Rural Scene Times

[island emt]

Thats exactly what I was trying to figure out.

Maybe they go in the kitchen and make a sandwich while waiting for their partner to decide whether to play or stay.

Maybe they sit down & do the computer run report prior to transport.

I had a cardiac call recently that had a 7 minute scene time with vitals , 12 lead showed STEMI , 02, & ASA done by the time we hit the truck. Didn't really need all the gear to know this lady was having the big one. Pale diaphoretic, clutching her chest, 3 word dyspnea. Big history of MI x 3.

Yes i could have spent a few more minutes on scene to get an IV started, but I'd actually rather do that moving down the road towards the Cath lab which is an hr plus travel time.

PSSSS: I don't even spend 30 minutes having my morning dump. :-}

Edited June 29, 2012 by island emt

[paramedicmike]

PSSSS: I don't even spend 30 minutes having my morning dump. :-}

Ok. This just might qualify as TMI.

[Richard B the EMT]

Ok. This just might qualify as TMI.

"Might qualify"? We went way past "Might".

[island emt]

Okay We spent more than 30 minutes on scene in the wee hours this AM. Call came as diff breathing /poss chest pain.On arrival 5 min later pt found in chair with VSA. very Elderly ,prior recent MI hx and terminal disease.

We did not work him and stayed to help his wife until family arrived to provide support.

Called funeral home and Dr.'s office to get a death notice .

Time on scene 1 hr 20 min.

[A Pox On This Place]

OK. I know I'm VERY far behind the loop here. I've been a cop or bailiff 25 years, I took EMT Basic this Spring because it's what I'd like to do in retirement. Joined a local fire ambu service. I'm bumming out at how slow I am, how far behind I am at getting gear ready let alone patient assessment.

My saving grace is a very demanding local semi-retired Nurse Practioner who is a very exacting 30 year ER nurse.

Ever felt butt assed over your head? The best thing I do is drive the rig out Code 3 through very deery woods.

[BushyFromOz]

= If they code something happened that you more than likely failed to catch.

Do you really believe that?

[BushyFromOz]

What do you spend all that time doing?

Its the job type that we get around here, non time critical medical calls that dont benefit yourself or the patient by busting your ass to meet a deadline that doesn't need to be there. We generally work as a crew of 2 without assistance so you probably spend 7-10 full minutes asking questions and then another 5-10 on management but the time is lost in moving patients from the house to the truck.

Patients with pain i will happily sit aorund for half an hour getting enough effect from narcotics before i attempt to move them.

Then there are those patients you cant physically move so you wait 20mins for another crew to assist

Time critical patients (STEMIs accepted) i can get out in around 10-15, but theres a few variables in that, and i always have an IV in those before i move them in case they drop their bundle - unless they are particularly difficult, but thats not very often. Complicated trauma patients 20 minutes is about normal if your on your own. 2 Guys providing all the care and extrication from vehicle/house naturally takes a few more minutes than having 4 guys there.

So, my answer is i make the decison on a case by case basis, ill scoop and run when i need to and ill stay and play when i decide its appropriate and all my decision making is based on safety for me and the best care for the patient.

As an aside note, i often find the ability to have a short scene time is not so much a reflection on the guy running the job but the organizational skill of your partner. Theres a lot of good ambos out there who are not good partners and being a good partner is often more dificult than being a good clinician

Edited July 10, 2012 by BushyFromOz

[Yarbo]

Transport times here to the Trauma Hospital are around 40-50 minutes, depending on traffic. This year Helicopter EMS has arrived, so it'll be interesting to see how beneifical they are.

Edited July 20, 2012 by Yarbo

[fire911medic]

This may be an unpopular response, but I've spent alot of time in very rural areas dealing with some very critical patients (ie times to basic ER may exceed an hour depending on where in the county I am and 2 + to definitive care). Many counties here carry basics only and medics are called for an intercept, or the county doesn't even have a hospital or the next one over has a 2 bed ER. No I am not talking about BFE, but we're pretty close to it. I was taught, even with urban which I spent a year doing just for a change of pace and even industrial. Do everything you can on the fly. Get the patient to the best possible care, and if it's not an adequate hospital, don't play around bypass it if the patient is stable enough and protocols allow. If not, fly 'em out. Don't make a critical patient sit for an hour or more in an inadequate ER and then get transferred and have all that transport time. It's not worth it. Of course making this decision is going to require much stronger diagnosing (oops we don't do that, we form opinions and treat those ) skills and you will find your skills getting much stronger because they will have to be. I love all my students to do rural rotations because it really does improve their skills and then when spending time in an urban environment with a hospital 15 minutes away they think they have it good. I'm definitely not fly happy, I think alot is flown that doesn't need to be, but I've also seen patients die or have poor outcomes that I suspect had they been in proper care earlier (ie cardiac and stroke patients) they would have been more successful. I'm not God, so I can't say that with certainty, but I would have been more aggressive. Of course, you have to work within protocols, but don't be afraid to push them a bit if it means better treatment for your patient. I'd rather explain why I flew out a stroke patient with known loss of function an hour ago than let them be transported an hour, then sit for an hour or more locally then get transferred the two hours. Forget that, if it makes someone mad, all well, they'll get over it. My patient got definitive care in about 30 min well within the 3 hour window. I'm happy and I'll explain that to a lawyer or my director anyday over why I didn't, and I'd never question my medic acting in the patient's best interest.

Ultimately, keep your skills sharp, do everything on the fly, and if locally they can't take care of it, send them immediately to where can. Don't play around. Remember patient's first ! Act as if it was you or someone you loved, and likely, you'll never act wrong and they'll know they were treated with utmost respect which is HUGE in rural communities. These people likely will know you well and you'll deal with them alot. You'll know the good and the bad about them and if you always are respectful, you'll have a unique relationship that you just don't get urban. You'll do great I'm sure ! Take care and always be safe.

[Guest ~~~]

Not sure if I am too late or not to reply to this topic, but heck I'll give it a swing. I live and work in a rural area, yet we are blessed to have so many vol. fire co.'s and small community hospitals around here (around 15-25 minutes away from each other) and they all offer ems services on top of that we have the county ems services. The problem with the volunteer fire/rescue departments is that they take so long just for one truck to roll out of the bay, the ambulance takes longer usually - that's when the county ems services step in. But on average it will take ten minutes for the first truck to roll, a few minutes after the ambulance will roll. Then takes around 3-10 minutes to arrive on scene for both vehicles to arrive on scene and after everything is under control and the pt is ready for transport it takes around 5-10 minutes to get them to the ED. With that being said the county ems service will be the first on the scene (if state police isn't already there) and then the county ems will stabilize the pt and give all the care possible till the fire dept. comes with their truck and ambulance, then they are usually ready for transport as soon as they show up. So when I was a field medic with the county ems was to basically to "stay and play" while we waited for the ambulance to show.