Rural Updates

[medic001918]

Oh my God!!!! I am agreeing with Quint on this one. :banghead: :puke:

Ok, first a little local geography. Grays River, Wa population like 300. The kids living in Grays River have to catch a bus about twenty five miles to a school in Nasselle, pop 400. The town is too small to have a school, yet they do have a volly fire department that does transport. The nearest hospital is about an hour away, east or west, nearest ALS service minimum 30 minutes. Were talking rural here, well as rural as you can get in Washington.

So what are we to tell the residents of Grays River? You need to divide the cost of an ALS service between the 300 of you, ambulance, supplies, quarters, about 8 full time AAS degreed Paramedics. Ummm little math, carry the 2, yeah that is going to equal a buttload of money. I agree with Quint the rural providers cannot afford to run at the levels of urban areas. Yes teachers have to have degrees but podunk America doesn't even have schools, so that analogy is not valid.

So what is the answer? I believe that in urban areas transport units should be staffed with Paramedics. Those Paramedics should have an AAS or above. Urban areas have the tax base to support ALS staff levels. Rural areas do not have the tax base to support ALS staff levels. It comes down to money, so unless we go to a socialized medical system we are stuck with it. Most of rural America relies on Basic level care, it is not possible to cover all of the rural areas with ALS without an increase in taxes, and we know people love to vote for new taxes. Rural providers are an important asset in BFE, even providing Red Cross first aid is something until an ALS intercept or ALS arrival can happen. It is better than the folks of Grays River, Wa having to wait 30+ minutes for an ambulance.

In a perfect world ALS would be everywhere, we don't live in perfect, at least that's what the Walgreen's commercial says.

Peace,

Marty

:joker:

Your teacher anaolgy just might provide the answer to the problem. In order to effectively staff the schools, they combine school districts together in one school to allow for degreed teachers rather then lowering the standards. Instead of telling your citizens that they need to absorb the entire cost, spread the cost among a district and provide a paramedic intercept response for a region instead of an isolated town. While this might not mean the paramedic is always available, the availability should be better than not having one at all within 30 minutes. But I suppose that all in all it comes down to what the citizens of any given area are willing to pay for and willing to accept as a standard level of service. Sometimes it's better for towns to combine resources in order to better serve the greater number of people.

Shane

NREMT-P

[Scaramedic]

Your teacher anaolgy just might provide the answer to the problem. In order to effectively staff the schools, they combine school districts together in one school to allow for degreed teachers rather then lowering the standards. Instead of telling your citizens that they need to absorb the entire cost, spread the cost among a district and provide a paramedic intercept response for a region instead of an isolated town. While this might not mean the paramedic is always available, the availability should be better than not having one at all within 30 minutes. But I suppose that all in all it comes down to what the citizens of any given area are willing to pay for and willing to accept as a standard level of service. Sometimes it's better for towns to combine resources in order to better serve the greater number of people.

Shane

NREMT-P

I agree totally Shane, but you still need a Basic/FR level response before the ALS intercept. That is what volly departments are good for getting on scene and giving the patient some level of medical care before ALS can get there. The idea of communities sharing the cost is awesome though. =D>

Peace,

Marty

:joker:

[SSG G-man]

Teachers are required to have a degree whether they are rural or urban. Teachers are required to have so many CEUs every year or on a 2 year rotation or they can lose thier certification or ability to teach within certain districts. Rural or urban, they seem to be able to maintain this despite their location and LOW PAY. We as parents, community leaders, or community members would expect nothing less, so why do we tolerate it in EMS?

Its simple, you implement higher education now and phase it in. The majority of people are grandfathered into the system. There will be no huge drain on resources available as EMS will now be viewed as a degreed career instead of somthing to pass the time. The state of Oregon has been doing this since 1998 and it has caused very few if any problems at all. Instead, more rounded, more educated students are on the streets providing higher levels of care.

Well when you are a teacher with 2 or 3 months off every summer it makes it a little easier to get those CEU's. (Just like people complaining about teachers low pay. They work 9 months a year. Get a summer job!! Sorry got on a tangent) Would EMS companies give time off to get the upgraded education? Doubt it!!

