Paramedic Care Principles & Practice Volume 5 Special Considerations / Operations Second Edition Chapter 13 Rural EMS Figure 13-1 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. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-2 A rural paramedic must anticipate radio dead spots and request orders to treat any possible medical conditions that may arise during transport. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-3 Public education is a critical part of fulfilling enrollment shortages in rural areas. As a paramedic, you should involve yourself in the training of techniques used by first responders such as CPR. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-4 As a rural paramedic, your education should never end. You can overcome lack of access to classroom instruction through use of the Internet or computerized programs and simulations. You have a responsibility to provide patients with the same high-level care as your urban counterparts. ( Ken Kerr) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-5a Hay bale stacker. ( Mark Foster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-5b Round hay baler. ( Mark Foster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-5c Tractor with 72-inch planter, typical of large commercial farms. ( Grant Heilman, Grant Heilman Photography, Inc.) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-5d Tractor and hay rake, typical of the old equipment found on many rural farms. ( Mark Foster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-6 Greenhouses hold many hidden dangers such as pesticides, insecticides, and fertilizers. Remember that fertilizers contain nitrites. When mixed with diesel fuel, as in the Oklahoma federal building bombing, they can form powerful explosives. ( Mark Foster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-7 This old silo looks harmless, but it possesses the potential for entombment in a confined space and exposure to toxic silo gas. ( Mark Foster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-8 A tractors PTO is a prime example of a possible mechanism for a wrap point injury. ( Mark Foster) Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 13-9 In rural settings, any serious bleeding injury can result in shock if distance delays treatment or transport. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Procedure 13-1 Removal of Pinch-Point Injury Patient: (a) Log splittera 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. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Procedure 13-1 (continued) Removal of Pinch-Point Injury Patient: (b) Hand caught in pinch-point mechanism for injury, with the possibility of compartment syndrome. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Procedure 13-1 (continued) Removal of Pinch-Point Injury Patient: (c) 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. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Procedure 13-1 (continued) Removal of Pinch-Point Injury Patient: (d) Stabilize both fractures and circulatory injuries during extrication. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Procedure 13-1 (continued) Removal of Pinch-Point Injury Patient: (e) Provide rapid treatment for shock, especially if the call for help was delayed for a lengthy period. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Procedure 13-1 (continued) Removal of Pinch-Point Injury Patient: (f) Package and transport to the nearest appropriate medical facility, using the most effective means of transport. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved. Figure 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. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright 2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey All rights reserved.