Getting used to the Rural Setting

[Dustdevil]

I wish I had that choice. For us if the lights are on the siren must also be on. No exceptions.

Is that an agency policy, or a provincial law?

State law in Texas says you must have both activated anytime you are disregarding traffic laws (speeding, running through stop signs or lights, etc...). That doesn't apply to me, because I just won't do any of those things. So long as you are driving within the traffic laws, there is no legal requirement for lights or siren. But if your employer is eat up with the siren, then I guess you gotta do what you gotta do to keep your job. Sure not a good sign that your employer is very smart though.

[rock_shoes]

Is that an agency policy, or a provincial law?

State law in Texas says you must have both activated anytime you are disregarding traffic laws (speeding, running through stop signs or lights, etc...). That doesn't apply to me, because I just won't do any of those things. So long as you are driving within the traffic laws, there is no legal requirement for lights or siren. But if your employer is eat up with the siren, then I guess you gotta do what you gotta do to keep your job. Sure not a good sign that your employer is very smart though.

You don't have to respond L/S to every call. Only to calls dispatched as such. You can turn the siren off on scene when the vehicle isn't in motion. If you aren't violating traffic laws there is no need for lights or sirens (other than slower moving traffic pulling over and letting you by of course). Personally I don't really like running L/S period. I would far rather up my standard of care to the point that saving a couple of minutes returning L/S is almost never necessary if ever.

As to the legality of it I'm fairly certain it's an issue of policy and procedure. I continue to see police run "lights only" at times. Wading through the volumes of P&P that come with a provincial service isn't high on my list of things to do tonight.

[Timmy]

I understand were your coming from. We to have quiet a few bad car accidents. Were lucky enough to have a big supermarket here but when you need to have a good shop you need to travel an hour away to the bigger town. I do all my clothes shopping because they don’t have many brand names here. I also do Christmas and Birthday shopping down there. There just about to open a McDonalds here which is quiet distressing because it will take the business away from the little local bakery’s and take away food shops that have been in the town for years.

I’ve lived in rural towns all my life, in fact I’ve lived on a farm for most of it. I love the lifestyle and the people. Sure you may not get the frequency or clinical presentations that a bigger hospital or EMS service may see but I think it’s important to incorporate work with a good lifestyle you enjoy.

I’ve lived in the city for a few months while I was going to medic school, I really despised it. Traffic, tiny little houses all packed close together, people everywhere, smog and the cost of living wasn’t my cup of tea at all.

My town is about 8,000 people but right across the river is another little town with about 3,000 people. It’s mostly an orchard, vegetable and dairy growing area. The town is built along the river and in amongst bush land. The two towns are joined by a big bridge and it’s about a 3 min drive though bush land across a causeway. It’s pretty much a service centre for the surrounding littler towns, we have quiet a few little towns spread over quiet a distance.

During the summer school holidays the towns population bumps by about 10,000 tourists who camp down the river. They normally bring speedboats, jet skis, dirtbikes and all those sort of toys. This can by quiet a busy time for EMS, fire, hospital and the town in general. We commonly see patient presentations from those toy accidents, burns from camp fires, gastro and food poisoning from camp food and generally people who just become unwell and present to A&E. We get quiet a few fire calls, normally 2 calls a day during December and January which is a lot to expect from a volunteer service. We have a lot of people who don’t know were they are, the river is full of little dirt tracks that wind around the bush for ages until you reach the river or the beach. A lot of tracks don’t have names just the beaches are named. Summer time also means an influx of thousands of overseas fruit and veggie pickers. With these people comes drugs and alcohol, they come here for work but they also don’t mind a good party or a good drink just to make the Australian experience that little more eventful.

I do agree with everyone when they say rural is challenging! It is, very much. Long transport times, not having the appropriate facilities, specialized staff and equipment and even waiting for help can take some time and become very frustrating. About a year and a half ago my hospital had a young man present with heart failure and needed to be put on bypass to be stable enough to be flown to Melbourne, of course we don’t have those intensive care resources available so they flew up a team from Melbourne and did it in our little 3 bed emergency department. Nursing here can be quiet challenging, we only have on call doctors and there’s no guarantee that one will be rostered on. I don’t blame them, after working 12 hours in the medical clinic they don’t need to be called back after hours to look at someone, everyone needs a break.