[Ridryder 911]

EMS is always looking for excuses on why they should not have to meet standards or receive an education. It is amazing, instead of making sure that we provide the best available care, with the highest educated personal, we are always making up more titles and whining.

You have a hospital or clinic in your community, hell even a nursing homes ? If they have a nurse or physician.. guess what they attended college or a university. It is a shame that even nursing homes will have a either an equivalent or higher educated person, on duty. ( LPN 14 month vo-tech - Paramedic 14 month Vo-tech,: or RN -ADN Paramedic- AAS). Why do they provide at least this level? Because it is mandated.. shame, level of care cannot be mandated in EMS.

Your community cannot afford professional EMS, okay place well trained first responder and rendezvous with an ALS crew. Some communities have found out that some urban areas will even contract out and place a ALS unit in town or maybe one closer to you.

Again, instead of looking for reasons not to upgrade, we should be turning our attention on how we can improve and increase better care. Diluting the education is not the solution.

Hell, even John Q. Public is even more aware of this than some EMT's. In this month's Men's Health there is an article on heart attack and how EMT's should be advanced and provide ALS care. It is a shame that the public recognizes this more than the profession.

I live in a rural area, have primary worked in either urban or rural, and it has always irritated me that people assume that because you work rural, you are allowed to "dumb it down" ! People who live in these areas deserve and should be expected the same initial care, as those that live in a large metro area. Just because you are in small areas, does not excuse you from having the same education, or the skills, needed to provide care. In fact, one needs to be more educated and experienced because of the lack of resources. I have always attested Paramedics are needed for those that are a distance from a tertiary hospital, not those that are a just couple of blocks away.

Again, look for solutions on how to increase revenue, to off-set costs, grant monies for rural health education. Look for a solution not an excuse.

As far as education, and CEU's it has became very easy. With the invention of internet, week-end conferences, there is no excuse anymore not to imrove or maintain certification. Hell, even the majority of CPR and ACLS can now be obtained over the internet..

R/r 911

[akflightmedic]

Well when you are a teacher with 2 or 3 months off every summer it makes it a little easier to get those CEU's. (Just like people complaining about teachers low pay. They work 9 months a year. Get a summer job!! Sorry got on a tangent) Would EMS companies give time off to get the upgraded education? Doubt it!!

Sorry, its people with your mentality that irk me. Teachers are the most undervalued unappreciated worker in the US system. Where would any of us be without first having a teacher?

So in the two months off, they should get a job and get CEUs. Brilliant plan. What job can you get in a matter of weeks and keep for only a month or two is going to pay anything to make it worth the hassle? None of them! Just pay them more, they deserve it. As for such a long vacation, my kids got out of school the last week of May and they return July 31st. The teachers had to stay a whole week after school ended to finish up everything, then they have to return at least a week before school starts to get it ready. Real nice long uninterrupted vacation there.

As for who has plenty of time off, surprisingly it is us, EMS or Fire workers. The average schedule is 24/48. That is 10 days a month of work. That is 120 days a year! That means we have 245 days a year off which is equal to about 8 months. Wow, we got it easy.

As for someone earlier who mentioned combining districts, it is a great idea and can be easily done. It just takes communication between the governing bodies. I currently work for Lake-Sumter EMS. Lake and Sumter county were/are very rural. They got together 5 years ago and did away with their individual county EMS systems. The County Commissioners merged the 2 systems and now we have Lake-Sumter EMS. The 2 counties formed a company that is responsible to the the county board. It is/was a great idea and is working beautifully.

[SSG G-man]

I guess since I am a job stealing under educated only doing it for a hobby and my ego Volunteer, I don't have quite as much time off. Uncle same has me in the office from 0600 to 1700(at least) M-F. Sat and Sun when needed. Due to high cost of living in this area (Washington, DC Metropolitan area) I live about 40 miles from work. Almost an hour getting in. Hour and a half to two hours getting home.

Not real conducive to college courses.

But, I should not worry about that. The paid crews are taking over the county slowly and I will eventually not be a Volunteer EMT anymore. I guess I can still keep the paid part time job I have for a transfer service.

