Have you ever worked for a remote or rural department or company and have also worked for a busy city department? Do you feel like you gained different skills because of the amount of time you were with your patients, whether it’s a lot of time or a little?
Working for a remote or rural company means that you might be with your patient for 15, 30, or even 60 or more minutes before you reach a hospital. If that patient is sick or injured, you might have to do a lot of interventions that you wouldn’t have the opportunity to do if a hospital was close by. RSI and using a ventilator, setting up drips and using an IV pump, post-cardiac arrest management, lab draws, and many other things. Being remote, also means that you might be on your own to treat the patient or patients because there might not be any ambulances or fire departments close by to help you. If you’ve ever single-handedly done CPR on a patient for a long period while driving to the hospital, you know how alone you are sometimes. Sometimes you have so much time with your patients, that you have a chance to really talk to them, assess them in depth, and get to know them. You have time to see if your interventions, or lack thereof, are having any impact on the patient. Also being remote, sometimes that means you’re going to do a lot of inter-facility transfers. Doing those allows you the chance to continue medications or interventions that the hospital initiated, like blood transfusions, balloon pumps or Impella devices, vasoactive and anti-hypertensive drips, invasive hemodynamics, ICP or intra-abdominal pressure monitoring and so much more. Some of these devices, medications, and interventions you might never see if you didn’t do these transfers.
Working in a city, with multiple hospital options nearby gives you need a different set of skills. Sometimes you’re only transporting the patient for a couple minutes, so you have to quickly gather all of the demographic information you need for your report, assess your patient, start your IV or give medications, manage the airway, and call in a report. Sometimes you don’t have enough time to do it all, so you have to prioritize what you have to get done now, and what things can wait until the patient gets to the hospital. With such short transport times, you frequently don’t see any positive or negative changes in your patient status. Within city limits, you sometimes have additional resources, if you need help: fire departments are close by, they can help with airway or CPR, other ambulances, or your stations are close by if you need to restock supplies or need another ALS provider to help you.
Whether you’re working in a busy city or remote area we still have a basic set of ALS skills we need to know, but being able to utilize those skills will vary from job to job, place to place. It can help you to grow your paramedic knowledge and skills to work in a different environment, because of the time differences you will have with your patients.
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