Rural County EMS System--Scares me

[NREMT-Basic]

Whoaaaaaaaaaaaaa Nelly! I agree that this thread should be locked down with all due haste. I didnt make this about urban vs. rural, nor did I start the thread. And you are quoting alot of other people in your latest rant and seem to be attributing the statements of others to me. You even managed to call Anatomy Chick "Sir".

As for you accusing me of sucking up to more senior members of the city, well...you obviously dont have the ability to differentiate between sucking up and paying senior members with decades of experience the respect that they deserve for their knowledge, experience, training and length of service.

Have I been argumentative during this thread. Yes, but really mostly with you. Yes I can quote things that you have said that are insulting to rural providers and statements you have made saying that urban services are superior. Honestly, I have never learned how to insert quotations into these posts.

I have no doubt that you will deny that all of that last post was aimed at me since you seem to be in the habit of saying things and then denying them. However, you used quotations from several different posters and seemed to want them to represent my thoughts and attitudes just for the sake of argument. Im really quite tired of all of this and am very tired of responding to things that you either directly or indirectly state only to deny them 3 post later. Give it a rest man. If it takes me saying ok you win for you to just be quiet, then ok, you win.

But even you must be able to see the ridiculous nature of your statement that responders whether they are basic or medic, urban or rural, do not save lives. If you roll on a code, and you and your partner are able to bring that patient back, whereas he probably would have died had EMS not shown up, then you and your partner saved his life. There werent doctors there, no nurses, no code team, just responders. Your argument that people in all walks of EMS do not save lives just doesnt hold water. If we dont save lives (and I am not saying we do on every call) then why do we exist at all. If Pre-hopsital emergency responders dont save lives in the field, the EMS is one of the greatest inside jokes ever perpatrated on mankind. Choking babies, MIs MVCs, MCIs, overdoses of every shape and kind, gun shot wounds, stabbings, any situation where a patient would have bled out without the efforts of an EMS crew these all to me seem like ways in which EMS saves lives each day. I cant believe that you have been an EMT for 10 years and dont believe that there are many many times that a patient would have died had EMS not been on scene within minutes after dispatch. Ever hear of the platinum 10? That has nothing to do with trauma and code teams at hospitals. That is a lifesaving benchmark of sorts for EMS.

So, as an early Christmas present to you, though I think that most of your points are illogical and self-contradictory, I will concede this round to you. You Win! Now get out there and dont save lives.

[NREMT-Basic]

Whoaaaaaaaaaaaaa Nelly! I agree that this thread should be locked down with all due haste. I didnt make this about urban vs. rural, nor did I start the thread. And you are quoting alot of other people in your latest rant and seem to be attributing the statements of others to me. You even managed to call Anatomy Chick "Sir".

As for you accusing me of sucking up to more senior members of the city, well...you obviously dont have the ability to differentiate between sucking up and paying senior members with decades of experience the respect that they deserve for their knowledge, experience, training and length of service.

Have I been argumentative during this thread. Yes, but really mostly with you. Yes I can quote things that you have said that are insulting to rural providers and statements you have made saying that urban services are superior. Honestly, I have never learned how to insert quotations into these posts.

I have no doubt that you will deny that all of that last post was aimed at me since you seem to be in the habit of saying things and then denying them. However, you used quotations from several different posters and seemed to want them to represent my thoughts and attitudes just for the sake of argument. Im really quite tired of all of this and am very tired of responding to things that you either directly or indirectly state only to deny them 3 post later. Give it a rest man. If it takes me saying ok you win for you to just be quiet, then ok, you win.

But even you must be able to see the ridiculous nature of your statement that responders whether they are basic or medic, urban or rural, do not save lives. If you roll on a code, and you and your partner are able to bring that patient back, whereas he probably would have died had EMS not shown up, then you and your partner saved his life. There werent doctors there, no nurses, no code team, just responders. Your argument that people in all walks of EMS do not save lives just doesnt hold water. If we dont save lives (and I am not saying we do on every call) then why do we exist at all. If Pre-hopsital emergency responders dont save lives in the field, the EMS is one of the greatest inside jokes ever perpatrated on mankind. Choking babies, MIs MVCs, MCIs, overdoses of every shape and kind, gun shot wounds, stabbings, any situation where a patient would have bled out without the efforts of an EMS crew these all to me seem like ways in which EMS saves lives each day. I cant believe that you have been an EMT for 10 years and dont believe that there are many many times that a patient would have died had EMS not been on scene within minutes after dispatch. Ever hear of the platinum 10? That has nothing to do with trauma and code teams at hospitals. That is a lifesaving benchmark of sorts for EMS.

So, as an early Christmas present to you, though I think that most of your points are illogical and self-contradictory, I will concede this round to you. You Win! Now get out there and dont save lives.

[whit72]

Ok this will be my last post on this subject.

