Rural EMS – A Fictional Letter to the Small Town Community
June 10, 2010 | Ambulance, crisis, Emergency Medical Services, EMS, EMS ethics, EMS Topics, Funding & Staffing, inside the mind of a paramedic, Paramedic, paramedic salary, politics, rural ems, Uncategorized | Ckemtp | 15 Comments

gravel road

Rural EMS has it’s challenges, not the least of which are the low pay and long hours. I believe that the lives of those in the sticks are just as important as the lives of those in the city and that rural folk need paramedics too. This is a fictional letter with a very real message. It could be written by a lot of paramedics and EMTs to a lot of people who live out in the sticks and I could have written this letter once when I left my small town EMS service to seek my EMS fame and fortune out there in the Big City. Now that I’ve come full circle and I’m once again working rural EMS I’m starting to wonder when I might have to write this letter again.

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Mr. and Mrs. Penry

1212 Gravel Road

SmallTown, USA.

Dear Mr. and Mrs. Penry,

My name is Chris and I am a paramedic working for your local EMS service. I live here on Mulberry St. in SmallTown and my parents and grandparents live out here as well. I’ve seen you on the street, at the local cafe, and pretty much anywhere in town for most of my life. I went to high school with your son, Johnny and thought about dating your daughter once but could never work up the courage to ask her out. I wanted to take her to the prom but I ended up taking Mary Buckrop instead. We sure got us in some trouble with the Sheriff when he caught us out by the lake, but he ended up letting us go. Thank goodness that he turned out to be so nice. He was one of the people that helped me through Paramedic school. He kept telling me that we needed good people for the ambulance out here in SmallTown and I’ve found out that he was right. We do.

That’s why I’m having trouble writing this letter to you, Mr. and Mrs. Penry. I’ve taken it upon myself to write a personalized letter to everyone in the SmallTown EMS district because I’m facing a hard decision that I’d like you all to know about. I’ve been a paramedic now for the last ten years. I became an EMT and started volunteering with the SmallTown EMS District right out of high school and did that while I worked down at the Grain Elevator and put myself through college over in MidSizeTown. It was there that I decided that I wanted to be a paramedic and I completed my paramedic training at St. MidSize Hospital. I immediately fell in love with the work and I knew that it was something that I always wanted to be a part of. I continued volunteering with SmallTown EMS while I worked a full-time job for MidSizeTown Ambulance Service. I worked there for seven years and got a good bit of experience. I also worked part-time at St. MidSize’s Emergency Room. I still do.

Three years ago when the voters approved SmallTown EMS District’s referendum to hire full-time paramedics, I jumped at the chance to come on board. This is my home. As cheesy as it may sound, I feel a connection with the people here in SmallTown and I feel that it’s my duty and my calling to protect them with my Paramedic skills. I’ve always studied and trained hard throughout my career to be the best paramedic I could be because I’ve felt it was my duty to be my best. I felt very good about coming on board with SmallTown EMS to protect my Neighbors, family, and Friends here in my hometown.

Rural EMS is different than is EMS in the city. Sure, we may not be as busy out here in SmallTown as we could be if we were a bigger city, but that doesn’t make it easier on us. People out here don’t have access to primary care since Doc. Walters closed up his shop. While they can drive out to see the clinic in MidSizeTown, that’s thirty miles away. Most people don’t make the drive as often as they should and since people aren’t getting regular checkups and primary medical care they tend to let their minor and chronic conditions get so bad that when they finally call us, it’s because they don’t have anything else they can do. A lot of the time, their minor condition has become life threatening because it got out of hand. We can take them to St. MidSize ER, but they don’t have the capability to do things like perform cardiac catheterization surgeries to fix heart attacks, or to take care of trauma patients that need surgery right away, or to handle complicated patients in their inpatient wards. Their ‘ICU’ is staffed by some dedicated people, but it only has two beds. This means that we have to bypass St. MidSize ER for the bigger hospitals in BigTown and that’s an hour away for us running Lights and Sirens. Because we have such long transport times and because our patients tend to be pretty sick when they call for us, we have to provide critical care level interventions. We carry more medications with us than do the big city ambulances and we can do more things than they can. That’s because ambulances in the city don’t have to be with their patients for as long as we do. They have a hospital within ten to fifteen minutes transport time of anywhere they may be. We have one within thirty minutes to an hour away. The fact that we’re so far away from hospital care forces us to be on our game all the time. We also have to be on call a lot to cover the duty ambulance when it’s away transporting a patient to the Big City. A normal call can take two hours. A critical call can take three or four. If we didn’t listen up, the calls that happen while the duty ambulance is away wouldn’t get a paramedic. I try not to let that happen.

