Rural versus Urban

[Just Plain Ruff]

ok, was doing some thinking last night. I know thats a dangerous thing.

Rural service covers 700 square miles - runs about 8 calls a day

Urban service covers square miles - runs 75 or so calls a day

Aside from population of the rural area versus the urban area what are the factors that drive the number of ambulance calls?

Surely the same kind of calls only a smaller amount occur in the rural area so I'm asking

Why do urban services have such a difference in ems runs?

What do you feel are the factors causing such a huge difference in ems calls.

consider rural Henry county Missouri(732 square miles) - population about 25000(approximately)and Independence MO with a population of 121,000(80 Square miles).

Daily call volume of Henry county - approximately 12 per day

Daily call volume of Independence - approximately 75

What drives the discrepancies?

Opinions are allowed here as well as facts.

See what happens when I begin to think? Now on to the debt ceiling crisis.

[uglyEMT]

I'll give it a go.

IMHO I think it has to do with the type of person in the different areas. Most rural folks are resiliant and don't see doctors for minor things or will drive themselves so if there is a 911 call its usually for something serious (to them at least) or which they have no other choice but to go by ambulance due to an immediate medical intervention need. Whereas most urban areas folks are less resiliant and or don't drive thus the higher call volume for the medical taxis.

BTW this in no means is ment as an insult to anyone just an observation.

Oh and Ruff quit the thinking, I can smell the smoke from here

debit celing crisis is easy balance the damn budget, go ask Clinton how he did it and gave us a surplus.

Edited July 28, 2011 by UGLyEMT

[Richard B the EMT]

While the type calls probably end up being roughly the same types, in urban areas, you've got larger populations in concentration. Figure "X" number of calls for injury or illness per "Y" number of people. A community of 20,000 will have less calls than with the 8,000,000+ people here in NYC, where, due to the seasonal hot weather, a few days ago, we did almost 5,000 calls in one 24 hour period.

Let me simplify: The higher the concentration of population, the more likely it becomes that someone is going to need an ambulance for something.

[Just Plain Ruff]

While the type calls probably end up being roughly the same types, in urban areas, you've got larger populations in concentration. Figure "X" number of calls for injury or illness per "Y" number of people. A community of 20,000 will have less calls than with the 8,000,000+ people here in NYC, where, due to the seasonal hot weather, a few days ago, we did almost 5,000 calls in one 24 hour period.

Let me simplify: The higher the concentration of population, the more likely it becomes that someone is going to need an ambulance for something.

Aside from the population aspect, why do you think EMS calls are higher in urban areas.

What I'm trying to say is that if Rural people don't call 911 unless absolutely necessary then what makes urban callers different?

Are they more apt to call 911 because they are more accustomed to having things their way or getting what they want or is the rural population more self sufficient?

Is it the way they were brought up, In the rural areas, people tend to do things themselves and deal with issues that come up with a "I can fix that" attitude. Do those in urban areas not have that attitude. Do those in urban areas expect for things to be given to them or fixed for them?

I'm just not sure. There really is a method to this post, I'm beginning to write a CE article on a similar topic and this along with your opinions are going to help shape that article. No-one will be directly quoted. I have many other friends aside from EMT City that I'm planning on tapping for their opinions also.

It will be a peer reviewed article so people better than me will have their chance to give an up or down vote on the article I write.

[Bernhard]

consider rural Henry county Missouri(732 square miles) - population about 25000(approximately)and Independence MO with a population of 121,000(80 Square miles).

Daily call volume of Henry county - approximately 12 per day

Daily call volume of Independence - approximately 75

What drives the discrepancies?

Quickly calculated, that makes a daily call volume per inhabitant of 0,5 per mill for Henry county and 0,6 per mill for Independence MO. This makes not that much call volume difference in my view, considering that much more people may actually be in the city due to work commuting or else. However, this calculation is not statistically validated. The real most possible cause for the slight difference could be anything, we have no information how these numbers ("approximately") were generated in the first place as well.

Subjectively I tend to believe from my experience, that people on the countryside call EMS only short before dying and not beeing able to ride to the next veterenariangeneral practioner any more. Once I had a bus crash in our "backlands" here (public transport bus vs. school bus) with around 20 injured people/school kids - most of them walked home alone. Big city would have called out the disaster plan, we managed this with two ambulances (the third got stuck in some acre, but that's another story).

EDIT: typo.

Edited July 28, 2011 by Bernhard

[Vorenus]

Aside from the population aspect, why do you think EMS calls are higher in urban areas.

