Wednesday, April 18, 2007

Short transport distances/times

I was reading a thread on an EMS forum the other day that had to do with the amount of time spent with the patient on calls. A forum member said something to the effect that we are aware that one of the challenges of rural EMS is that transport times are often comparatively long, but wondered about the challenge of the very short transport time in an urban EMS system. Even though I consider just about everything about Vermont to be rural, I feel I have the two extremes with the two services I run with. In Enosburgh, we often have 30 minutes in the back of the truck with the patient. That's plenty of time to run through every assessment and intervention available and/or appropriate. Obviously the flip side of the coin is that definitive care is also 30 minutes away. In St. Albans, the opposite is often true, with drive-time to NMC frequently in the under-five minute range.

I ran with AmCare in St. Albans for nearly a year before starting to do some shifts at Enosburgh, and I think I understand the meaning of the phrase "trial by fire". Depending on the priority of the patient's illness or injury, we often have to move from a very focused assessment to a treatment plan, and right into treatment within minutes. With very few standing orders, communicating with OLMC can also tie up a minute or two. Don't misunderstand: We learn to do it efficiently, but never at the cost of good patient care.

I find it easier on Enosburgh calls to do IVs, simply because I learned to get them done in a minute or two. I sometimes think that the hardest part about an in-ambulance IV isn't finding the vein, but making sure everything is ready beforehand (flush, lock, catheter, tape, etc.) because there is not an extra set of hands back there to hand you stuff.

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