Rural vs Urban- a local news article

[Eydawn]

So, this article ran in my local paper the other day, and I thought it was really interesting.

http://www.coloradoan.com/article/20130901/NEWS01/309010046/Patchwork-system-means-emergency-response-varies-across-Colorado

I thought it laid out the bare bones truth pretty well; EMS in Colorado is a county regulated affair, and there's a lot of discrepancy. I also like how it emphasized the difference between EMT-B training and the 1500 hours required for paramedic...

Thoughts?

Wendy

CO EMT-B

RN-ADN

[paramedicmike]

I like, too, how it pointed out that if you go rural you need to expect something different than what you'd get if you went urban. It seems all too often an occurrence that people head out to the hills and then expect the same services in the same time frame that they get in a more urban setting.

For the lay person it's not a bad piece.

[island emt]

Comparing a heavily populated state like Maryland to the rural vastness of Colorado is a joke.

Yes if you go out in the boonies you may not get the same response times or level of care as you get in a major North American city of over a million inhabitants.

Many states have this same issue.

There are parts of my state where your response time might be in excess of an hour, and transport to a hospital could be over two hours.

thats what you need to expect when you move away from society and go out to homestead.

[Just Plain Ruff]

I live in Maryland and it's pretty impressive the amount of resources that I have within 5 miles of my apartment. I have 6 ambulances, 11 fire trucks and countless police agencies. Even the NSA is within 5-6miles and they also have a pretty well armed police force.

There are at least 4 medical helicopters that can get to my apartment complex within 5-10 minutes of each other and those are just the state police helicopters, I have heard rumors of private helicopters as well.

It's nice to have that tax that everyone who drives pays. I have no issue paying that fee.

I also know that the Shock Trauma center provides excellent care.

I also spent many months in Colorado and did some pretty remote driving through backroads to Breckenridge and other places via Colorado Springs and never really worried about my health and being injured but it was a fear as to how long the ambulance would take to get to me.

But if you choose to live in a rural area, I mean really rural area, then you have to expect a decrease in the level of services that you would normally expect to get in a more populated area such as Colorado springs or denver.

Same as in rural maryland, I expect that if I go into the boonies of maryland then my ambulance coming to get me will take a lot longer than the ambulance which would respond to my apartment in Hanover MD.

IT's the nature of the beast. You cannot get away from it. The article did a good job of explaining the decrease in the level of care you are going to get and that rightfully you should expect. I'm not saying you should expect mediocre levels of service but you get what you pay for most of the time and if you don't pay for a full time paramedic staffed ambulance service, then you get less than you deserve. Sorry but that's not a dig at EMT providers.

[EMS49393]

I live and work in Maryland, in a county that is fairly heavily populated but does have some rural areas (not Colorado rural, mind you). My county is largely volunteer and is supplemented by some paid BLS and ALS providers, and I can assure you that it's not supplemented nearly enough. I was stationed on an ALS chase vehicle with a BLS partner. The partner is not a mandatory spot and they are often pulled from me to staff another opening. We have another ALS chase vehicle in the northern part of the county that is staffed with two ALS providers during the day and one ALS provider at night. Both of us are dual dispatched with three different fire stations for every EMS call (BLS and ALS) except the lift assists. We are not terribly busy, but response and transport times can run the northern unit into a three hour call very easily. My furthest response time is currently about 30 minutes for areas I cover when the northern car is out of service on a call. My furthest response time in my area is about 22 minutes long. Unfortunately, we have beaten in the volunteers a few times even with these long responses. Many of the stations now have at least a paid BLS provider/driver during the daytime.

Sadly, it's difficult for the stations in these areas to retain volunteers when you only run 400 calls a year and have the chance of being stuck on a call for two or three hours. We can't blame the volunteers, but we can't seem to get them the help they have been asking for either because funding is a constant issue, even with unbelievably high taxes in this state. What's even more sad to me, is that response times don't seem to really bother anyone but the paid providers in the county. It doesn't seem to bother politicians, or even the public, unless it is the person waiting for the help to arrive. It's a largely fire driven county and they're pretty reluctant to shift money from fire to EMS regardless of how high the call volume for EMS is compared to fire. We are working hard to change that but like everything it takes time or a major catastrophe.

