Rural EMS

[phideux]

I worked a rural station for about 6 months. Our area went from 45 to 85 miles from our main hospital, there was a boo-boo station ER about 12 miles closer. Depending on the call, the copter would go on auto launch, we'd let em know if we needed them when we got on scene, or turn them around. We were stationed with a volly fire crew that stayed at the station, there was usually an EMT on the fire truck.
Our call volume was low, but erratic. One shift you would do a 24 and not turn a wheel the whole shift, The next you would run 6-8 calls. our calls were divided up about 70/30, the 30% being usual either straight up medical or trauma calls, the 70% being the downtown taxi run. If we didn't fly the patient, there was plenty of time to do stuff in the back. When you have an hour transport on a critical medical pt, or a bad trauma, it keeps you on your toes.

 

[EMT11KDL]

I currently work in a Rural System. I have worked in Urban also, but I like Rural a lot more. I went from Rural to Urban, back to Rural.

Urban: Many paid providers on scene, including fire, and most of the time LEO. Newer equipment, short transport times, and backup available for critical patients. Also, usually do to the shorter transport times, smaller set of protocols meaning less drugs and less skills you can do. The agency I was with was a very fast due to the Call Volume, it was walk in and load the patient in the back in less than 10 minutes no matter what. Than a 5-10 Min transport time to ED. Total Call time normally 15-25 Minutes, most of the time all skills performed were in the back of the Bus (IV, 12-Lead, Medication Admin). Now there are times when we couldn't do that, but those cases were rare compared to the rest of the calls.

Rural: Less hands on scene, normally extra hands were from a volly dept, but they are usually a lot more helpful than the Paid guys. like someone else said, less ego issues. The fact that we have a longer transport time, we have a larger scope of practice. Most of the time I do my first 12 lead and IV before we leave the scene because of the roads that we are on. My Avg transport time to our local small hospital is 30 minutes, and can be anywhere from 60-180 minutes to our major hospital. We utilize Air, but our decision is always based on time, how long will it take me to get them to the hospital vs how long will it take the Helo. If it is less than 10 min difference we drive. Also, it seems like we get more accidents were we get delayed with extrication compared to Urban, I think it is due to the speeds people travel out here. Our "Sick" Patients seem to be more sick than urban also, this is mostly because a lot of the area is farming community and they have the mindset of I wont go to the Doctor till I am on my death bed, and they literally take this to heart. So be ready to have some very sick patients.

Hope that helps.

 

[bushinspector]

Being in rural Oklahoma most of these issues are true to life. You will be able to have a much more active roll in the lives of the patients. I would encourage you to talk funding with everyone and get the local communities involved. Have fund raising activities to buy some very much needed equipment.. You will be very surprised on how the rural communities will interact and raise funds if they can understand it can be the difference between life and death.

Check and see if your state has 522 funding from the school districts.

I am in the process of attracting some Paramedics from Oklahoma City to drive an hour out to serve in the rural environment. I feel your pain, but the aspect of serving in the rural America could be much more rewarding.

 

[RocketMedic]

Bush, are you out toward Woodward or where?

 

[RocketMedic]

Being in rural Oklahoma most of these issues are true to life. You will be able to have a much more active roll in the lives of the patients. I would encourage you to talk funding with everyone and get the local communities involved. Have fund raising activities to buy some very much needed equipment.. You will be very surprised on how the rural communities will interact and raise funds if they can understand it can be the difference between life and death.

Check and see if your state has 522 funding from the school districts.

I am in the process of attracting some Paramedics from Oklahoma City to drive an hour out to serve in the rural environment. I feel your pain, but the aspect of serving in the rural America could be much more rewarding.

I was one of the target Oklahoma City paramedics, but to be honest, the rural services just couldn't compete on pay. I am willing to work longer hours, but too many places blow it with either "variable overtime", unpaid hours at work (a la Sinor) or mandatory recall that necessitates living there or staying an extra day.

 

[bushinspector]

I was one of the target Oklahoma City paramedics, but to be honest, the rural services just couldn't compete on pay. I am willing to work longer hours, but too many places blow it with either "variable overtime", unpaid hours at work (a la Sinor) or mandatory recall that necessitates living there or staying an extra day.

Would have PM you but I guess that I have not been on the forum long enough yet. Watonga to be exact and non fire based. Don't know your definition on "just couldn't compete on pay." I have never believed in the garbage of "variable overtime" or "unpaid hours of work." no need to live their due to having quarters at the station. Call volume is so low, that we would even allow the medic to bring a spouse.