I make these statements with the utmost respect towards you.

Nremt B wrote:

Honestly, I have never learned how to insert quotations into these posts.

I dont believe that for a moment, you have made over 150 posts here, you cant claim ignorance on this one.

I believe some of the statements you posted you actually believe, so I will try to decipher some EMS myths for you.

Nremt b wrote:

But even you must be able to see the ridiculous nature of your statement that responders whether they are basic or medic, urban or rural, do not save lives. If you roll on a code, and you and your partner are able to bring that patient back, whereas he probably would have died had EMS not shown up, then you and your partner saved his life.

Bring the pt back, Survival rates for the cardiac arrest pt. are grim, traumatic arrests are less then that. I don't consider the return of pulses a life saved. As you gain more experience you will realize this.

Nremt b wrote:

There werent doctors there, no nurses, no code team, just responders. Your argument that people in all walks of EMS do not save lives just doesnt hold water.

People don't just arrest, there is usually an underlying cause. However that underlying cause in most cases is far beyond EMS reach, and needs more definitive care. So yes I guess if you consider the return of pulse's a live saved then I would have to agree with you. The ones that survive to discharge without tremendous deficit, is what I consider a save. I can count the times on one hand that I have been a witness to that.

Nremt b wrote:

If Pre-hopsital emergency responders don't save lives in the field, the EMS is one of the greatest inside jokes ever perpatrated on mankind.

No one of the biggest jokes ever perpetrated on mankind is the fact that we think we can cheat death.

Nremt b wrote:

Choking babies, MIs MVCs, MCIs, overdoses of every shape and kind, gun shot wounds, stabbings, any situation where a patient would have bled out without the efforts of an EMS crew these all to me seem like ways in which EMS saves lives each day.

Choking babies with total airway obstruction, are usually never saved by the EMS professionals. If that babies survives its because the parents were successful in clearing that pts airway or at least reducing it to a partial, until EMS arrived. Figure the parent would have tried to clear it for at least two minutes before activating EMS or didn't notice they were choking, with are average response times over 5 mins, so that puts you at eight minutes or so without o2, if they baby is truly obstructed you will be working an arrest when you arrive, by then you probably wont have a rhythm to work with. I believe the leading cause of death for children under the age of 12 is trauma. For traumatic arrest prognosis see above.

Overdoses, I don't even want to discuss them for some reason they always live. They have like cast iron hearts.

MVC see explanation above on traumatic arrests.

As far as stabbings, and gunshot wounds. We are rarely successful at extensive arterial bleed control, and never successful at internal arterial bleed control. No matter the level of certification. These injuries are are corrected or handled in one way surgery. Time is of the essence nothing else.

There are however treatable illness or injuries that we play an important roll in every day, CHF, Diabetics, MI and so on. To take the credit for saving that life, is a stretch at best. Withholding the severely acute. Even then more definitive car is needed for complete stabilization, or life saving.

Nremt b wrote:

I cant believe that you have been an EMT for 10 years and dont believe that there are many many times that a patient would have died had EMS not been on scene within minutes after dispatch.

I never said that. I stated that we were one of many important steps it takes to help save a life. Not the only one. There are many steps after us that have to be successful also to have a positive pt outcome. Unless your a unresponsive diabetic, I however don't consider that saving a life. Soon you wont either.

I do however find your enthusiasm refreshing, however if you entered EMS to save lives you will be very disappointed. This is a very humbling profession, yet rwarding at times. The more you witness it, the better you will understand.

To state that we alone as EMS professionals save lives, is close minded. There are many others that play a vital role also.

Again I never meant to offend you with my comments, If they did I apologize.

[Timmy]

I will tell you about the rural system were I live.

In Australia the ambulance is government funded, so there are 8 different ambulance services one for each state. Were I live Rural Ambulance Victoria is responsible for all calls. All paramedics are ASL or Intensive care.

In my town we have 2 ASL trucks running 24/7 with an on call station wagon.

East of me is Yarrawonga which runs 1 ASL truck 24/7. To the South we have another 1 ASL truck again 24/7. About 45mins from my town is a rural city which operates 15 ASL trucks and 4 Intensive care trucks. Our chopper is a 45min flight away. There all the same ‘company’ so they back each other up.

This is a map of my states rural services:

Just a little guide to the key:

Area Office: Were the comms and command are run also fleet ect. These also function as normal ambulance service.

Branch Pro: Station is staffed with ASL and or Intensive Care Paramedics.

Branch Community: Service is run by community ambulance officers or volunteers. Sort of like an EMT. These areas are remote and have an extremely low work load.

These services do not transport, they rapid respond to a call in a Ford Territory and wait till the ASL guy’s rock and transport.

Branch Seasonal: Are manned by ASL or Intensive Care, these areas are mainly snow fields or holidays towns so they only get paramedics when the holiday season is on.

