The problem with Rural EMS

[USEMS1]

For more than sixteen years I have seen the problem of long response times in rural areas. The situation has not and will not change unless you make the change. The lackadaisical attitudes of those living in these areas further contribute to the condition. The complaisance is embedded by our elected officials to the point that if they ran the Navy, our ships would still have sails. Often I hear them speak words of their great wisdom such as, "We have always done it that way", in an effort to justify their actions or in this case, inactions.

I have researched this problem for many years. The problem CAN be resolved without spending anymore funding than we are currently spending for EMS coverage in the rural areas. ARE YOU INTERESTED?

[WolfmanHarris]

Very much so. I'd like to see the infrastructure for Rural EMS catch up with the quality of providers I've met. But you're sorta preaching to the converted around here. What specifically did you have in mind? Because if it's an armed EMS rebellion, I'm afraid I'm going to have to pass.

[stiches]

I work with a rural service and I feel that although we have slower response times it would be difficult to respond any qiucker. Considering the sometimes 50km distances and typical Saskatchewan weather. But if you have any better ideas than what are in place I would like to hear what you have in mind.

[Chief1C]

With the endless list, different for every person, of the things that are wrong with EMS.. It could take as long to fix them, as it has to cause them.. I foresee change, but not anytime soon. Have to start from square one, on a national level. No individual EMS systems with in counties or states.

Take the control of EMS away from the states. Make scopes for entire vast areas, not from city to city. What works in center city Los Angeles, CA isn't fit for Medicine Lake, MT; or a secluded, snowed in village in Alaska, where transport time is going to be four hours. There's a subtle difference, and that's time. Better equipment, better training, better standards; for Urban EMS and Rural EMS.. and Rural could be suburban.. or it could be Frontier.

[JPINFV]

Take the control of EMS away from the states.

Under what part of the constitution are you going to justify the federal government taking control of EMS away from the states?

[mobey]

Are we talking long responce times from home to the ambulance bay to begin the call? or ambulance from the hall to the scene?

You really can't do much about ambulance hall to scene times, If you choose to live in remote saskatchewan, then you get what you ask for. I had many calls that were 1/2 hr + just to get to scene, if you want to live an isolated lifestyle then that is your choice.

[spenac]

I think we are about to get some kind of sales speech.

But as far as time to scene we have probably 25% calls over 45 minutes. Biggest problem is money. Until money is given to properly equip and staff delays in ambulances getting out the door, and even to scene, times will be long. There is no way to operate my part time service correctly with the amount of money it gets from city/county and from collections.

So what are you selling?

[Chief1C]

We had a man in one day from an insurance agency, he was trying to estimate the cost for a couple who built a large summer home. While he was impressed with our pumping capacity, tanks and mutual aid plans.

However, he was concerned that I said it would take about 25 minutes to get to the scene, in good weather. He said that at most, it should only take 5 to 8 minutes to get from the station to any scene. Apparently they actually plow the roads between 10pm and 6am where ever he lives. and those are just state highways. Some township and municipal roads may not get plowed for days, depending on how much snow, and the size of their road crew..

It can take from a matter of seconds to 45 minutes to reach the farthest points of our coverage. Longer if it's winter weather, we've taken people out in graders, backhoes and with our snostretcher..

I say if you choose to live more than 15 minutes from a fire station or ambulance; then you have probably written off any chance at being resuscitated; or having your fire extinguished before the roof collapses.

Under what part of the constitution are you going to justify the federal government taking control of EMS away from the states?

Maybe not take control away from them, but regulate how it can be maintained, so it will not fall below a uniform standard.

Look at how much different programs differ from state to state. Some clearly lack the ability to maintain a modern EMS system.

[crotchitymedic1986]

Let me sarcastically respond with this question, do response times really matter (remember this is slightly tongue in cheek) especially in a rural environment ?

1. In most rural environments, you also have a rural hospital that is likely to not be a trauma center, a stroke center, or have cardiac cath/CABG. So lets say you get there in 6 minutes, and then transport to your local rural hospital/nursing home/Tire and Lube Center, what have you accomplished ? They still have to be transported to the city hospital. But then you say, we can fly them -- Ok, you get there in 6 minutes, and 40 minutes later the helicopter is patient loaded and lifting off -- so what ?

2. What about cardiac arrest, surely you want to get there quickly and save them, dont you ? What percentage of your calls are cardiac arrests -- 1%, and of that group of patients how many walk out of the hospital -- maybe 10-20% of that 1% (remember going to closest rural hospital). So is it responsible to spend millions to save less than 1/2 of 1% of your patients ?

3. I would argue that probably 90-95% of your patients would survive a 30 minute response time. So again, if only a small percentage would benefit, is it worth all the money. It would kind of be like building a dialysis center in your rural community because you had "1" CRF patient in your town.

4. What about the golden hour --- how many multisystem, critical trauma patients survive to walk out of the hospital -- especially with the trauma center being so far away ?

Get me a hot pizza delivered in 10 minutes, as that is important. Most people who call 911 can wait 20-30 minutes (just look at any urban 911 system on friday night).

[spenac]

2. What about cardiac arrest, surely you want to get there quickly and save them, dont you ? What percentage of your calls are cardiac arrests -- 1%, and of that group of patients how many walk out of the hospital -- maybe 10-20% of that 1% (remember going to closest rural hospital). So is it responsible to spend millions to save less than 1/2 of 1% of your patients ?

4. What about the golden hour --- how many multisystem, critical trauma patients survive to walk out of the hospital -- especially with the trauma center being so far away ?

Get me a hot pizza delivered in 10 minutes, as that is important. Most people who call 911 can wait 20-30 minutes (just look at any urban 911 system on friday night).

Your sarcasm sadly is how the county I work in part time looks at it. They just dropped any funding to the two towns that provide EMS service to it leaving several thousand people with no ambulance response. The two citys have the legal right not to respond beyond city limits.

Now the county I'm in with full time their philosophy is if our stationing ambulances even in remote lightly populated areas saves one persons life in the next hundred years it was worth the added expense.

Golden hour is no longer standard, so non issue even though my part time it was the golden 90 minutes to a band aid facility.

Your right people want to know that they can get pizza more than they're interested in an ambulnce until the actual emergency happens.

Oh and actually my educated guess is 80% could wait 24 hours for the ambulance with no ill affects, in fact many would be well by the time ambulance arrived.