The down side is no advancement, no benefits and not much excitement. We are a basic service with individual state protocols.

Looking for two medics to fill out the schedule and will work around other schedules. My thought was to have a older medic that was looking to slow down a little, or a medic that was doing online classes and needed plenty of time to study. Shifts run in 12 hour increments. Would not want someone to move to the town, just trying to give someone a little candy.....

 

[bushinspector]

Just noticed that this is a old thread....I really don't care, any form of communication is good...up to a point....

 

[RocketMedic]

Just noticed that this is a old thread....I really don't care, any form of communication is good...up to a point....

No need to worry, Bush, this forum is slower than others and the discussion and information are still relevant. I moved down to San Antonio last month, but the struggle is the same everywhere. Rural TX has most of the same problems.

I looked around Oklahoma but couldn't find anything that I could realistically justify as a full-time job. Pay over 35k a year, benefits, etc- few places had that. Too many pay 11-for 24, variable-overtime, etc, and it burns people out. The other thing is marketing. Most services don't market themselves at all, and certainly not publically, and when they do, potential applicants often wait days or weeks before any contact at all from the service and there generally isn't any useful info beyond a rig pic and a party. Even looking at this thread- if I were an applicant, where's the information for me? Where's the timeliness? Where's the organization? Personally, if I call a service asking about information about a job during business hours, I expect the phone to be answered or an email reply within a few days at most.

If any service (especially rural) wants recruits, community recognition and support, it needs to market itself. Far too few actually do.

 

[bushinspector]

The reason that you have not seen those things yet is due to some construction on the kitchen and bathrooms. Wanted to get everything in place before any marketing takes place. I am just in the process of coming up with a plan and this forum is just a tool to get some information. On the other hand if someone from OKC comes across this and is interested, so be it.

 

[RocketMedic]

That's what I mean, bush. You have to be proactive about the real message. I could give two biscuits about the kitchen. Recruits are attracted best by open, honest discussion of pay, benefits, etc

 

[Apple Bill]

I work rural volly fire on one side of the city and rural paid EMS on the other.
Sorry to duplicate what anyone else has said, but here's my take;
-Responding time and transport time will be longer. Sunday we were at mid-county post and got a priority 1 call, it took about 20 minutes to get there. Priority 2 transport to a major hospital is roughly 30 minutes. Priorty 1 to the closest level II is about 20 minutes if we're on the right side of the county. On the upside, for a priority 2, most paramedics can have their paperwork done before going back into service.
-Fire, whether small town paid or rural volly, will not be primadonnas. A lot of time they know the patient and put some weight on you to take care of their grandma's church pew buddy. You'll also be able to get valuable information. Don't hesitate to request fire assistance. From the fire side, we love to help.
-Lights & sirens mean something. In a rural setting people actually pull over. I see a huge difference every time I have to run hot into the city. About the time I cross the county line people get dumber and less courteous.
-Trying to find some places will suck. As the basic on the truck, trying to remember how to get back out sucks more. Those places will have no cell or gps service. Help your partner note landmarks for turning on the way in, especially at night.
-The roads are rough. Try to get your IV in place before taking off otherwise you'll have to wait for the highway, unless you are just that awesome. A lot of the paras out here are.
-Know your stuff. Rural folk are sharp and seem to catch BS or insecurity pretty quick.
-Situational awareness is crucial. Animals, hazards, guns, etc.
-Be ready to convince someone if they need a true ER. There are regional hospitals in each major town around here. Usually if you transport a pt there, you or another crew will be transporting them into the city later in the shift.

Enjoy! There are many paramedics at my service that left the city service so they could actually use their skills. Hospitals aren't around the corner.

 

[Leatherpuke]

I will soon be starting my first EMS job as an AEMT in a rural setting. I've worked volly fire in the area for a couple years so I'm at least familiar with the people.

Anyway, my biggest piece of advice ( not that it means much, I haven't worked a single day in EMS yet.) is to pay particular attention to establishing rapport with your patients in a rural setting. That Grandma you're talking to has probably lived in the same town for 85 years and she knows EVERYBODY. SHe plays bridge with the mayor's wife, her grand son is the county sheriff, her nephew is the mayor from the next town over.......etc. Take the time to talk to them and be polite, you never know who she is going to tell about her experience with you.

Secondly, I can't speak for anywhere else, but in my area of Kansas an AEMT can do quite a bit more than start IV's. In the county where I'll be working it is pretty normal for AEMT's to be running the ALS rig. I don't know what the deal is with the rest of the country but Kansas uses AEMT's like Jr. Paramedics, not just EMT's that can give IV's.