Here’s the deal, Mr. and Mrs. Penry, I’m not complaining about my job. I love it. I love the work and I really don’t mind all of the hours that I have to put in. While it’s hard on my family to have me gone so often, they have always understood. My wife Mary supports me in my desire to cover the town we grew up in. She has since Prom night. She’s been great. However, we’ve got our new little boy that just turned three this last month and he doesn’t understand why Daddy has to be gone so often. He also is starting to get very expensive, as kids do, and the meager salary I get working in town isn’t covering all of my bills. I took a pretty hard pay cut to come here. I wanted to and thought that I could keep my part-time job at St. MidSize to make ends meet. Unfortunately, since I’m always on call for SmallTown, I can’t hardly work any hours at St. Midsize. We don’t get paid to be on call, only for when we’re on duty and I’d say no to covering but then someone in town might die because I’m not here to take the second call. I answer the second call all the time, like I did the night of Johnny’s car accident. I’ve heard he’s doing better but I can tell you that he probably wouldn’t be had I not decided to stay home and cover that night. Mary had plans to go to dinner in MidSizeTown but I just wanted to stick around for an hour to make sure the duty truck was back in town. I’m sure glad I did.

I’m going to come right out and say it. There’s a job opening in BigCity EMS that would pay me twenty-thousand dollars a year more than I make here in SmallTown. I’d be able to work one job and wouldn’t have to put in so many hours away from my family. We wouldn’t have to skimp and save to pay the bills nearly as hard as we do now. I’d love to stay here and take care of my home town but the pay is just too low to survive on. A lot of good people have left since we went full time when they realized they couldn’t survive on the pay. I’ve been doing my best to train the kids that they hired to replace them, but they only seem to be coming here to use it as a stepping stone to a better job in the big city. I think that our town deserves better but I can see why the people would leave. I didn’t become a paramedic to get rich but I don’t think that I deserve to live in poverty because I choose to help my home town. People out here need experienced paramedics just as much as the people do in the big city. The lives of the people in the city aren’t any more important than the lives of the people out here. I feel strongly about rural EMS and I feel strongly about my home town I just can’t make it anymore. The bank might come take the house and my family doesn’t deserve to suffer because I choose to help those that can’t pay me back.

So, Mr. and Mrs. Penry, I’m asking you what you think I should do. One day the unthinkable is going to happen to someone and I want to make sure that there are good people to take care of them when it does, but I can’t have my family suffer financially anymore. My kid needs his daddy and my wife needs her husband. The bank needs the mortgage and my student loans need paying off. It’s a tough decision I’m facing and I’m asking the community what they think I should do.

If you need me, just call 911. I’ll come like I always do. If I’m not on the duty truck you can just stop by the house. You know how to get ahold of me. Say Hi to Johnny for me.

Sincerely,

Chris NREMT-P

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  • Yup. There is a brain drain in many professions, from rural to urban. It is really too bad, but unavoidable – for many complex socio- economic reasons. 25-30 years ago we talked about how the best medics were needed in the rural areas, but the rural areas didn't have then. Even your Doc closed up shop. My guess, if your town is like ours, you can't even buy all your groceries in town either. We drive to Midsize weekly, and the Big City Costco monthly.

    Starting Monday, I'll be commuting 3 hrs roundtrip, from Smalltown, through Midsize, and into the Big City.

    Good letter!

  • I know people who work EMS in my home town and this matches their situation to a 'T' Great write

  • Maryltrigg

    My daughter is a paramedic who also had to leave her hometown in order to survive. These people are a large part of the unsung, unappreciated heroes. I have so often heard people denigrating the EMT's and talking about the big bucks they make. I can assure you that so far fromthe truth. People have to face the fact that paramedics are sometimes the only ones standing between them and death. Just watch the news and see who are the first ones there when an emergency arises. They don't ask for much. A decent living wage and some respect. Thank you.The mother of an usung hero.

  • Ambulance Driver

    I'm going to take a very unpopular stance here.

    Most of this country is served by volunteer EMS, and if not, by rural EMS systems who pay far less than their big-city counterparts. And none of that will ever change, because those communities rely on the altruism of the people who seek careers in EMS.

