Perception

I recently decided to take a trip back in time on my Facebook timeline. I stumbled across lots of good and bad memories, but what stuck out today was some comments I had made a few years back when the local county fire department was seeking funding to provide paramedic-level service to a remote community in southern California. At the time I was working for the ambulance service in the area and I had been called some pretty derogatory names both on social media and even in the opinion sections of the local papers over my stance on the subject. I had made it clear that I didn’t feel the entire county should have to shoulder the cost of the service for one very small remote community. Mind you, this community was provided 24/7 fire protection and EMT-Basic level first-responder service from a large and very well run fire department.

I had never been against the idea of a community coming together to pay for a higher level of service. That’s the beauty of this country. We can do that. The issue I had was the entitlement mentality when these people wrote all the nasty letters to the editor saying that this service should have already been there. They mostly blamed my employer, accusing us of somehow being responsible for the county not funding the service. I was personally called names when I voiced my opinion in the defense of my employer and a few of my coworkers who never said a word were actually told that they weren’t welcome to eat or shop at a few of the local establishments in that community while they were on duty.

At the time, I knew they had it pretty good given the size of their community. What I didn’t know is how good they had it. Fast forward a few years later to when I’m working for a rural EMS service in North Texas, and I had a crystal clear picture of how good they had it.

Very shortly after I started my new job at the rural service, I got my reality check at 3am. We were toned out to respond to a report of a “sick person” in the far corner of the county. Throughout my entire career up until this point, I could pretty much guarantee that first-responders would already be on scene given the lengthy response time. Not this time. Not only were they not on scene, but they hadn’t even checked en-route. Prior to making contact with the patient, I didn’t think it was a big deal. In my mind, it was probably the usual I’ve-been-sick-for-days-and-waited-until-3am-today-to-call kind of situation. Wrong again.

My partner and I walked down this very narrow walkway to a restroom in the very back of the house. There sat a middle-aged man on the floor leaning against the wall, holding a small trash can that he had been vomiting in. I immediately noticed the ashen skin tone that I had seen on several patients who’s hearts were on the verge of stopping. I leaned down to speak to him and to assess his circulation. I couldn’t feel a radial pulse, which came as no surprise given his presentation. He was very slow to respond but did mention that he had felt weak and very sick to his stomach for the last hour. My first thought was that we needed to get moving. It was going to be at least a 30 minute drive to the nearest rural hospital and an hour drive to the closest PCI-capable hospital.  As fast as I wanted to get him out of there, a few problems stood in my way: He was too big to safely carry, too weak to stand, and the hallway was too small to get our gurney through. This left us with only one option: Call for additional help and start treating him where he was.

We immediately placed him on oxygen, attempted to obtain vital signs and was in the process of placing the ECG electrodes when he went limp and fell to his side. I had turned the monitor on just long enough to see the 3rd-degree AV block before he collapsed. He had no pulse. I started CPR while my partner grabbed some additional gear from the ambulance. I attempted to ask dispatch if the volunteer fire department had checked en route yet, however my radio couldn’t get a signal in the house so I had to use my cell phone. I was informed that they had been toned 3 times with no response and that the only other ambulance in our area was on another assignment. This meant that a different volunteer fire department would have to be toned out to see if they could respond as mutual-aid. My partner and I were able to get an IV, intubate the patient and push the necessary medications in attempt to regain spontaneous circulation. Fortunately, we had a LUCAS (auto CPR) device on our ambulance, which helped prevent fatigue. After over 30 minutes, we had run out of options. What little electrical activity we had in the beginning had diminished to a solid flat line on the ECG monitor. I consulted with the ER doctor who agreed that it was time to stop resuscitation efforts.

The volunteers never came. Now I’m not saying that in a negative way. That’s just the nature of volunteer departments. They show up if they can. Most of them have jobs and lives and can’t always jump at the sound of their pager. What got me about this call, is that the patient lived in a community that was the same size as the one in California. Same tax base, same EMS response time.

Fast forward another year and I’m on scene of a call where an elderly man has fallen and broken his hip. Once again, this man is too large for 2 people to safely carry. I called dispatch to see if the first-responders had checked en route only to be told that they don’t exist in this area. There was a nearby volunteer fire service, but they don’t respond to medical assignments unless the crew on scene specifically asks for them. Once again, roughly the same size community.

To me, this is the level of service that I would expect in a remote community. The pizzas don’t deliver out here, the grocery store is at least 30 minutes away and the medical services aren’t down the street. It’s a price you pay when you live away from the population centers.

Back when the big debate over paramedic service was still hot and heavy, there was actually a woman quoted saying that she has serious medial problems and has chosen to live in a rural community, therefore she has a RIGHT to a timely EMS response. I have never understood how somebody could move to a rural community and then expect the save level of emergency service that the people in larger, metropolitan areas receive. I sometimes wonder if these people would think so negatively about the services they currently receive if they suddenly had to live with the services that I now receive.

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