How far to the ER?

[Vorenus]

Take turns with driving vrs attending is one thing you can do if you are both qualified.

Personally, I don`t like changing within one shift. I like to change within a round of shifts when having with the same partner and both being qualified to do so, but I avoid doing it in one particular shift, don`t know why, I just don`t like the concept. Though, if my partner is tired of driving after a long route, and he asks me wether I could drive from now on, that`s obviously different.

But that would be only happening with transports, `cause with our emergency calls, we are kind of lucky. Our main station is in a small city with about 12.000 people and an primary care ER. The second station is in an even smaller settlement, with no attached clinic. But either way, it`s seldom to have times to the ER that are higher than between 15-20 minutes (primary care ER). The next big trauma ER, which is also attached to the nearest hospital with cardiology/neurology and the means to intervene surgical in those fields, is maximum 30-45 minutes away, often even shorter.

[Richard B the EMT]

Taking into account that FDNY EMS runs 8 hour tours, and almost all calls are usually within 15 minutes (45 at an extreme outside) travel time to the nearest (appropriate) ER, our Ops guide says that partners switch between driving and teching mid tour. Nobody I worked with ever felt the need to do so, so if starting tour as tech, you finished tour as tech. An exception would be if the EMT or Paramedic had already established a relationship with a patient, even if that personnel was acting as the driver that particular tour, and for that call, the partners would trade off. I've done that a few times.

Obviously, with each call being a distance transport in the areas under discussion, the FDNY way probably wouldn't work. Speaking personally, for continuity on the call, you start with a patient, you'd finish with that patient.

[Chief1C]

About forty-five minutes to the nearest band-aid center, and ninety minutes to the nearest trauma center, by ground.

[Bernhard]

Several normal hospitals (capacity: surgical including CT/MRT, medical including cath lab, maternity ward) within 20 minutes driving time, five maximum level care centers (trauma, neuro, cardiac and a whole bunch of special disciplines) within 30-45 minutes, two large psychiatric clinics within 30-45 minutes, four pediatric hospitals within 30-45 minutes, one of the large hospitals has really all what you want including special treatment capacity for multiple CBRN and burn victims, another one with a special toxicology department, both just 45 minutes away if you drive carefully.

So. it's not a problem of "how long" but of "where".

For the ressources:

By law, any emergency scene near a road should be reached within 12-15 minutes by the first ambulance. If we need, we have at least four EMS helicopters within 15 minute range (one of them 24hr available, field night landing ability) and if I really really want then I have up to ~40 within one hour (evaluated last when FIFA soccer world championship took place in the neighbouring big city in 2006). Maximum helicopter number on scene was 4 on two of my calls - and it was a "normal" multi victim vehicle crash, no disaster. Far more than 100 ambulances are available in 1 hour (evaluated last year when a plane had a problem at neighbouring airport, luckily nothing happened beside a large bluelight party). For the flood disaster in eastern Germany in 2002 there were over 1000 responders with their equipment "on the road" within two hours, just from my state not including others (and not including fire fighters/technical rescue)..

And they call this "rural" here.

I know, I always have to readjust my definitions of long transport times when I hear about distances in other countries...

However, winter conditions may multiply arrival and ground transport times a lot.

[emtannie]

Ahh Northy, I feel your pain... I know you and I have discussed this before - there are times when I work the rural areas too, just at the opposite end of the province from you..

You still have your iPhone/iTouch from practicum? I hope you still carry it with you... Load some videos on it. The DVD idea for pediatrics - use your iPhone... most little kids are getting used to watching videos on their parents' phones now... I see it here a lot. And, on the return trip, make sure you have something loaded to keep you and your partner entertained - podcasts, music, something to get you through that shift... I use my iTouch a lot - still being a student geek, I listen to podcasts, play on the ACLS simulation, review medications, or give my brain a break, and just listen to music.

After your 16 hours, are you timed out? Here if we are on for 16 hours, we have to time out for 10...there are a couple loopholes to that, that of course our employer (who shall remain nameless) has figured out, and I have been caught in that loophole a few times...

Be safe up there!

[Chief1C]

Cross word puzzle books. We have them for the ride back, and seabands. I wanna go work where you do, that would be so cool. I've often spoke of my favorite part of "rural EMS". Meeting all the interesting people. A lot of people retire here, and I've met so many people with the greatest stories to tell... and the best part, the ride is so long, you get a good view on their life. I could write a book. But I won't, I've done that too many times.

[thriceknight]

Up here on the northern California coast,several hours north of San Francisco, we have 1.25hr-2.25hr ground transport times. Closest level 1 trauma center is inland roughly 2.25hrs by ground,so weather permitting we rely on HEMS. So if we do not RAS/AMA and the Pt is stable its basically an hour plus trip in any direction. We basically look at the ride up with the Pt a good time to work on our soft skills. Plus our community is so small that you probably know the Pt so that can be nice. Otherwise we just monitor and let them rest quietly.

[a_shane2_go]

Just to remind you guys that your "nameless employer" does not tell you that if you are in anyway disiplined etc in Alberta for trying to use your right to refuse unsafe work via OH and S. It is a $500,000 fine! Remind them of this next time they try and push you farther. I was young and dumb once. And had a 42 hour day and put on 1800km/s with a 20 min nap in that span.(private ambulance service) BE SAFE i've spinal'd and coded too many of our own in the north.

Oh and to stay in-line with the thread. We have a micky mouse rural ER in town, but its two and a half hours to a Level I,II or III.

Edited April 30, 2012 by a_shane2_go

[dstevens58]

16-25 miles depending on the hospital and location the call originates in our area.

[Arctickat]

MedicNorth, you're clearly not alone in this. Even in higher density areas people still tend to be isolated. Our transport times typically exceed 2 hours one way, the back of our ambulances include DVD player, Video Game Console, Nintendo DS, and a cribbage board. Ambulances are also equipped with tablet computers and smart phones.

However, I've felt that a stimulating conversation with my patient has always been the best for passing the time.

We always take turns per call as to who drives or attends for the most part, but in cases where the crew is an ALS with BLS partner, it's typically the ALS in the back.

a_shane2_go makes a good point, but it's a good idea that during those long empty trips back to base the attendant, who is now just a passenger, get some shut eye. Then, swap with his partner so he can get some sleep too rather than waste time and living on a 20 minute cat nap. I'd be interested in seeing your reference to a particular OHS regulation though before putting my job on the line because of his say so because I doubt that it exists. Refusing to work because one is tired is open to substantial subjective interpretation and most employers would likely succeed in terminating employment for just cause. I'm also not too sure what relevance there is in pointing out that it was a private service.

For the record, my crews are 144 hours on call with a 16 hour maximum duty time in a 24 hour period and guaranteed an 8 hour rest period 97.5% of the time.

Edited April 30, 2012 by Arctickat