    They don't value what we do, and they won't value what we do, at least not in the form of better wages and equipment, until the reality of not having EMS care smacks them right in the face. It's going to have to effect people personally first. Mr. and Mrs. Penry are going to have to bury Johnny because the ambulance took an hour to arrive, or Mrs. Penry is going to have to wipe Mr. Penry's butt for him for the next twenty years, because they didn't have an ambulance to take him to the big hospital within the thrombolytic treatment window for his stroke.

    We've always heard the saying, “You never appreciate the cops, until you need one.” Same for the fire department. When enough people have waited an eternity after calling 911, there will come a cry for better police response, or fire suppression, or EMS, and they'll cough up their tax dollars to support it.

    But it's not going to happen until they see us as an essential service. They're not going to buy the cow while they can get the milk for free.

    I applaud our volunteer EMS brethren, and I walked for ten years in your shoes in rural EMS, but I firmly believe that virtually any community can afford to support an EMS system. It's just a matter of priorities. Only in America will you find someone with a $5 a day cigarette habit who bitches about a $100 a year tax millage to fund their EMS system.

    Like many country folks, I can't stand those people who move to the country to escape the high taxes and hustle and bustle of the city, and then immediately set to making their new community just like the one they just fled. I don't know of anyone who likes taxes, and I think we already pay far too many of them, but taxes are useful to a society to fund those things that an individual cannot provide for himself – roads, police, potable water, military defense, and so on.

    We have a parish here that funded its entire EMS system by adding a $3 monthly surcharge to everyone's water bill. They still bill Medicare, Medicaid and private insurance, but $36 a year from 100k homes makes a nice subsidy, does it not? Take even a small town of 500 homes. Charge a $100 yearly structure tax, and that's $50k in money for salaries, equipment, or education. It can be done.

    It's not that Mr. and Mrs. Penry can't afford our services. It's that they won't, because they know they can always find someone willing to provide it for free.

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  • Jsleight

    So very true, I work small town Fire/EMS and just strict ambulance, each year we get $16K from the two towns that we cover, which isn't much, but we make due with billing insurance and Medicare/Medicaid. What bugs me the most is when we ask for a little more money because we need to fix the ambulance or we need to replace the pump on our engine and the town votes it down, or when they vote down a 2% pay raise of town public safety employees which would only cost the town $10K a year, but they'll vote “yes” to the $20K survey for the new Wal-Mart. Its gotten so bad in our town that the fire department can no longer enter a structure fire without mutual aid, because the second engine we have failed the state pump test, and the voters turned down our plea for a replacement. The unfortunate reality of our jobs is that people only appreciate us when they need us, and sometimes not even then. They don't realize how much we sacrifice to do this job, and the toll it takes on us. But we will soldier on, because thats what we do, its who we are, and nothing will ever change that.

  • Jsleight

    So very true, I work small town Fire/EMS and just strict ambulance, each year we get $16K from the two towns that we cover, which isn't much, but we make due with billing insurance and Medicare/Medicaid. What bugs me the most is when we ask for a little more money because we need to fix the ambulance or we need to replace the pump on our engine and the town votes it down, or when they vote down a 2% pay raise of town public safety employees which would only cost the town $10K a year, but they'll vote “yes” to the $20K survey for the new Wal-Mart. Its gotten so bad in our town that the fire department can no longer enter a structure fire without mutual aid, because the second engine we have failed the state pump test, and the voters turned down our plea for a replacement. The unfortunate reality of our jobs is that people only appreciate us when they need us, and sometimes not even then. They don't realize how much we sacrifice to do this job, and the toll it takes on us. But we will soldier on, because thats what we do, its who we are, and nothing will ever change that.

  • John

    I read this “letter” after I read the article and comments about the nurses in MINN who went on strike and the two posts could not compliment each other more and support the case for better treatment of EMS professionals. I have to agree with AD in many respects. As long as so many of us are willing to protect our towns and villages for free or almost free, nothing will change. The sheriff no longer rounds up a possee in order to chase down the bad guys, our all volunteer military personnel get very well compensated and, I would love a job that paid $50,000 a year (and up) with 2 months off in the summer and long vactions in the winter and spring. What we in EMS still have not learned is that until we put aside petty bickering and stand together the only thing that will advance is our technology – for those who can afford it. We, as individuals must stand together and demand a living wage with appropriate benefits. Sadly, as AD states, some people may have to suffer because we will no longer be treated as second class citizens, but don't we and our families deserve the respect that the other professionals we work shoulder to shoulder with receive?