[Dustdevil]

I think my head is going to explode. :?

Are there really only half a dozen people on this board who get it? Is the rest of EMS really this clueless?

All of the questions asked in this thread are SO simple! They have all been asked and answered a dozen times or more in these forums. Yet the same people keep acting as if this is the first time anybody has ever thought of this stuff, completely ignoring the simple facts as they are presented.

There is not a single damn thing difficult about any of this. It's simple as farking pie! It doesn't even take an advanced degree in management to figure out that we could very easily establish a nationwide system of advanced EMS educational requirements and professional ALS services in every community in the country without sacrificing anything, just as we have done for primary education. If you can't figure out how, screw you. You're too stupid to be in EMS. Leave it to men of intelligence, vision, and action to get it done. If you aren't part of the solution, you're just part of the problem. Whining is not a solution. Lead, follow, or get the hell out of the way. Territorial obstructionism is not an option.

NOTE TO ALL READERS: Use of the word "you" in the above rant does not refer to you personally, so don't get all bent out of shape over it.

[Ridryder 911]

Amen Dust!...

What is next requiring physicians to attend Universities?..oops.. wait that happened, oh.. what about nurses, lab techs.. oops that happened as well...well at least I can be an ambulance driver.

The public is demanding we have better education as more baby boomers become older adults they were raised upon Johnny & Roy and they expect at least that level, as well as their children. Now physicians is studying why we continue to screw up procedures and the outcomes are going down. Even the insurance companies and medicare are tired of paying high dollar amounts just for a taxi ride.. the only resistance to change is ourselves. Now this is a shame and sucks.

Our own so called profession, rather boost upon ego on how things are so good (are they?). Are we the only ones that are not seeing it ? Apparently so.

John Q. Public is tired of hearing and seeing excuses. You want to play health care, you better damn well better be prepared. This means in all realms. The public is now expecting excellent prehospital care, this includes AMI recognition, ACLS, pain management, and competent medics. We want to be recognized and honored for such, but at the same time we do not want me our obligations. These being whatever is for the good of the patient, not just for ourselves.

I know there will be a possibility of composing a tri-district in my area in the distant future. Am I happy about this? No, but this would be in the best interest of the patient(s). All persons wold receive Paramedic level of care as well as establishing a funding to maintain that level for all citizens. Again, the good of the many outweigh the needs of one.

I predict within 5 years, there will be a rapid amount of changes. Public will demand it so much, major changes will have to occur. The unfortunate thing will be someone else will mandate it and not ask our opinion, thoughts or really care what we think.. but alas we are going to allow it to occur. The writing is is on the wall, instead of fighting change we need to be sure that we (EMS) will control it and make the appropriate changes for ourselves and not have to depend on someone else to do it for us.

R/r 911

[PRPGfirerescuetech]

Word.

We need people to take the reigns....but....who?

[Scaramedic]

Are there really only half a dozen people on this board who get it? Is the rest of EMS really this clueless?

I hope I'm one of those half dozen Dust. :wink:

I agree with you Rid & Dust, ALS should be the standard. The only exception should be tiny, remote communities and only until ALS can get to the patient or an intercept can happen. As a side note, Medicare will cover ALS intercepts so somebody will get paid for it.

I will take it even a step further First Response and EMS should be separate entities. An ambulance should be a unit staffed by Medics, with all the ALS toys it can carry. A First Response Unit can be staffed by FR's and only transport to ALS intercepts and carry the usual BLS equipment. I know it is semantics but the public needs to know the difference. The Basic level should be just that, the standard scope of practice, none of those "add on skills" that so many states and FD's love.

One last issue I have, people choose to live in these remote areas. Some of the "towns" we have in the mountains are all but inaccessible during the winter months. I beg to ask the question, is it worth it for a crew to risk their lives to go 40 miles into the mountains to save someone who chose to live at the butt end of the universe? If the people in that area want to help get them down that's fine, but crews coming out of the city shouldn't have to go 'mountain rescue' for the Ted Kazinski's of the world. Just my opinion, please fell free to flame me on that one.

Peace,

Marty

:joker: