1. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 13 Rural EMS

2. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Special Problems in Rural Areas Rural EMS Situations

3. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Special Problems in Rural EMS Distance and time Communication difficulties Enrollment shortages Training and practice Inadequate medical support

4. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A universal access number, such as 911, is essential for rapid public access to the EMS system. However, many rural areas lack such a number, hampering communications and increasing response times.

5. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A rural paramedic must anticipate radio dead spots and request orders to treat any possible medical situations that may arise during transport.

6. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Creative Problem Solving Radio dead spots Flexible training sessions and education Positive relationships with hospitals Ingenuity and increased responsibilities

7. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ As a rural paramedic, your education should never end. You have a responsibility to provide high-level care.

8. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rural paramedics must be highly skilled and practiced to compensate for extended run times and more complicated logistics found in the rural setting.

9. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The Distance Factor It may be difficult to meet the “golden hour” guideline. You may spend more time with the patient on board the ambulance. The actions of a rural paramedic may have a more definitive outcome.

10. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In local hospitals with a part-time emergency room, it may be necessary to call ahead to have necessary personnel in the building upon your arrival.

11. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

12. Agricultural Emergencies Safety first Consider the dangers of: –Livestock –Chemicals –Fuel tanks –Fumes in storage bins and silos –Heavy or outdated farm equipment

13. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Farm Machinery Familiarize yourself with farm equipment. Stabilize and shut off equipment. Lock-out/tag-out.

14. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hay bale stacker

15. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Round hay baler

16. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Tractor with 72-inch planter, typical of large commercial farms

17. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Tractor and hay rake, typical of the old equipment found on many rural farms

18. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Materials Use SCBA Pesticides, crop spray or dust, manure storage pits Silo gas

19. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Greenhouses hold many hidden dangers such as pesticides, insecticides, and fertilizers. Remember that fertilizers possess nitrites. When mixed with diesel fuel, as in the Oklahoma bombing, they can form powerful explosives.

20. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ This old silo looks calm, but it possesses the potential for entombment in a confined space and exposure to toxic silo gas.

21. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Potential for Trauma Wound contamination Crushing Twisting Tearing Penetrating Combination of the above

22. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Compartment Syndrome Circulation is cut off to a portion of the body. Toxins build up in the blood. When circulation is restored, the patient goes into shock.

23. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Mechanism of Injury (Agricultural Equipment) Wrap points Pinch points Shear points Crush points

24. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A tractor’s PTO is a prime example of a mechanism possible for a wrap-point injury.

25. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Medical Care In general, provide the same emergency medical care to patients of agricultural emergencies as you would to any other patient with similar injuries.

26. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Removal of a Pinch-Point Injury Patient

27. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Log splitter—a typical mechanism for a pinch- point injury in a rural setting. Note the absence of protective gear on the farmer, except for lightweight work gloves.

28. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hand caught in pinch-point mechanism with the possibility of compartmentalization.

29. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Determine if machinery is operated by other equipment, in this case a tractor. If so, use the machinery to extricate the patient. Then lock- out/ tag-out the appropriate levers or switches.

30. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Stabilize both fractures and circulatory injuries during extrication.

31. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Provide rapid treatment for shock, especially if the call for help was delayed for a lengthy period.

32. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Package and transport to the nearest appropriate medical facility, using the most effective means of transport.

33. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In rural settings, any serious bleeding injury can result in shock if distance delays treatment or transport.

34. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Recreational Emergencies Populations of rural communities can increase with people seeking recreation.

35. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Be familiar with recreational or wilderness areas in your response area.

36. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The recreational activities that draw people to rural settings for vacations, adventure, and sports activities also increase the chances for EMS involvement in environmental emergencies.

37. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Special Problems in Rural Areas Rural EMS Situations