About an hours drive away is a town of about 40,000 people, they call it a rural city. It’s a nice town, big enough but still has a country feel about it. A lot of business people and tradesman travel to and back and some of the nurses that work at my hospital work part time here and part time over there to keep up with the different clinical presentations, you find the nurses who specialize in midwifery, ICU and emergency do this. This town has the major hospital for the area, the trauma centre and specialist services.

We have about 5 ALS paramedics in my town, they normally run one ALS truck 24/7 but sometimes run two. It’s pretty easy going, they always have a steady flow of calls. The only bad thing I guess is they do a lot of driving to the trauma centre so it takes the truck out of service for about 4 hours.

The drought has severely effected the town in many ways, a lot of people are having to sell there farms and animals and the lack of water it quiet concerning. But it amazes me how the people pull together and help each other out as much as they can.

I know you may find it quiet difficult to become accustom to rural life but I’m sure you’ll find the locals very nice and welcoming, you’ll fit in just fine.

[scope2776]

Just to play devil's advocate...

Sometimes I think urban medicine is more difficult because you don't have the luxury of time. For example it's a challenge to deliver my patients to the ER with ABC's established, a through assessment performed, and treatment began. Sometimes the best medics can overcome this challenge, sometimes the weak ones do not. I believe that my assessment skills must be sharper, my clinical skills more precise, I often have to multitask, and I must always triage skills and diagnostic procedures. I have never worked in rural medicine, and I have a respect for those that do, but how nice would it be to have an abundant amount of time to explore differentials, perform multiple tests, have long amounts of time to consider and perform procedures?

I take pride in keeping scene times low and beginning appropriate treatment even though the hospital is 10 minutes away. I'm not saying urban medicine is better, just different. Truthfully, short transports can be used as a crutch by weak urban medics; just as inappropriate helicopter transports can be used as a crutch by rural medics.

[spenac]

Just to play devil's advocate...

Sometimes I think urban medicine is more difficult because you don't have the luxury of time. For example it's a challenge to deliver my patients to the ER with ABC's established, a through assessment performed, and treatment began. Sometimes the best medics can overcome this challenge, sometimes the weak ones do not. I believe that my assessment skills must be sharper, my clinical skills more precise, I often have to multitask, and I must always triage skills and diagnostic procedures. I have never worked in rural medicine, and I have a respect for those that do, but how nice would it be to have an abundant amount of time to explore differentials, perform multiple tests, have long amounts of time to consider and perform procedures?

I take pride in keeping scene times low and beginning appropriate treatment even though the hospital is 10 minutes away. I'm not saying urban medicine is better, just different. Truthfully, short transports can be used as a crutch by weak urban medics; just as inappropriate helicopter transports can be used as a crutch by rural medics.

Good attempt. I will give you that a good medic will do much in a short time. We in the rurals also do much in those first 2-3 minutes, but then we have time to see if what we did works or not. We have to go deeper into the drug bag. We have to pay attn for the hour or more for the smallest of changes in patients S/S so we can stay ahead. If we ever get behind that hour or more is an extremely long ride. As to helicopter crutch by rural medics, even if I call a helicopter I still have the patient over 45 minutes, so not really much of a crutch. Up to just this July helicopter was 1.5 hours out. In my rural world we also have very limited ability to communicate with the hospital so we have to make almost all choices of care with nothing really to guide us beyond our education.

[emtannie]

First... Dust, loved your post (and you know how much it pains me to day that... lol)

Red, you have already realized how different rural EMS is from urban EMS... and I suspect you have already had those calls where you feel like you are in over your head because of the long transport times and lack of backup. This is your head up to improve your education, and to increase your knowledge. Since you have already come here to look for help, I know that this is already in your mind... every patient deserves our very best, so go out and be the very best.

Rural EMS has challenges that are different from urban. Scope2776 brought up some of the urban challenges. I do think, from having worked both urban and rural, that weak medics depend on the "well it is only a few minutes to hospital, and then I can hand off the patient." Rural EMS doesn't have that luxury.. at times, there is no backup. It's you, your partner, and the patient.... for a lonnnnnnggg time...

The rural service I work for has only had helicopter response available for the past year. We have strict guidelines on when it can be called to a scene. Until then we had fixed wing response, which still meant that we would have to package a patient and transport to the nearest viable runway, which at times was up to 40 minutes away. We always have to consider whether waiting for a plane and transporting to an airstrip was more effective than transporting directly to a hospital.

