ALS, More important in rural or urban areas?

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Permalink Reply by B.J. Jones on August 3, 2009 at 11:06pm

Rural because of the distances to the nearest competent medical facility! Just my own opinion... LOL

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Permalink Reply by Tracy on August 3, 2009 at 11:51pm

I agree. But the overall call volume makes ALS in rural areas hard to justify and budget for. It will only happen in a lot of places if mandates are put on local governments by the state and/or federal governments. Until then rural areas will have to provide the best level of service they can with the best EMT's they can find.

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Permalink Reply by Ben Waller on August 4, 2009 at 12:39am

Breathing: more important in rural or urban areas? Like ALS, they are important in both places.

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Permalink Reply by Gul Dukat on August 4, 2009 at 2:40am

My thoughts are that they are probably equally important, however if you held a gun to my head and made me answer I would say rural.

Let’s be honest in most urban settings you probably can be at an E.R. of some nature within 10 min. or less so you could make the argument that if you had to choose one or the other that the longer response times and even the nature of the calls would lead you to think rural.

But I am not saying that ALS does not have a place in the urban setting, I am just saying if you are going to say only one or the other.

Now having said that I will say that I believe one of the real problems we have in EMS in America is that we have a very poor distribution of our ALS resources.

The state I live in and I’m sure its like this in most states has a very disproportionate amount of ALS providers (meaning Paramedics) working and practicing in the urban and in particular sub urban setting compared to the more rural settings. Obviously money, run volume, distance, etc. are all going to play in this.

But as an example (BTW, this is in no way meant to be a fire vs. non-fire issue) a suburban fire service in the area has roughly 70 some line firemen. Out of those I believe roughly 50 are certified as Paramedics. If you are lucky enough to live in this city and you fall and twist your ankle you will be blessed with 2 Paramedics arriving on the transporting Ambulance and most likely 3 of the 4 Firemen on the engine will also be Paramedics.

Now go just 60 mile west of this city and you are involved in a two car MVA and you are ejected and unconscious then you will be responded to and treated by a county paid EMS service that is BLS only. Go 10 more miles and you will get the BLS service only this time they are volunteer (nothing wrong with that per say I’m just pointing out that everybody here is BLS and there are NO ALS personnel available).

In a perfect world 30 of those 50 Paramedics would be spread out to the west, but again only in a perfect world.

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Permalink Reply by TheCannulator on August 4, 2009 at 5:15am

What is more important in rural areas is access to specialised services.

Like Trauma, Cardiology, Neurosurgery, Maternity. Providing extra ALS services in rural areas to make up for tight arse governments is not the answer. Centralising some services might be required depending on population and spread however it shouldn't be the copout decision.

Resources like aeromed (providing they can stay in the air) have made it easy to forego regional specialist centres and services. Putting trauma in the big smoke isn't the same as putting maternity specialists there too in isolation.

I don't think it's one or the other. To say some deserve care moreso than others is divisive.

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Permalink Reply by BostonMedic109 on August 4, 2009 at 9:56am

Having worked both congested "big city" and rural/suburban for over thirty years (concurrently) it's not the linear distance but the time distance to "appropriate" medical facilities and in both circumstances it's those first few critical minutes that either win or lose a patient. With regards to arrival at the ED 12-15 miles or 5th floor walk up are equi-distant. And to those who tout "real" calls versus "waste of times" medical emergencies are based upon the perception of the patient not the ego of the responder. I've told newbies for years," I'm going to let you practice on a few thousand not too sick patients, so when someone is critical you'll notice it quickly as different and those repetitive evaluations that weren't really that necessary WILL HAVE HONED YOUR SKILLS TO A RAZOR SHARP DEGREE

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Permalink Reply by Ed Opp on August 4, 2009 at 4:27pm

Come on guys and ladies, we don't live in a perfect world. The farther you are away from a hospital, the more important it is to have ALS services. In a perfect world we would have trauma centers on every corner and surgeons standing by with the latest in modern medicine. Here's the kicker to this whole discussion, wait until this healthcare issue comes around. If you think providing better care and funding is an issue today, when big brother takes over the system we will be dummied back into the stone ages. Your trauma patients and cardiac emergencies will be a nightmare. The consequences of the national healthcare proposal leaves us way out in the cold.