  • John

    I read this “letter” after I read the article and comments about the nurses in MINN who went on strike and the two posts could not compliment each other more and support the case for better treatment of EMS professionals. I have to agree with AD in many respects. As long as so many of us are willing to protect our towns and villages for free or almost free, nothing will change. The sheriff no longer rounds up a possee in order to chase down the bad guys, our all volunteer military personnel get very well compensated and, I would love a job that paid $50,000 a year (and up) with 2 months off in the summer and long vactions in the winter and spring. What we in EMS still have not learned is that until we put aside petty bickering and stand together the only thing that will advance is our technology – for those who can afford it. We, as individuals must stand together and demand a living wage with appropriate benefits. Sadly, as AD states, some people may have to suffer because we will no longer be treated as second class citizens, but don't we and our families deserve the respect that the other professionals we work shoulder to shoulder with receive?

  • Carl

    Brother you have said it! There is always the 'we want but we don't want to pay' and it is getting EVER so much worse. People feel that they are 'entitled' and don't have to support their community. What ever happened to the teaching of 'civics', you know, the you are a citizen of the county, state, county, town/city and these are YOUR responsibiities to make it work? Selfishness apppears to be a genetic add -on to todays populace. Again, better, clearer words have not been spoken here lately. Like the saying goes – IF YOU WANT TO PLAY YOU GOT TO PAY!

  • Carl

    Brother you have said it! There is always the 'we want but we don't want to pay' and it is getting EVER so much worse. People feel that they are 'entitled' and don't have to support their community. What ever happened to the teaching of 'civics', you know, the you are a citizen of the county, state, county, town/city and these are YOUR responsibiities to make it work? Selfishness apppears to be a genetic add -on to todays populace. Again, better, clearer words have not been spoken here lately. Like the saying goes – IF YOU WANT TO PLAY YOU GOT TO PAY!

  • Rural EMT

    You hit the nail on the head! I could've written that letter. The distances all apply too. It's 35 miles to the closest ER and we cover 400 sq miles with two units. Every time the pager goes off for our volunteer service, it's a minimum 3-hr slice out of your day. No one is paid.

    Our service doesn't bill at all, so it's still 100% free. We operate primarily on donations and receive enough money from the county to pay for fuel, usually.

    In recent months, there have been 3 of us who have responded to most of the calls. It's getting harder to find volunteers. It's a shame that some residents in our area work in MidSize or BigCity EMS systems but can't spare a little time to help locally. It would help take the burden off of the three of us who never miss a call.

  • Rural EMT

    You hit the nail on the head! I could've written that letter. The distances all apply too. It's 35 miles to the closest ER and we cover 400 sq miles with two units. Every time the pager goes off for our volunteer service, it's a minimum 3-hr slice out of your day. No one is paid.

    Our service doesn't bill at all, so it's still 100% free. We operate primarily on donations and receive enough money from the county to pay for fuel, usually.

    In recent months, there have been 3 of us who have responded to most of the calls. It's getting harder to find volunteers. It's a shame that some residents in our area work in MidSize or BigCity EMS systems but can't spare a little time to help locally. It would help take the burden off of the three of us who never miss a call.

  • JT

    If you don't like the pay that's offered, then go find a different job. Have fun in the big city, you will be replaced. Especially in this economy.

  • JT

    If you don't like the pay that's offered, then go find a different job. Have fun in the big city, you will be replaced. Especially in this economy.

  • This letter hits close to home. While I wasn't in a rural setting, I was in an economically depressed area. We were a combination volunteer and paid service. Half the time because of how poor our income was, most of the medics and EMTs pulled some extra shifts helping to staff the calls on our free time and we'd always “forget” to write down we crewed an extra call.

    I had to move from a company I loved. We were a small local service that provided excellent care to those we served, better than the surrounding companies who had to come in to mutual aid. We got no help from the local government because, as we were told, “If it still drives and makes noise, it's a good vehicle.” I got paid in promises sometimes, others I got half in one check and the rest in the other because bills to keep the station with electricity, gas, water, and the truck payments came first.

    AD said it best when he said that nothing would happen until the local communities realize that we're needed. Unfortunately, we're the scape goats for everything. If a transport for a patient is delayed, it's our fault because we didn't arrive in time and that we should know where we're going. It's not the citys' fault for not putting a new street sign up after someone stole the street sign, and it's certainly not the family's fault for not having a visible address that can be seen even at 2 am.

    Until EMS as a whole puts their collective foot down and stops allowing people to walk all over us, things will never change.

    ~M. Trommashere~