Do whatever you can to improve your education. Look at your region, and ask yourself scenario questions "If there was an mvc in location X, how would I handle it? Where are my resources?" "If I had a STEMI patient, what can I do?" Running those potential scenarios through your head before they happen will be a help too.

I wish you all the best, and welcome to the site!

[Rescue0ne]

What exactly is rural EMS?

I began my journey into EMS when I was a teenager. The county we lived in had 2 stop lights, no major supermarket chain, no fast food chains, and it was 45-60 minutes to the closest trauma center (which happened to be a level I). I consider that to be rural EMS. Additionally, that trauma center was also the closet facility that was worth a crap. Yes, there was a small community hospital 30 min away, but they killed more patients than they saved, due to lack of quality ER staff.

At present, I'm now 30 min away from a level II trauma center. A level I is being built soon, 10-15 minutes away, on the very edge of our response area. I'm loving this fact, primarily for the patient's sake...but also because we'll save alot on fuel expenses. I no longer consider myself to be a rural medic, more like a suburban medic, I suppose. Heck, it'll cut down on the number of times I call for the helicopter, if nothing else...which isn't really that often to begin with.

I've forgotten the point of this post. Anyway, in my opinion, anything more than an hour away from any type of trauma center should/would/could be considered "frontier EMS".

I'd like others opinion on this matter.

[rock_shoes]

Well RescueOne by your definition I just spent my first year in EMS out on the "Frontier". I must admit it's been a really interesting ride with the nearest trauma centre being 1 hour 45 min. away L/S from the local hospital. I just did a maternity call 2 hours away from the local hospital on a 4x4 road earlier this month. Contractions 2 min apart we ended up flying in the doc by helicopter at daybreak to break the membrane. Fortunately the delivery was textbook following the membrane being ruptured (she delivered 7 minutes later). Now I'm about to move on to another rural community. Fortunately this community has a higher call volume and the trauma centre is only 30 min L/S from the local hospital.

[Timmy]

If I finish my nursing and have the brain power and financial resources to continue on with post graduate study I’d very much like to become an RN with the Royal Flying Doctor service here in Australia. I guess it’s more fitting to refer to RFDS as extremely remote care rather than rural care because there dealing with some seriously sick and injured people in some of the most remote places on earth.

Apart from responding to casualties who need stabilization and transport to specialist facilities you also run remote clinics (health promotion, dom mid care, immunization, general medical clinics ect) For some of these people your there only medical care within days and days of traveling along remote/isolated/bumpy/crappy roads and they might only have one fly in every 2 months.

I volunteered with one nurse who had worked with RFDS for a few years. She told me that some of her patients have gone to help and back. One call out she attended involved a patient from a car accident, they rolled there 4x4 along an isolated road. It was 48 hours before another vehicle came by and was able to help, the RN and paramedic from the remote clinic took the ambulance out which was a 4 hour drive to reach them, they had to camp at the accident scene over night as you don’t travel at night in the outback, the environment prevented RFDS coming and landing so they had to travel 4 hours back to there little remote clinic with a tube’ed and ventilated patient and waited for the weather conditions to clear for RFDS to fly in.

You just can’t imagine looking after someone who is that sick in such conditions. 4 days it tool for a critically injured patient to touch down at an appropriate facility. You have limited diagnostic gear and the patient’s life purely depends on your knowledge and skill and if the whole thing turns to crap mid air there’s only so much you can do.

9 time out of 10 the RFDS is on scene pretty quickly but it all depends on the weather and appropriate places to land. I can’t wait to work in such an environment! Bring it on!

[crotchitymedic1986]

Taking bets on how many shifts go by before this conversation takes place:

Dispatch: Unit 123 respond to 67 Macedonia Church Road for unresponsive patient.

Unit 123: Dispatch that road is not on our map.

Dispatch: 10-4, take Hwy 53 until you see the big red barn, turn left on Billy Clay Road, go until you get to where the Sardis Church used to be before it burned down, turn right on that dirt road. That road splits at the Crick (creek), turn left at the split, the patient will be in the 3rd trailer on the right, just past the school bus that is up on blocks. Family states they will have all the dogs rounded up by the time you get there.