[Cookie]

The county where I live has:

Total population 8,010

Square miles (land) 511.08

Population per square mile 15.67

Spread out through the county are 8 communities, the largest two have populations of less than 2,000. Of these eight communities there are three ALS units. The other 5 communities have a BLS unit and depending on the nature of the call will be tiered with another unit that is ALS. Our county is also aging, with the greater population over 65. We have on community hospital in one of the towns, and a slightly larger hospital across the river into the next state, which is actually closer for the unit I am on. We are all volunteer, everyone.

We see just about everything, from the truck driver who decided he needed to go to the hospital because he did not have a BM that day, or the farmer who got him arm torn off in the power take off on the tractor, to the baby being born in the local gas station, or one of our own members having burns over 58 percent of his body. I have helped pick up body parts from the interstate from accidents, or helped the stranded in a snowstorm. We get it all, maybe not as often as the urban based units but we do get our share. We may not show up in matching EMS shirts and pants, our folks know who we are and what we all do for a living, be it farmer, cook, butcher, mortician, nurse.

I hate these threads that turn into a pissing match of quotes, or people pitting paid vs volunteer, we are all here for the same reason, we do what we do because we want to be it paid or volunteer, to help people regardless of their location or illness or accident.

[NREMT-Basic]

I will say this and then let the thread die, at least for my part. In a relatively recent issue of the journal of the American Medical Association, the AMAs immediate past president was asked about the life-saving capabilities of EMS crews, he was also asked how valuable he believes them to be on the continuum of emergency medical care. He replied: "In my opinion, as a former trauma physician, the vast majority of the patients experiencing major traumas in any of a myriad of ways have their fate in terms of life or death determined by the very first responder to assess that patient." Of course he isnt offering figures because the question was anecdotal, but he would certainly seem to believe that EMS responders do in fact save lives. What you failed to see Whit, was that I was not saying that first responders (aka EMS from Basics to Paramedic level) are given total credit for saving lives in 100% of the calls to which they respond. However, I would like to think, that im your 10 years as an EMT you would be able to count the times that you prevented a person with serious trauma from dying would need to be counted on more than one hand. My count so far...well, I am told by my mentor that I have 1 "save" under my belt. Called to a private residence where a child eating outside the presence of her patents began to choke on a rather large hunk of sandwich. By the time the parents realized this, the child was cyanotic with a completely compromised airway and barely conscious or responsive. I was told by the medic to try to remove the foreign body, which I couldnt and our protocols state that you get one try to get that thing out of there with your fingers or pickups and then only if you can see the whole object. When i couldnt remove the foreign body and thus assist the child in protecting her own airway, I used that old standby the Heimlich Maneuver. As I stepped behind the patient she went limp in my arms. As the paramedic held her upright, I performed a series of abdominal thrusts which eventually dislodged the food and achieved a patent airway. No, I dont want to be known as I guy who stamps little stars on his shirt for each life he saves....thats not the way I see it. But since no one else was there or able to assist this patient from choking to death, who prevented her death. The hospital, nurses, medical control. Nope. Just a medic and an EMT using a technique as old as the hills. So for me, thats one. I would hate to think that after ten years I couldnt look back on my career as either an emt or future medic and say that my skills only pulled someone back five times...

I appreciate your apology for being insulting. But, its a rare person indeed who can be insulting and apologize for it in the same breath. I wont argue with you anymore and I also wont apologize except to the people who have had their time wasted and their brain cells fried by reading this ignorant thread. And yes, I count myself among the wankers who contributed to this thread. EMS professionals save lives thousands of times each day around the world, as do doctors, nurses, surgeons, support staff, school teachers, janitors and the list goes on forever. When I say that I am proud to have saved a life, I am not beating my chest about it. I am merely saying that I am proud and honored to have been called upon to assist someone in one of their greatest times of need. And I wrote that girls parents a letter through the hospital saying that I was honored to be allowed to help their child. I dont care who gets the credit for the save, so long as the saves get made.

[DwayneEMTP]

Good Lord, one of the most childish and unproductive statements made over and over here is "I hope they lock this thread"

If you don't want to participate, don't, but quite hoping Admin will lock the thread after your latest 'one-up' attempt.

Say your piece, or choose not to...but quite trying to decide that your last post was so brilliant that the rest of us don't need to hear any more on the matter.

We're all pretty much full grown. When Admin is tired they will lock the thread. When the rest of us are tired we'll click passed it. OK?

Dwayne

[NREMT-Basic]

Dwayne-

First of all, when you go on the offensive, you should at least have the manners to say who you are aiming your post at. Obviously since your latest post appears directly after mine, I assume you are addressing me. If I want to ask Admin to lock a thread, I have every right to do that and don't need your permission. As you say, I am a big boy and don't need your blessing to do anything.