That being said, I couldn't imagine trying to recruit and retain volunteers in a place as rural as some of Colorado. The amount of time it takes to run a call has to run into several hours. I don't know where your closest hospitals are to some of your areas, but if your response times are greater than 30 minutes, your time to hospitals is probably equal to or better that time. Add in the possibility of having to bypass a hospital because it doesn't have the services your patient needs, you tack on more time. Then you transfer the care, drive all the way back, and are faced with a report that could take an hour or better to complete. That's a serious amount of dedication for a person doing it for free. I still volunteer myself, but a three hour call is pretty rare for me. My first due has a hospital right in town that handles 85% of our calls, and most of my calls last about 90 minutes from dispatch to the time I drop my finished report.

Hopefully the residents and travelers understand the risks of being in such a remote area. I think this article does a pretty good job outlining those risks along with making the services in the areas out to be very professional, both paid and volunteer. They're doing the best they can with the remoteness of the landscape, and the resources at hand, but it looks like they still look for ways to improve the responses as well as the level of care received on the scene. That's what I took away from this article anyway.

[Just Plain Ruff]

I live and work in Maryland, in a county that is fairly heavily populated but does have some rural areas (not Colorado rural, mind you). My county is largely volunteer and is supplemented by some paid BLS and ALS providers, and I can assure you that it's not supplemented nearly enough. I was stationed on an ALS chase vehicle with a BLS partner. The partner is not a mandatory spot and they are often pulled from me to staff another opening. We have another ALS chase vehicle in the northern part of the county that is staffed with two ALS providers during the day and one ALS provider at night. Both of us are dual dispatched with three different fire stations for every EMS call (BLS and ALS) except the lift assists. We are not terribly busy, but response and transport times can run the northern unit into a three hour call very easily. My furthest response time is currently about 30 minutes for areas I cover when the northern car is out of service on a call. My furthest response time in my area is about 22 minutes long. Unfortunately, we have beaten in the volunteers a few times even with these long responses. Many of the stations now have at least a paid BLS provider/driver during the daytime.

Sadly, it's difficult for the stations in these areas to retain volunteers when you only run 400 calls a year and have the chance of being stuck on a call for two or three hours. We can't blame the volunteers, but we can't seem to get them the help they have been asking for either because funding is a constant issue, even with unbelievably high taxes in this state. What's even more sad to me, is that response times don't seem to really bother anyone but the paid providers in the county. It doesn't seem to bother politicians, or even the public, unless it is the person waiting for the help to arrive. It's a largely fire driven county and they're pretty reluctant to shift money from fire to EMS regardless of how high the call volume for EMS is compared to fire. We are working hard to change that but like everything it takes time or a major catastrophe.

That being said, I couldn't imagine trying to recruit and retain volunteers in a place as rural as some of Colorado. The amount of time it takes to run a call has to run into several hours. I don't know where your closest hospitals are to some of your areas, but if your response times are greater than 30 minutes, your time to hospitals is probably equal to or better that time. Add in the possibility of having to bypass a hospital because it doesn't have the services your patient needs, you tack on more time. Then you transfer the care, drive all the way back, and are faced with a report that could take an hour or better to complete. That's a serious amount of dedication for a person doing it for free. I still volunteer myself, but a three hour call is pretty rare for me. My first due has a hospital right in town that handles 85% of our calls, and most of my calls last about 90 minutes from dispatch to the time I drop my finished report.

Hopefully the residents and travelers understand the risks of being in such a remote area. I think this article does a pretty good job outlining those risks along with making the services in the areas out to be very professional, both paid and volunteer. They're doing the best they can with the remoteness of the landscape, and the resources at hand, but it looks like they still look for ways to improve the responses as well as the level of care received on the scene. That's what I took away from this article anyway.

Great response EMS, I was speaking strictly from a resident point of view, you live it.

