Locating patients in rural area's

[thrutheashes]

We all know that rural EMS has it's challenges. The shifts where absolutely nothing happens. Followed by the shifts where you don't stop moving. Some challenges are easier to deal with than others. But the challenges of trying to help people help themselves has become a sore point with me lately, and it' s due to issues that I have dealt with off the job, however if dealing with them on the job the consequences could be disastrous for the pt's.

While ferrying my sister's friends all over the country side, I've been asking for range road numbers, or township numbers, and instead I get the typical "turn at the red barn (conveniently repainted white), turn at he rock, first house on left in the second driveway on the right." Confused yet?? For providers who grew up in the country, and are still working in rural, you are definitely a rare breed, and have some idea what I am talking about. For the good chunk of providers that come into the boonies to gain experience, before heading off into the nicely organised city, you are confused as hell. And after dealing with the third or fourth such interaction such as this in under a week, it got me thinking, if you don't know where you live, how do you expect people to come help?

Sure, home phones are supposed to be tagged with Legal Land descriptions that show up with e911 systems, however as one of my colleagues found out the other night, they are not always up to date. Cell phones can be traced via gps.......if the phone is tagging enough cell towers. In december I had pleasure of responding to someone who kept giving the wrong address in town, was calling from his cell phone, and when 911 attempted to gps the phone, it was showing 3 miles away in the middle of a field. So GPS is not the most accurate way either.

So ruling out telepathy, how are emergency services of any variety, expected to make their way? Yeah, the directions work most of the time, when it's good visibility in the middle of the day. However at 2am in the middle of a blizzard, I dare you to find those same landmarks.

I am looking for ideas for a public awareness type campaign. Something to get people thinking about knowing their locations. So far I'm thinking magnets/stickers with a place to write Legal land descriptions or street address's and directions on it. If anyone can come up with any constructive or different types of idea's please let me know.

Thanks,

thrutheashes

[brentoli]

I just want to point out two errors.

First if the e911 system is not correct, whoever handles 911 for your area needs to get with their ANI/ALI provider. That is their responsiblity to keep correct, and when errors are found they should be fowarded to them.

Secondly, there are several modes of GPS on cell phones.

All new phones can transmit exact satellite based lat/lon to the 911 node. The only error in those coordinates would be on par with error in your GPS in your car.

Some phones/carriers can triangulate positions. That also comes with a decent rate of reliability. Also 911 centers can contact cell phone companies to get subscribers name and addresses in cases with extigent circumstances.

Finally, old cell phones send the tower location to the 911 center.

Just wanted to clarify some statements you made.

[thrutheashes]

I thank you for correcting me there. However, that does not take away from the point I was trying to make. We are only as good as the information we have, and if the info we get is incorrect, it doesn't matter much about the technology. A lot of people can save everyone a lot of grief just by knowing their address.

I just want to point out two errors.

First if the e911 system is not correct, whoever handles 911 for your area needs to get with their ANI/ALI provider. That is their responsiblity to keep correct, and when errors are found they should be fowarded to them.

Secondly, there are several modes of GPS on cell phones.

All new phones can transmit exact satellite based lat/lon to the 911 node. The only error in those coordinates would be on par with error in your GPS in your car.

Some phones/carriers can triangulate positions. That also comes with a decent rate of reliability. Also 911 centers can contact cell phone companies to get subscribers name and addresses in cases with extigent circumstances.

Finally, old cell phones send the tower location to the 911 center.

Just wanted to clarify some statements you made.

Edited February 26, 2011 by thrutheashes

[brentoli]

I thank you for correcting me there. However, that does not take away from the point I was trying to make. We are only as good as the information we have, and if the info we get is incorrect, it doesn't matter much about the technology. A lot of people can save everyone a lot of grief just by knowing where their address.

I completely agree. Just being a full time dispatcher, I felt the need to correct some information.

I am lucky, I live in a fairly suburban county, with good addressing and good infrastructure. However, I grew up in the boondocks of Missouri, so I can empathize with your problem.

