Rural Medics vs City Medics

Around here there a many debates about which is better. We have one particular city department that swears they are way better because they treat way more patients. This is a department that has a hospital without 5 minutes of EVERY part of their venue, and I’m serious when I say that, they are NEVER more than 5 minutes from a hospital. They rarely start IV’s, they are arrogant, they have piss poor attitudes, they won’t give medications. Hell, I witnessed them bring in a full arrest patient, NO monitor, NO IV! How can you be better than someone when you pull shit like that? Not everyone is the same, I have seen a FEW decent people on this department, but that is rare and those people never last more than a few months.

There are a few medics I know that consider themselves “city” medics, however they have a bit more time to get to a hospital. These medics usually have anywhere from 10-30 minutes of transport time, depending on the hospital the patient chooses. These medics have told me before that rural medics are way better than city medics. Why? For many reasons. I’m currently in Critical Care Paramedic class. It’s kicking my ass some, but one student in there is really struggling, he’s a “city” medic. He has more than 10 minutes to get to a hospital. The drugs we are learning in this class…I already know them because I’m one of those rural medics and we have this stuff

Quick lesson here to help you understand better. There are 4 classifications that hospitals can have and you are about to learn about them, they are Level 1, Level 2, Level 3, and Level 4. Let’s start with the lowest level and work our way up.

Level 4 – Do you have an Urgent Care near you? Or a hospital near you that is so small they have 2 ER room beds and can not admit patients for a long stay? Chances are you don’t, not unless you live a good drive from the big city. I have one, at 2 different jobs I work at, they each have one in their area. This is basically like going to visit your doctor. You show up there with anything more than a paper cut and they are calling 911 for your butt! Yes, hospitals call 911 for ambulances, mine do all the time.

Level 3 – This is just a step above the Level 4 class. These hospitals can admit patients, are larger, and have the power to do more, they just do not have the staff. These hospitals usual accept sick patients for long stays but if you broke anything you are going to be sent else where. If you have a heart attack or stroke, they only have the ability to diagnose these problems, if you need it treated then you will be sent else where, either by helicopter or the bandaid box. How many of these do I have in my area? One job has 3 of them, the other has 1.

Level 2 -This level has a significant increase in care over the other two. They can treat just like the highest level, a Level 1, however the staff to treat is not required to be in house. Meaning, they are required to have the capabilities ready within 20 minutes. So, you have a heart attack, go to my local Level 3 center, they diagnose it as a heart attack. The weather, naturally, is shitty so they whirly bird won’t come pick you up, now you get the bandaid box with my partner and I. We can’t bypass the Level 2 center, because they can treat you. On our way we call them, say we have a heart attack and to activate the cath lab, they have 20 minutes to have that staff ready if they want to keep their Level 2 status. Level 2 centers tend to be in the outer layers of the city, also known as the suburbs.

Level 1 – This is the highest classification of hospital. They are usually, though not always, teaching hospitals. They have every capability in the hospital, waiting 24 hours a day. They can treat everything, and treat it well. It so happens that my “area” has some of the top adult and pediatric hospitals in the world.

Now, when I am working and you come in really sick to the hospitals here and have to be transferred out, we have to take you to the city. We call them “city trips” or “city runs”. You know how long it takes me to get from this Level 3 hospital to a Level 1 for you to get the help you need? If the weather is good, 1 hour and 30 minutes! Yes, you read that right. If the weather is good, you’re flying most the time, but not always, each patient is different.

So what do you do during that time? Well you can type all this up like I am, because this patient is sleeping. Some sleep. I had a 4 hour and 45 minutes transport time for special care…yes, I spent almost FIVE hours with this patient and she was amazing! You’ve read that story. We entertain ourselves, bring cards, have movies on our iPads for the kids when we get them. I bring my computer and DVDs sometimes. This weekend alone, in two days, I have traveled over 500 miles in an ambulance! But what else makes us better? Our treatments, we constantly have to watch the patient, change our care, think like a doctor. I can tell you from experience, it is way more challenging to be a rural medic! And way more fun!