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Permalink Reply by Amy Lee on August 4, 2009 at 7:00pm

I grew up in a rural setting that has a level 4 hospital. Until recently, they didn't have a steady diet of emergency room doctors that didn't double as your family doctor. I took my EMTB training there and until recently I would have said ALS in a rural setting was more important. I still think ALS trained providers in a rural setting is important, however I also believe that no matter what you do to "save" your patient, it will only be good enough if the receiving facility is capable of taking care of your patient. In my town, we had the only hospital within a 60 mile radius, and at times it took the flight helicopter close to thirty to forty minutes to respond if a patient were to need higher care (lots of highway TAs, mountain climbing accidents, and for some reason a fair share of small plane accidents). I work in an urban setting with a multitude of hospitals within ten minutes or less. However, I think the same philosophy applies. If you take a patient with an acute STEMI to a hospital that doesn't have a functioning cath lab, how much good did you really do for your patient, even if you, as an ALS provider, did everything medically correct? Though, I concede that there are some rural areas that just don't have a choice.

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Permalink Reply by TheCannulator on August 4, 2009 at 7:40pm

Big brother taking over is exatly what you need by all accounts, so I wouldn't spruik too loud.

Ed Opp said:

Come on guys and ladies, we don't live in a perfect world. The farther you are away from a hospital, the more important it is to have ALS services. In a perfect world we would have trauma centers on every corner and surgeons standing by with the latest in modern medicine. Here's the kicker to this whole discussion, wait until this healthcare issue comes around. If you think providing better care and funding is an issue today, when big brother takes over the system we will be dummied back into the stone ages. Your trauma patients and cardiac emergencies will be a nightmare. The consequences of the national healthcare proposal leaves us way out in the cold.

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Permalink Reply by Nathan on August 4, 2009 at 8:01pm

Cannulator, Yes it is, Im all for it! It might be a cluster at first but all other places that have the systems seem to love it after it gets the kinks out of it! But that's another thread...
Amy, I agree with you (to a point) that it doesnt matter how good your pre hospital EMS is if you dont have decent hospitals in your area. That kinda proves the argument that good ALS is more vital in a rural setting. You, with your good ALS level skills will have to go somewhere that can handle your trauma or stroke or other specialty patient. That means your will have to keep them alive even longer, thus making your skills even more vital to that patients survival.

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Permalink Reply by Ben Waller on August 4, 2009 at 9:55pm

Simple triage...even if a high percentage of urban patients don't really need ALS, the ones that do greatly outnumber the rural ones that need ALS. Simple math, greatest good for the greatest number, whatever you want to call it, the greater number of urban patients mean that more of them will benefit from ALS than the rural ones.

It's just like the real estate industry. What counts is location, location, and location.


nathan said:

Cannulator, Yes it is, Im all for it! It might be a cluster at first but all other places that have the systems seem to love it after it gets the kinks out of it! But that's another thread...
Amy, I agree with you (to a point) that it doesnt matter how good your pre hospital EMS is if you dont have decent hospitals in your area. That kinda proves the argument that good ALS is more vital in a rural setting. You, with your good ALS level skills will have to go somewhere that can handle your trauma or stroke or other specialty patient. That means your will have to keep them alive even longer, thus making your skills even more vital to that patients survival.

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Permalink Reply by Nathan on August 5, 2009 at 12:02am

Thats true, but thats more about how many ALS units do we need not where are they are more vital. I would agree that if you had to pick one or the other, it would be better to help more people in the urban environment. But as to which one greater effects each patient....

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