Do you have major events or festivals in your area? Your idea for magnets is a good one, I would corrdinate with other agencies in your county (all PD, Fire, and EMS districts) and even try to get corprate sponsors, to help defray the costs of the materials. Figure out the # of households in your county (available by census data) get a couple of sponsors on board to place their logo on a 3x5 magnet with the information, and do a mass mailing of them. With the sponsors you could cut down on much, or even all of the cost. You might check into it, but they may even be able to work that in as a tax write off for their company.

EDIT: I just saw you are from Canadia. But I am sure there are still aspects of this that will work for you, and this idea is good for anyone in the US as well. Just make sure my name is on the magnets.

Edited February 26, 2011 by brentoli

[Chief1C]

We get directions like that. Ever seen Funny Farm? The directions the old man on the porch give, to find Red Bud? That's like what we get. Only not everyone uses 911. Some of our coverage area doesn't have it, they use a seven digit line. Or they can call direct, a phone on the wall, right here in my bedroom..or living room, rings. They mostly use it to bitch about the ambulance bill, but some call it for emergencies. The government just did away with Rural Routes, Star Routes and Rural Free Delivery. Everyone has a street address. We have a single map, per station, it's huge, about 8" thick. Gotta look it up before leaving, write it down. I can point out every single house, hundreds, possibly thousands, that I've been to. I can name who lives on which road, in which house, and who lived there fifty years ago. Because that's the way I was trained. I was educated, to be a rural EMT, by learning how to find people, using just a name, or landmarks that nobody except the ambulance crew will remember, fifty years from now.

The latest thing, other than e911, is triangulation of position w/ cell phones. We distribute little orange stickers paid for by the fire district, that have their new address, possibly new road name, and HELP System Grid Number on it. The HELP System, is what we used before everyone had a "street address". They give you a house number, and a code. Like 37A-911, is the fire house. Grid 37, Inset Alpha, Location 911. Open the map book to page 37, open the inset (which is a page for a page) Like on the page, it will have the town drawn w/ it's limits, and name, but no streets. The inset will have the blow up w/ the streets and numbers. look for the number 911.. and you have yourself a location. It's quite simple. http://www.joe.org/joe/1986fall/sa4.php

[emtannie]

Ashes, I can SO relate to your pain… we too, get the “go down the Black and White trail” (which isn’t marked by that name on any map), when you get to this little town, take the second left, drive until you see the white house with the green car in the driveway – it isn’t that house, it is the one next to it…”

We are lucky, that the County has put up rural address signs, based on the Township and range road, and every farm has one of these signs at their main driveway…

Yet, people still don’t realize how important it is to know their land location and their rural address. Our dispatch does have ANIALI but not all the locations are correct.

I teach a lot of first aid classes in rural areas, and I spend quite a bit of time on this in my classes, explaining why it is so important to know the address so we can find them. It isn’t enough though, because I only reach a small number of people compared to the number of rural residences.

You are right - public education is the key. Is there any way you can work with the county where you are at, and maybe they could send something out with their tax notices? Maybe you could put together an informational page, with that magnet, and it could be included in the tax mailout. And, to offset the costs, maybe the county, or a group like FCSS (Family and Community Support Services) could assist with some of the funds for it.

What are the agricultural businesses in your area? Maybe the UFA, a bulk fuel retailer, equipment dealership, or other business would be willing to hand out informational packages, and sponsor the program too…

Just a few thoughts....

[HERBIE1]

Mistakes and mix ups happens even in an urban area. We have people who SWEAR to dispatch they have given the right address, yet we are standing at that location and it's an empty lot, or nobody there has called. They mix up Street and Avenue, Place and Street, floor numbers, etc. I've had people give their old address, and forget they have moved. Cell phones are a help, but they are not associated with a fixed location. That means even with a CAD system, you cannot verify that a phone number corresponds with a certain building. The matter of triangulating their call or contacting their carrier is not a simple matter, plus it takes time you may not have. Then again, in the vast majority of such cases, the call was anything but an emergency- foot pain for 2 weeks, ran out of their meds, help me change the batteries in my home BP machine, pain in my legs for 2 years...

