ALS Care in Urban vs Rural areas thoughts?

[stcommodore]

This is a debate about two TOTALLY different worlds and that basically has no end. Does the urban setting need medics, Yes. Does the rural setting need medics, yes. Sick people need paramedics regardless of location.

[spenac]

This is a debate about two TOTALLY different worlds and that basically has no end. Does the urban setting need medics, Yes. Does the rural setting need medics, yes. Sick people need paramedics regardless of location.

Darn politician trying to make everbody happy.

[Dustdevil]

Darn politician trying to make everbody happy.

Nah, he's making too much sense to be a politician.

[medicsteven]

Wow , could I go on forever about this . As a flight nurse , I see the very real need for more advanced services in the rural area`s . Although there may not be the large numbers of MVC`s , there are a lot of farm and ranch accidents as well as recreational accidents that are life or limb threatening . It takes a long time to get to these people to start with and then they face a long transport to the hospital . These are the people that need advanced care . That is taking nothing away from the basic services - they do an awesome job and often with less than perfect equipment .

[unknown]

Wow , could I go on forever about this . As a flight nurse , I see the very real need for more advanced services in the rural area`s . Although there may not be the large numbers of MVC`s , there are a lot of farm and ranch accidents as well as recreational accidents that are life or limb threatening . It takes a long time to get to these people to start with and then they face a long transport to the hospital . These are the people that need advanced care . That is taking nothing away from the basic services - they do an awesome job and often with less than perfect equipment .

And as this flight nurses Comm Spec combined we could go on for eternity!!!!! We have been there and done that in the rural aspects for several years now haven't we?

[toutdoors]

I believe that the biggest issue is summed up very simply; money. I spent 5 years in a volunteer fire department that worked very closely with a volunteer ambulance, it wasn't until my last two years there, that one of the EMT's from the ambulance took the paramedic. Let us not forget that volunteers put in a great many hours dedicating themselves to their community. Now ask them to leave work early for the better part of a year two or three days a week to take night classes, and more than likely they will have to drive at least a half an hour or more to get to the class. Then take away that family vacation this summer because you are doing your ride and clinic time. Now that you finally made it through the studies and tests, and still have a job, and your family, your ambulance crew finds itself being requested by smaller ambulance services that are transporting to your small community hospital because you have a paramedic on your crew and they have a critical patient. This can be alot to ask of one or two people on an ambulance team that may be made up of only 6-10 people taking turns being on call. I agree wholeheartedly that the rural areas would be of great benefit if there were more medics available. I guess the next key word is EDUCATION of the public, and those who hold the purse strings, see if we can't dole out a few bucks to those dedicated volunteers who put everything on hold at a moments notice to try to help someone they may or may not know. I miss the volunteers I used to work with, but love the 24 up 48 down schedule, now at least I can plan around someonelse's emergencies.

[spenac]

I believe that the biggest issue is summed up very simply; money. I spent 5 years in a volunteer fire department that worked very closely with a volunteer ambulance, it wasn't until my last two years there, that one of the EMT's from the ambulance took the paramedic. Let us not forget that volunteers put in a great many hours dedicating themselves to their community. Now ask them to leave work early for the better part of a year two or three days a week to take night classes, and more than likely they will have to drive at least a half an hour or more to get to the class. Then take away that family vacation this summer because you are doing your ride and clinic time. Now that you finally made it through the studies and tests, and still have a job, and your family, your ambulance crew finds itself being requested by smaller ambulance services that are transporting to your small community hospital because you have a paramedic on your crew and they have a critical patient. This can be alot to ask of one or two people on an ambulance team that may be made up of only 6-10 people taking turns being on call. I agree wholeheartedly that the rural areas would be of great benefit if there were more medics available. I guess the next key word is EDUCATION of the public, and those who hold the purse strings, see if we can't dole out a few bucks to those dedicated volunteers who put everything on hold at a moments notice to try to help someone they may or may not know. I miss the volunteers I used to work with, but love the 24 up 48 down schedule, now at least I can plan around someonelse's emergencies.

More proof and reasons that all services should be paid.

[toutdoors]

I coundn't agree with you more spenac, but believe that when we say that all services should be paid, we are painting with a very broad brush.

I might be misinterpreting what you are saying also. Do you mean that the smalltown USA ambulance, that serves 300 people should be on a full time paid basis, or should they be a paid per call type of service?

Even if it were only pay call service, who would pay for the medic school? The service, the community, or the individual? That is alot to ask from some of these small towns and services as well as those dedicated EMT's who volunteer.

Maybe the answer lies within the larger hospitals, maybe we (as an organization of EMS personnel) need to lobby the big time hospitals for some money to the outlying areas surrounding them. After all, if they would pay for a few people to take the medic class, the medics may prolong someone's life long enough to make it to the cath lab or OR, or at least to the ER, so the hospital can charge an astronomical fee for services to recoup those few medic classes they paid for?

I know, a little sarcasm here, but let us not forget that EMS is still relatively new in the US. Oh sure, we were throwing people in the back of paddy wagons and onto flatbed trucks a long long time ago, but it wasn't until The White Paper in the 60's that EMS was really born here in the US.

