RURAL EMERGENCY MEDICINE

BYDARRYL W. JACKSON D.O.

Opportunities

• Many opportunities for rural medicine • Very few specialists (volume = specialist)• ER Physicians recruited to bigger towns• Many rural towns have major shortages• Rural America is hungry for physicians

Compensation

• Lower hourly rates for rural ER• Ability to work more hours• Hours are available because of shortages• More hours can be worked because of low

volumes• Sleep while you get paid• End result is very little difference in annual

salaries

Family Physicians

• Needed in rural areas because shortage of ER trained residents

• Well equipped to handle rural ER because of wide knowledge base

• Will your residency train you well enough to handle an ER?

• Use your electives wisely• Moonlighting is great training

Training

• Electives as a student and resident• Basics: BLS, ACLS, NRP• Be prepared: ALSO, ATLS• Attend workshops and seminars, Journals• Shadow, Volunteer, Moonlight with other

Physicians available to back you up• Stay up to date: READ, READ, READ, READ!......

Improvise

• Rural hospitals are generally poor• Infant intubated with straight-cath• Removed aluminum bottle with a ringcutter• Plastic splint for an ear with plastic cup• Using hair to repair lacs on a childs head• Use what you have don’t wish you had

something else

Decision Making

• Use common sense• Fewer protocols set up in Rural ER• Your job most often in a true emergency is to

“STABILIZE THE PATIENT”.• If you are not capable or qualified ship them

out• Stabilize and transfer, Stabilize and transfer….

Disadvantages

• No specialists available at your side• Equipment and Pharmaceuticals very limited• Isolated some distance from larger hospitals

and Trauma Centers.• Consulting resources limited so BYOB (bring

your own books)• YOU THE MAN!

Advantages

• People are far more appreciative of the help they do receive.

• Fewer non-emergent cases• People respect your time• Co-workers don’t have “That’s not my job”

attitude. • Get paid to sleep• YOU THE MAN!

Barriers

• EMS often not available• Very expensive and small towns can not afford• Very little help from the Government for EMS• Low volume = low dollars for rural hospitals• Isolation: must rely on transfers, Mediflight,

EMS• Held to the same standard with substandard

situations

Summary

• Great opportunities in rural ER• Advantages far outweigh disadvantages• Exciting and rewarding • We need help to get past the barriers in Rural

Emergency Medicine• Common sense: knowledge not protocols• Improvise

Question and Answer session

• Thank You!!!!• Ask any question you would like it does not

have to be about this lecture.