Secondly, (and I intend to address this in an entirely new thread), this infighting simply must stop and, yes I will admit to being one of many perpetrators who have kept it rolling. Given my educational level, social skills and ability to communicate effectively and intelligently without resorting to name calling or snide remarks, I am embarrassed that on numerous occassions I have not done this. Far too often, as with VS's recent post calling a sexual assault victim an idiot, I allow my emotions to cloud my judgement and am guilty of hijacking a thread simply to go on the counter offensive and engage in name calling, insults and other inappropriate tactics to feel as though I am making a point. Let me be clear. I do not feel that the purpose of these threads is to make a point. The purpose is to hold open, intelligent and meaningful dialogue pertaining to the profession of EMS in all of its forms. I like the occassional silly thread that has nothing to do with anything just as much as anyone else, but when any thread degenerates into name calling and abusive accusations, I find myself leaving the City for sometime with a bad taste in my mouth, often from the way that I myself have behaved. So, from this point forward, I will not allow myself to get baited into arguing and petty bickering. I will conduct myself with the decorum and professionalism that we all seek to advance in our chosen field of EMS. I have often wondered what someone who is not active in the EMS community but passes through the City must think of us all. Anyone with access to a computer can read our threads and to be honest, I am embarrassed at the picture that so many of them paint of so may of us as EMS professionals. How can we expect those outside of the field of EMS to respect us as professionals, we we cant seem to managed to behave that way on a consistent basis. So it is with this is mind that I will do my utmost to be a positive, contributory and mature member of this online community which is based on the profession that we all love so much and that so many of us have chosen to. I lay blame squarely on my shoulders for the argumentative nature of so many threads. But I don't take all the blame. I think it is safe to say that a large number of those who regularly post have at some time and possibly even frequently allow themselves to use threads to play the game of I know more than you do and my truck is bigger that yours. As we head toward the new year, lets all make a commitment to be civil and professional whether the post is extraordinarily serious in tone or more light hearted. I will attempt to offer my own actions from this point forward as an example and I sincerely hope that the rest of the City will venture to do the same thing. If we bash and insult each other, how can we expect any respect from those who may just be "passing through."

Thanks to all who take the time to read this and I really do hope that if someone finds something I have said offensive, incorrect, etc that they will respectfully let me know so that we can all learn from each other. And remember, some things are better suited for PMs. Thanks to one and all, happy holidays and heres looking toward a new and improved level of discussion and participation as we move into the new year.

[Niftymedi911]

Yeah, the two counties I referred to have probably a combined population of 1/10th of Lee County or even less.

There is no way that a rural county with a population of 31000 or so could staff more than 2 ambulances maybe 3.

So the Lee County analogy is not really applicable in this case I don't think. Correct me if I'm wrong though.

our response times are averaging about 22 minutes to arrive on scene. Total call time over an hour unless we are in the city where we are based.

Yeah, I realized after I typed it that there was adifference, Lee County, FL is close to 600,000 year round residents and close to 800,000 during snowbird season. (Nov-Apr)

I would never want to live in rural, I used to and was hit by a drunk driver, it took 16 minutes for fire to show up which called for a helo. EMS arrived at 34 minutes after dispatch, Then approx 45 minutes after the initial dispatch the helo showed up and 56 minutes later I was in the air on my way to the trauma center. I wasn't as bad as some people but I didnt make that "Golden Hour", if it was anymore life threatening then it was I would of been screwed, (not that it already was)

Turns out after my accident I suffered bi-lateral tib/fib fractures to both left and right legs, a 6 inch laceration to the lumbar region of my back and head trauma with LOC. Ended up bitting a tube after I arrived for surgery to repair both legs.

The good thing was that the agency I work for now is the one who transported me by air. We handle a 5 county area response with our choppers.

[DwayneEMTP]

Dwayne-

First of all, when you go on the offensive, you should at least have the manners to say who you are aiming your post at. Obviously since your latest post appears directly after mine, I assume you are addressing me. If I want to ask Admin to lock a thread, I have every right to do that and don't need your permission. As you say, I am a big boy and don't need your blessing to do anything.

I reread you post, previous to the one you mention and didn't find anywhere that you asked to lock the thread. So your ASSumption was foolish. As I said in my post...it was said "over and over", sorry you took offense. I believed if you, or anyone else had asked to lock the thread then it would be obvious whom I was referring to, as well as my general opinion on the matter for anyone reading.

You have so much to offer if you ever get passed the 5th grade "I have the right to do this" stuff...You seem to feel the need to pretend I demanded that you ask for my permission...not so. I believe my point was pretty clear, I refuse to wrap in in velvet so that you are not able to blow it out of proportion.

The rest of your post was awsome! I thank you for it...And will make a stronger attempt to heed that wisdom in the future...

Have a great day all!

Dwayne