Rural Paramedics

[hagerff/emti]

Hey guys I am wondering your thoughts on rural paramedics. I live in a rural area (when I say rural I mean the middle of North Dakota) that is primarily served by volunteer ambulance services. However, just with in the last three years a new program has started. We now have a Quick Responce/Paramedic Unit that serves 9 volunteer ambulances in a 40 mile range. This unit is based out of a local hospital that all of these ambulances transport too. Currently this program is funded by a grant that was applied for through the Federal govt. Right now this program may face being shut down as the end of the grant is nearing. What I am wondering is if any of you have a similar situation? How is that funded, maintained, and Staffed?

[Chief802]

Unfortunatly for years the system has been operating backwards. The paramedics have been concentrated in the urban areas where difinitive care is only 2-3 minutes away and BLS or First responders have been in the rural areas where response times alone can be 15-30 minutes. Now add a 5-10 minute on scene time and another 20-30 minute ride to the nearest hospital, (let alone a trauma unit) and you have the need for advanced care where none is available. I believe the need is present for paramedics in the rural areas, however, as in your case, once you get them there, how do you keep them there and trained.
Luckily, I am from a department that is in a very aggressive E.M.S. system. We are trained at the ILS level, but we are doing everything that paramedics are doing in our state with very few exceptions. We are administering drugs, i.e. Epi, atropine, lidocaine, benadril, glucagon, Narcan. We are intubating in the field,(most of our nurses in our hospitals are not trained to intubate), giving Neb treatments, etc. etc.
If you are truly a rural area, find a way to keep the care that is in place. The public you serve deserves it.

[dousaems]

The grant was a great way to get the system started, and should have given a bit of time to prepare for the future. Maybe applying for another grant is an options, but to be honest, the hospital that is running the squad should technically absorb the cost. After all, who provides the supplies, where does all the business go, etc.?
One system I currently work with has three ALS chase units that is hospital-bassed and subsidized. Paramedic down time is minimal, since they help out in the ED when not busy on runs or restocking and checking their rigs. This makes the medics happy (they keep up their skills and get good pay and benefits) and helps the hospital, which uses the medics as supplemental folks in the ED. It also helps promote an excellent working relationship with the medical director, and allows the medics to have access to more skills than a station based medic might.
Case in point - In the system I described, we have RSI as an option for airway control. In another system I work with (station-based, see the medical director once a year), we had to fight tooth and nail to nasally intubate, and that only occurred a year or so ago. Lots more trust in the first system.
Even if the census of the hospital is not that high, remind the management folks that htey can bill for the materials used on the rigs, if they supply them. Ambulance billing is great, and it works for ALS chase services too.

[hagerff/emti]

Well here is a little more info on the current situation. The medics here also help in the ER at the hosp. THey can go into the OR and Tube a pt and etc. The assist with afterhours clinic and such. THe hosp has agreeded that the service cannot leave....ITS A MUST. The hosp it viewing the medics as help and has assumed most of the programs costs. The rest are paid by the following. The Medics have also started a new program on their own. THey are currently running a billing service for the vollie squads. They charge a min. dollar amount to bill the ins companies and patients. In most of the vollie squads here we wernt billing under the correct medicare standards and werent making anything off the calls. So with the medics help the vollie services have made a turn around. They also are teaching classes (basic, inter, refresher, and ce classes). This helps them earn the needed money to run the program. It is in its first (ungranted) year and hope its a good one for them. I am currently looking at other grants that I can write so if you have any information on where I can find EMS grants let me know.

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D. Hager
FF/NREMT-I
West Trail Amb. Svc
Mayville FD

REAL HEROES WEAR SCBA'S NOT CAPES

We will eat smoke and pull out bodies as long as they continue to build them. Just once I would like them to ask one of us how to build it!!

[skymedic]

At least you guys only have to worry about 40 miles of coverage radius with an ALS system
I have the pleasure of working in Namibia (formerly German South West Africa) where RURAL takes on new meaning. Here we have a grand total of SIX ALS personnel to cover the entire country. All are based in the capital, Windhoek, and are all employed by one of teh two private air EMS services in the country. the golden hour for us often translates into the platinum day, where a patient must often lie on the roadside for some time before the next passeer by arrives, who must then seek the nearest farm / town to call us, after which teh nearest LZ / access route must be found, then 20 min to aircraft airborne, up to 3 hours flight time, then sometimes still a trip by road from LZ to scene. while we all did our training in South Africa, we've found the protocols thence inhereted to be inadequate on many an occasion when it comes to dealing with patients "in the sticks". Some of us had the privelege of completing ACLS, PALS and ATLS before taking up employment here, so the extra insight and skills taught have proved invaluable.

As regards funding, as i mentioned, all ALS is in private employment, none in state service. The state in most area lacks even personnel with a BLS qualification, and have to make do with nursing staff from local hospitals / clinics, who have had no formal training as regards dealing with emergencies in the pre-hospital environment. So the public who lack the benefit of medical insurance or have enough sound financial backing are unfortunately not in a position to afford private EMS, and are at the mercy of the state health services. In the cities / towns, where we have operational bases, we have an agreement with the state health services that all disposables used on state cases will be replaced be the receiving state hospital. That is, assuming they have the stock on hand. Our vehicle costs and personnel costs are left unaccounted for and get written off to tax.

Not the best business sense, but probably the most humane option when it comes to rendering an essential service in a country where the government is not in a position to supply it themselves.

[N3UEA]

A lot has changed in the past few years in here. When I started in EMS there were 6 ALS squad units in the county, each with two Paramedics. In the past 3-4 years, the suburban BLS units put a Medic & an EMT on the BLS units & took the 2 Paramedic ALS units out of service. They would then have a supervisor in a squad to back then up in certain situations (codes, MVA with entrapment, etc). Only one service has not changed & still operates squads with two Paramedics. This service is still supported by one of the smallest hospital in the county. This service is in mostly a rural setting with one of the squads in a small boro but still get a good bit of rural calls with response times averaging 8-20 minutes. In the past, 5 of the 6 ALS units were all hospital supported. Now, the MICUs (which are 1 Medic & 1 EMT) are based where the BLS units that were the busiest are located with a few satellite stations thrown in for good measure. These are supported by billing for transport only.