What I'm trying to say is that if Rural people don't call 911 unless absolutely necessary then what makes urban callers different?

Are they more apt to call 911 because they are more accustomed to having things their way or getting what they want or is the rural population more self sufficient?

Is it the way they were brought up, In the rural areas, people tend to do things themselves and deal with issues that come up with a "I can fix that" attitude. Do those in urban areas not have that attitude. Do those in urban areas expect for things to be given to them or fixed for them?

In the most cases of industrialized countries life standard is now nearly the same, if you compare rural and urban areas - there are of course differences, but they are minor compared to regions of this world, where there still is a huge difference between those two settings.

Even though that being so, I guess most living in a rural setting have saved that attitude, or got it tutored by the elder generation.

I just changed position 2 months ago - from an urban post to a more rural one (though they are not that far away from each other), and that`s just my personal opinion, but there really are more bullshit-calls in an urban setting (which doesn`t mean they`re non-existent in rural areas ).

So for me, that would be one explanation, but with such differences as you posted above, that can`t be the only `cause. I guess it`s a mixture between attitude, the idea Richard proposed and some other influences (a large crowd being settled in a small space is an adavantage for infectious diseases, some basic points like smog, stress, etc.)

Edited July 28, 2011 by Vorenus

[Just Plain Ruff]

we have no information how these numbers ("approximately") were generated in the first place as well.

Actually the numbers I gave are pretty accurate as I have friends that work in both systems and they said that was an average of calls for each system.

They don't have true exact figures because those are held in the dispatch statistics system which only management seems to have access to at least in Independence MO.

The henry county call volume is based on a friends recollection over lunch and my recollection from when I worked there a little over 2 years ago. At that time the average daily call volume for each of the 2 services that covered the county was 7-8 for the largest service and 3-5 for the smallest service.

so the numbers, while statistically not as exact as i'd like them to be, are in fact pretty close to accurate.

[Chief1C]

City to the south probably has three calls an hour, our entire county is lucky to see one call a day... Sometimes one call a week. I just did a rural health survey from a state university, they were trying to determine funding shortfalls in rural EMS, and the most frequently run call types. Our top three call types, on two services, three ambulances, running a combined 983 calls were: #1 Fall Victim in Private Residence; #2 Diabetic Emergency; #3 Chest Pains. The top call factor for the fire service was Motor Vehicle Accidents (105). To understand why the number is so high, you'd have to understand local industry booms. Today's industrial boom, is almost equal to what it would have been during the lumber, mining and tanning boom of the 1870's.

To give an idea of how broad and extensive the survey of rural health and health services was, it took me fifteen hours to fill it out.

*Spelling. Damn auto correct.

Edited July 28, 2011 by 2c4

[Just Plain Ruff]

These are great responses. Keep em coming.

Some of the responses have hit me between the eyes and made me realize I need to broaden my search out to county and state officials.

This just became a year long project and the CE article is no where even close to being started.

This should be fun. Now just where can I find a place on my calendar what with travelling for work, working, family time, teaching my son the drums, the 5K training, the pregnancy and all the doctor appointments, my 3rd grade sunday school lessons to put together, the book that my son and I are writing (chapter 3 already), playing with my daughter, and my time with God. Just where can I find the time?

I will just have to make the time.

[BAYAMedic]

Another factor to consider is the dynamics of the individual population. Not knowing the citys in question I cannot adress that directly. Nursing facilities out here make up a healthy percentage of one of my agancys call volume. They contract for evaluation and transport, and when you end up with a higher number of these mega facilities you in turn end up with a sicker than average population base creating an outliar of the stats, as well as having protocals in place of when a nurse ships some one outa to the ER vs. when grandma finally decided shes too sick to stay at home. So a less sick patient gets transported in that urban environment. I believe that whoever said that thoses in a rural area are heartier has a valid point. I never ran on a 3 am stubbed toe call in they rural areas I have worked. That leads to question the reason why with a lower percentage of poverty in some urban areas, why is there a greater use of social programs. Availability and access. Many of my rural patients have no insurance so refuse to call for fear of a huge bill and don't realize there is other options than self pay available and havent had someone sign them up for state insurance etc. . Although the ambulance is available the patients who have called in my rural area, the people often apologise for the inconveniance of taking them in. Whereas my urban job often have suitcase curb waiters. I realize I have generalized a bit and addressed the question with a broad sweeping brush stroke , thoses have been my experiances.