Does this mean that we should take what we get and be happy with it? Not neccessarily, I think we should look back on what was, and what we have today, and be thankful for the advancements. Then let us take a look ahead and determine what we would like to see short term and long term, and decide how best to procede.

To all of you dedicated volunteer EMT's, my hat is off to you, I was only a volunteer firefighter, but heard all the ambulance pages for the EMS and transport to larger hospital calls go out.

To all of you full time paramedics, please don't forget where you started, and that BLS is the start of ALS. (Day one stuff I know, I am in the medic class now, trying to better myself and my service) Also, please share with all of the EMT's out there your experiences and any knowledge that you can pass on that will create a learning opportunity for these individuals. Some of these people want to get to where you are, they are just waiting for their chance to get in class, or get the finances.

When the call is over, we are all in this together, some of us drive, some of us do basic stuff, some do advanced stuff, and the docs get all the money for working in the nice clean controlled atmosphere, but then again they can have that; all I want is my little piece of the pie, and the satisfaction that comes with it.

It is very interesting to sit and read some of the thoughts that are out there. It seems that you can see who works the large service that would be associated with a larger urban environment, and then you can see who is working as hard as they can with what little they have and all on their own for an extended period of time. Makes for some interesting reading, and gives us a chance to see why things are not always the same all over, although it would be simpler if they were.

To everyone: Have a great summer filled with laughter, sun and fun family times, and keep up your hard work. I look forward to reading more from you folks.

[spenac]

I coundn't agree with you more spenac, but believe that when we say that all services should be paid, we are painting with a very broad brush.

I might be misinterpreting what you are saying also. Do you mean that the smalltown USA ambulance, that serves 300 people should be on a full time paid basis, or should they be a paid per call type of service?

It is very interesting to sit and read some of the thoughts that are out there. It seems that you can see who works the large service that would be associated with a larger urban environment, and then you can see who is working as hard as they can with what little they have and all on their own for an extended period of time. Makes for some interesting reading, and gives us a chance to see why things are not always the same all over, although it would be simpler if they were.

As a small town very rural person I whole heartily know that all communitys can afford to have paid staff. There is no justification in this day and age for a volly service. I was a volly and it makes me mad when I look back at what the small county chose to pay for but would not pay us. They are now paid by the way. Here is a good discussion on this subject: http://www.emtcity.com/phpBB2/viewtopic.php?t=9332

I do feel that rural areas really need ALS more so than the citys but really all ambulances should be ALS.

[Dustdevil]

Good points, Tout. I disagree with many of them, but I can see that your heart and head are in the right place.

I'm afraid I do not share your support of volunteer EMS providers. They are the very reason that EMS is no better off now than we were thirty-five years ago. We could have come a very long way in that time if so many communities were not mislead into believing that EMS is nothing more than a and a three-week first aid course for people who want to play with sirens for a hobby. That EMS is a fraternal club that people pay to join, instead of a profession that must be paid for. That if they don't pay for it, it's okay, because someone will still show up. Those volunteers aren't providing their communities with anything of value. They are denying their community what they need. I see no altruistic honour in that dubious distinction.

Can a town of 300 afford to pay? Some absolutely can. Others absolutely should look for cooperative arrangements with their neighbouring communities, the county, and as you suggest, hospitals. Where there is a will, there is a way. But as long as people still have someone showing up most of the time -- regardless of educational, experiential, or professional qualifications -- don't even know they need it. No perceived need = no will.

I don't see the part-time/per call system as a significant improvement over a volunteer system. That's not pay. That's just a stipend for your trouble. It is not likely to be incentive for the provider to continue for educational excellence. It's certainly not going to attract any experienced or quality providers. At best, all it does is encourage the local bubbas to go to EMT school so they can be one of the cool kids. EMT school and 5 runs a month adds up to a crappy provider for life. No, that's not progress.

Who pays for the education? Don't know. Don't care. Those who truly want to be professionals always somehow manage to pay for it. But I agree that if a community wants progress, it doesn't come for free. They need to either pay to attract professionals (the preferred method, and must more expedient), or pay to develop their own. Of course that route has more potholes than the road to Baghdad International Airport. No town is going to pay for two years of professional education in the hopes that that person will work for them on the cheap somewhere down the line. Consequently, you're starting off with sub-standard education, then putting those people to work with no experience, in a rural system where the best educated and experienced people should be the providers. Unfortunately, just like most people believe that all ambulances are the same, they also believe that all providers are the same. And appallingly, way too many medics believe that too. "My six month paramedic certificate is just as good as your fancy associates degree!" How often do we hear that one?

This stuff about EMS being a young profession is nonsense. The provision of medicine in the field goes back centuries. Emergency! showed us our future potential over thirty-five years ago, yet it has still not become a standard because people who watch television honestly believe they have EMS, and because the fire service fights any significant progress tooth and nail for their own selfish, greedy, political and financial gain.

Significant positive progress in EMS provision will come only when two things happen: the vollies and the firemonkeys must get out of the way and let it happen.