There is really nothing you can do. You need to be familiar with your area, but if we don't get the correct info, there's really not much we can do.

The most difficult situations are 3rd party calls. People SWEAR their friend or family member is home, they cannot get reach them, and when we arrive, there is no answer. I've had more than a few cases where we ended up doing a forcible entry into a home, destroyed a door lock, jamb, or a window, and find out the place was empty. A couple times the resident returns home while we are there and are horrified that their property was damaged. I feel bad, but explain that someone was certain they were in trouble and needed help.

About 20 years ago, a crew had a similar situation, but were assured by a neighbor they saw the patient leave the house. The crew did not do a forced entry, left, and returned several hours when the husband came home to find the victim dead on the floor. HUGE lawsuit.

I'd rather apologize to the resident later than have to face a lawsuit and justify why we didn't make every effort to gain entry and confirm a person's status. I can't speak to other areas, but here the city actually compensates the person if we do make a "mistake" such as this. Still cheaper than a wrongful death lawsuit.

[mobey]

It is funny that you bring this up as a kind of "complaint". This challenge is one of the reason's I thrive for the rural setting.

Here in ab it is easy, with the little blue signs at every intersection, In Sask there are NO signs. The country roads in sk are not assigned "township, or rangeroad" numbers.

We find all rural addresses in the manner you described in your OP.

As much as it is the responcibility of a caller to get you there, it is your responcibility to find your way. This is why I take my own local awareness seriously.

When you work rural, you have too learn all the major landmarks in the immediate area. The locals may call a large body of water "Bare-ass-beach", and you may one day get called to the south end of that beach. If you have not made yourself aware of the local hangout, that is your problem. You now have to deal with locals trying thier best to describe where they are.

I own 4 sections of land in Sk.... Ill be honest, I don't know the land location (LSD) for each quarter. If I have an injury while working on my farm, you may very well get dispatched to the 'ol Mckeen yard (not a yardsite anymore). West of the Heimark dam (though the river has been dry since the 60's)

[paramedicmike]

I don't know. I've always tried to do the best I could with the tools I have available to me.

There is always a chance technology will fail. How we adapt and overcome says more about our abilities than whether we can follow the GPS to an address.

Just MHO.

[thrutheashes]

As much as it is the responcibility of a caller to get you there, it is your responcibility to find your way. This is why I take my own local awareness seriously.

When you work rural, you have too learn all the major landmarks in the immediate area. The locals may call a large body of water "Bare-ass-beach", and you may one day get called to the south end of that beach. If you have not made yourself aware of the local hangout, that is your problem. You now have to deal with locals trying thier best to describe where they are.

I fully agree with there, Mobey. We need to take some responsibility ourselves. That's why we en devour to keep our maps fully updated, and new hires get oriented to our area. However that only goes so far. One of the first, and most frusterating calls I had working for a service was a cardiac call. They had beautiful directions. However they substituted west for east, and we were half a county the wrong direction before we/dispatch/the caller managed to get things straightened out and get on the right path. this despite having the directions confirmed four times, and requesting for the legal land four times. This was all on an industrial site. They should have had that information readily available. They didn't. And no one thought to run outside and check the sign on the flipping bldg. Our already crappy response time, as they were in a spot near the edge of our response area, was turned even crappier because they did not know where they were. The patient did not survive. would he have survived had our response not been more than doubled due to lousy directions?? Who knows.

Mobey, you and paramedicmike both have valid points. However why can we not educate the public on the importance of knowing or having ready access to this information. Not only for us, but for other emergency services as well. Yes breakdowns in communication will happen. But are we doing everything we can if we see the problem and don't try to educate people on it?? That's the whole purpose behind this thread. Not to bitch and gripe about crappy directions and people not knowing where they are and expecting help. It's about trying to figure out what we can due to educate the public on the importance of this issue, and try and keep the crap directions and "I don't know my legal land, but turn at the burnt out field" sort of comments to a minimum. To be honest, if we only reach 10% of the people in our area, it would make a change to our calls.