Maybe we can get together and compare notes or have a beer summit. How far are you from Hanover? I'd be interested to see if there's the possibility of a ride-along out your way? Plus my family is always looking for things to do in Maryland so what do you have out there for us to come see in your neck of the woods?

[island emt]

49393: You bring up many good point on the issues that rural /semi rural areas have with staffing and retention.

The amount of time required start to finish can be in the 3-4 hour range and thats if the weathers good and the roads are dry.

The minimum time to run even a simple transport call here is 2 hrs , plus the clean & restock+ the electronic run report. Thats the trip to the nearest ER. If the Pt has to go to a level II with stroke/ cath lab/ trauma capabilities add 2 hours to the run time.

edit for: fat fingered spelling corrections

Edited September 5, 2013 by island emt

[Chief1C]

We have a heavy population of "seasonal residents". Many of which hail from urban areas of NJ, MD, DE, VA, etc. They expect a lot more than they get. 1st. They assume it's tax funded, they get really fricken pissed when a bill turns up in the mail. "But we paid the EMS tax?" Nope, you didn't... Only permanent residents who work in the municiplaity paid that, and it stands for Emergency Management Services Tax, not..EMS as in an ambulance. We don't see a dime. We get what you pay for the bill, and two grants per year.

Then they wonder why it takes so long. Well, when researching a property in Podunk, one should always find out how long it will take the fire department to get there, if the shack decides to burn down. I know their homeowners insurance people care. How quick can you get to this address? Depends. On what? Depends what the emergency is. We'll come as quick as safely possible, but we can only cover so much ground. I would advise against going into cardiac arrest. You should go to Walmart and buy an AED, if you're gonna do that. What do you mean? Well, it's 17 miles away. If the place is on fire, it's probably going to burn down if its snowing. That road doesn't get plowed. What if it's a NC fire? (natural cover) Well, that's an emergency, but there are fire breaks. Well what if they need an ambulance and the road isn't plowed? How did they get in there if the road isn't plowed? .......silence... We have a snow mobile. Can it fight fires? Small ones. How small? How much fire can a 2lb dry chemical extinguisher put out? Not much. Well, that's your answer. Where the nearest hydrant? Oh, about 28 miles away. WHAT?!?!? How do you get water? We bring it with us. What if you run out? We have other people bring it with them too. And if they run out? We go get more. Where? Do they have a pool? No. They should get a pool. They ususally hang up by this point.

Edited September 7, 2013 by Chief1C

[triemal04]

Oh please please please tell me that was a real conversation!

[Chief1C]

That's the gist of two phone calls per week, every spring and every fall. Everyone wants a summer home, and everyone wants a hunting cabin. Someplaces have no neighbors, no phone and no power; usually replaced with cell boosters, propane heating and lamps, etc. The downside is, if you need help, nobody will know without a means of outside communication. Nobody considers what happens in an emergency. It is literally the last thing on the list. I've had insurance companies call for fire reports on total destruction fires, and we don't have one. Nobody knew it was on fire, and it completely burned out. That has happened in occupied places, too. Someone reports smoke, and it ends up being a fatal fire. Even in the more populated areas, but with no neighbors and on uncommonly traveled roads. Its only a serious problem if its a wildland fire, which will just keep going; or a wreck. Just because a vehicle can get there, doesn't mean an ambulance can..or a rescue truck for that matter.

Which is why the industry of making ATV's, RTV's, etc. that are outfitted for Rescue, Fire and EMS has exploded. Which makes you look at modern apparatus. Bigger and better, no no no, not in rural America. This is a shoe box, make it do everything on this list, make the pump more powerful, but lighter; make it hold more hose, more water and more foam, but you can't go outside the confines of the box, and can't be heavier than X. You depended on certain comforts and equipment all your career, till you get out in the middle of god's country, and you can only bring what will fit in a Polaris 6x6, and you only have three people to do it. Makes you realize that you depend on things you'll never need, and how little you actually do need to handle damn near any task.

Edited September 7, 2013 by Chief1C