Long Transport Times?

[Alcomedicism]

That is why we continously apply for grants that we wont get, and we keep having venison fundraiser dinners.

-Dixie

[ccparameduck]

Ever consider this...? How much time do you have with your patient in metro areas? sometimes not enough to do what needs to be done. Wam Bam Medics. Now for we who are fortunate to have to spend a longer period of time with our patients, we have to have our crap in one pile. This patient is depending on you to know your trade well enough to support them for as long as necessary.

I'm a critical care medic in Rural Montana. We service a 4999 square mile county including the Crow Indian Reservation which overlaps into neighboring communities. On average we spend 30-40 minutes in transport but it is not uncommon to spend upwards of 2 hours with a patient bringing them out of the hills when flight is not available (flight comes from a neighboring county and is not always available to us)

Kudos to those of you who are well studied in your trade and can perform to the best of your abilities as opposed to Wam Bam. I know our patients are appreciative...even if we never hear from them! Keep up the hard work Rural EMS

[Clarkster]

When I started in Melbourne Australia in 1997, I was an Ambulance Officer (EMT-, I was fortunate enough to be posted on the outskirts of town, were we had 15-20minute transport times and at least 15 minutes before the Mobile Intensive Care Para's (MICA) turned up. In Melbourne, they duel respond MICA to all Code 1 (Cardiac, SOB, MVA, Trauma), so you had you butt hanging out trying to get through your basic care before they turned up. If your BLS, O2, Obs, Monitor, Pulse Ox, etc etc wasn't done, they would write you up, regardless how green you were. These guys were feared by all students on the road.

In the inner city this happened as well, except you had MICA chasing you up the road and when you got there they would give you a rocket for not getting you BLS done in 90 secs. Crazy Stuff.

By the time I did MICA, things have changed some what. I always say to the guys, take your time or you will one day miss something so obvious you will kick yourself for weeks over it.

But there is more...these MICA guys would turn out to a call, single truck response, and if it wasn't an Intensive Care job, they would call control and get a AO car to come and transport so they were not tied up doing shite.

Glad I have moved on from there!!

[bandaidpatrol]

Also keep in mind, rural PA doesn't have Critical Care EMT's, Intermediates, Shock Trauma, IV, Cardiac Care, etc. EMS certs.

We have First Responder, Basic EMT-Ambulance, and EMT-Paramedic.

Epi w/ out med command is just now coming in, we can give none other than first aid, oxygen and resuscitation; our own system works against us.

That's another problem. Pa's EMS system was built for Harrisburg, Philadelphia, and Pittsburgh; not for coon pecker point. The EMS certifications are old and out of date, they don't even require services to have AED's.

Before anything can get better, EMS needs a change too.

[emt630]

It depends on what part of town the call is in. (and how fast the driver decides to go :wink: ) It can range from 20-45 minutes (20-35 minutes just to get to the scene) (we have made it to the hospital in 15 minutes before.....). Some calls doesn't seem that long and others feel like we won't ever get to the hospital...

[strippel]

I'm spoiled now. I have recently had calls that last 12 minutes from dispatch to being available at the hospital. I like being in the city 8) .

When I started (almost 20 years ago), It could take 15-25 minutes just to get to the scene, then another 45-60 minutes transporting.

[akroeze]

I'm spoiled now. I have recently had calls that last 12 minutes from dispatch to being available at the hospital. I like being in the city 8) .

Out of curiosity, how do you get a proper assessment/treatment done in that time?

[strippel]

I don't know where you ride, but I gave up the country for the city.

City people are usually quite different, with their own set of problems. Many 911 calls are not of an urgent nature. If the patient is walking, keep them walking to the bench seat. If they are not in distress, and have good vitals, start transport. Many patients meet you at the sidewalk. No lifting, moving, or litter required.

Most times, the patients have minor complaints, so there is limited treatment to do. Listen to their lungs, palpate the abdomen, and look at them. Most importantly, listen to them. Many times, people just need someone to talk with.

[blackelkmedicine]

The ALS service I work for covers both urban and rural. We still depend on volunteers for mostly transport. Its not unusual at all to be on scene 1 hr. or more awaiting transport. The closet town to a hospital we cover is approx. 10 min. transport. The furthest town from the hospital we cover is at least 1/2 ride. Even balls to the wall. Scene time is extended more in the wee hours, obviously, so stable or critical, its an 1 1/2-2hr call. But, on the positive side, dont you agree it makes for a better paramedic? Extended pt. care, extended tx's. down the algorrythyms. Less support staff? We still split crews in this area, I've been alone on scene many times awaiting help. I usually deputize a family member to be my "assistant". lol. What else can you do? The look on the E.R. staff's face is funny, when u report a total of 10 epi's. (3-5 min. protocol.) Until they understand the distance. Long distance sucks! But it does keep you sharp.

[Summit]

Local:

The EMS service I work for covers a huge county, almost 2000sqmi, and rural, with a population density of only about 6/sqmi. It is a mountainous playground for the tourists and locals. Our coverage area is over 2000 when a mutual response zones in three neighboring counties is considered.

Our EMS response time is usually under 25 minutes (most of the time under 15) if all four districts are optimally staffed.

We have three little clinics, one of them only open 0800-1700. They have 2, 3, and 4 bed "EDs" staffed by a family practice MD or DO (the 4 bed is almost always a DO). These are *usually* within 50 minutes or less of most of our service area in good weather.

Ground:

A real hospital with a ICU or real OR and an emergency medicine doc and CT scanner is 90-140min minutes away (depending where you are) Code 3 in good weather climbing over either an 11000ft or 11400ft high mountain pass. It could be as bad as four hours in heavy snow and heavy traffic.

We have E450 double transport rig with two stryker stretchers and a third pt can be put on the bench seat (also two monitors) so we can move all those 10-50 + ski injuries without losing two ambulances and crews for 4hr roundtrips. They are beasts on the switchbacks.

Trauma:

On the far end on one side of the county you can get to a small level III trauma center in 75 minutes by going over two passes (not that a level III is really much of a trauma center) otherwise its usually 120 minutes to a Level II.

Air:

There is a helicopter that is based about a 30 minute flight away during the day. During the night (or when the nearby helo is unavailable) they have to come from the city, a 50+ minute flight away. They will land at heliports at night, but not on scene. They won't fly in bad weather (which is always in the mountains).

We sometimes call in fixed wing air ambulances. We have two airstrips in the county. One of them has IAP and night lighting.

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Those are some pretty hefty times and obstacles, but we are far from the worst!

Of course, if you count SAR missions, it can take 14 hours to respond and evacuate a broken leg off of a 14er...