is the same problem all small communities have attracting any health care provider.

R/r 911

[mobey]

I have always thought things were ass-backwards. I used to work for a BLS rural service with 2+ hr transport times and many a times I found myself inadequate. My instructor for me intermediate course was a 25+ yr veteran EMT-P from a busy urban service and he wined daily about all the nonsence calls and how he never got to use his "skills".

But the problem is again in the closed minded small services who claim they have no money for ALS. The BLS service I was in only did a few hundred calls a year and claimed they had no money for ALS.

Simply put I feel we need to cram education down the publics throat about where thier money is being wasted. I know if we could have told our public what they could have out of a service compared to what they do have, they would have been pretty quick to fork over the cash. I have been in the service I am in now for just a few months and I have worked 4 codes we could have used ALS on but other than that with a 5-10 min transport I don't see any other calls they would have benefitted on. (Keep in mind BLS can do a few ALS procedures in AB).

[spenac]

The public does not care. They only want the funny looking vehicle with flashing lights and siren, because all we are is a fast taxi. No matter how you educate, explain, etc, they don't get it. Rural areas such as I work at, and especially where I used to work at, have a much greater need for Paramedics than the citys.

It is funny from what I have seen here though that you almost should not call a city paramedic a paramedic when you consider how limited there protocols, the mommy may I requirements, and limited drugs and toys. Not saying all but several of the city procedures are very limited as described here on the city.

But back on topic it is lack of pay that keeps paramedics out of the sticks. In my area it is nice to see a start in change of attitude and pay going up for all involved.

[Just Plain Ruff]

Let's ask the public what they want. Other than the fact that the public doesn't know what the hell it wants let's ask them.

I thought about this question and post and said to myself.

If I had a choice between a responder who could only put me on oxygen and take me to the hospital providing strictly bls service or I had a responder who could reverse my CHF or fix my critical blood sugar level or give me medications during a anaphylactic reaction. Which would I choose?

I of course would choose the latter. I'm a little biased but I can almast guarantee that anyone would want the latter.

unfortunately when you factor in cost of providing and ALS service versus a BLS service then the public (naive as they can always be) will choose the BLS service because it's cheaper. Again, the lack of education of the public needs to be taken into account here and addressed.

What usually happens is someone in power, like the mayor or a prominent citizen suffers an illness or trauma that a ALS responder would have been much more able to handle but instead is treated by a BLS service, then the system will more than likely change. But until that catalyst occurs, until a situation where a ALS provider could have made a tremendous difference in the outcome of that particular citizen then most communities will blissfully sit back and say "As long as it doesn't happen to me, then I'm happy with the status quo"

Ignorance is bliss

[Scaramedic]

Yeah, the pay is the issue for me. I would love to move to the coast, say Long Beach (WA) or Astoria. Unfortunately the pay for Medics on the coast is pathetic. Yet these guy and gals are responding to some real remote areas. Forget streets or even paved roads. They are responding to logging roads that are one lane wide with log trucks rolling down them at high speed. They might be a good hour away from the city limits at times.

I don't know about where you work Spenac, but I don't work at a limited protocol mother may I system. In fact a lot of our protocols would be better used at some of the rural areas that have much more limited protocols.

This is part of the reason I am going to the dark side, Nurses get payed well everywhere for the most part.

[Kiwiology]

Great topic. We Kiwis are in a simmilar situation, most rural services are run by volly medics, if they are at work, well, sorry no cover. Mutual aid, well, sorry, we've only got one or two paid medics in the next town over because they have a low call volume so your mutual aid is probably going to be a single crew transport, if you're lucky, the fire service (also vollys) will get turned out to provide some O2 or first aid.

If you need ALS you're probably going to have to wait for a fly car or the whirly bird. We put resources into areas depending on the need - by which I mean, "how much do we REALLY NEED to spend this money?"

Our BLS service here is a mix of BLS and CFR+D so if you live in a low workload area, your local ambulance may turn up with one EMT-B and a CFR+D or two CFR+D or worse yet, a single EMT-B or CFR+D because nobody else is able to be rostered on (paid staff to vollys is about 1:3 here)

Lets say that your local BLS rig turns up with one EMT-B and a CFR+D to a high speed car crash or some guy crushed by his John Deere (hey, they're out in the boon docks remember?). Or perhaps its some old guy on his farm who codes ... the call goes out for an Advanced Paramedic. Well, Dispatch is either going to send the nearest ILS or ALS ambulance or the chopper (ALS). Long wait, long transport time etc etc etc ... same problem world wide

I guess it just does not make financial sense to have Paramedics sitting round in the boon docks playin the banjo and whittlin'. Sad.

[Dustdevil]

It would be interesting to question somebody like Hilary about how "free healthcare for everybody" would affect EMS. I am betting it has never even crossed their mind, and they don't consider EMS to be healthcare.

If they do, by some slim chance, consider us healthcare, I'd like to see the looks on their faces when they find out that a huge portion of the country doesn't have it, and how much it would cost to provide it. I think we'd quickly learn a lot about what they really think about "universal healthcare",

[mediccjh]

One thing you must remember about Urban systems is that though you may be physically less than 5 minutes from the hospital, one must take into account extrication time. When you have to carry your equipment up multiple flights, take care of the patient, extricate patient and equipment, it takes time. Even in the high-rises in elevators, there is still the elevator wait. Therefore, you can still be with your patients for the longer times that one would see in some rural areas.

[gvandellen]

There are only two groups that you can target in the community if you want for money and education should be directed towards them. Parents of small children and the elderly. No one else cares. You can play off the fears of parents that an allergic reaction could happen to their child or could choke at any moment. Just put up one billboard in a town that says "A paramedic can help your choking child....Does your town have enough?" See if any money comes in after city hall gets 300 phone calls. Just a thought...