The Rural EMT

☆ February 13, 2011

from my collection

I have an x-ray collection.  I love the big sheets of film, the look inside.  I started nabbing them wherever and whenever I could; then people started giving me x-rays as presents.  A new friend, not knowing my penchant for x-rays, recently sent me one in the mail (you know who you are :)   But this is a tangent; this post is not about my x-ray fetish, this post is where I shall answer the questions you left me here, regarding my EMT studies and rural Emergency Medical Services.

What made you want to do this?
Around here, there is no paid fire department nor a paid ambulance service.  That means, if there were no volunteers, one could have a house on fire or terrible car crash or a medical emergency and call 911 and no one would show up.  Can you imagine?  When the ambulance coordinator approached me this past summer and asked if I wanted to be in this class, I couldn’t say no, for several reasons:
~ It’s an amazing opportunity ~ I’ve dated EMTs and firefighters and know how hard it is to get on a crew in the city.
~ It’s a skill set I find incredibly valuable ~ especially because I know I will continue spending my life largely distant from the hubs of civilization – if not here, then in other mountains, deserts, oceans – and I’m pretty sure I won’t be alone.
~ Dare I be perfectly honest?  When I was offered a spot in this class, it was at the height of the stalker stuff.  And I thought, ‘if I know how to fix it, I’ll know better how to break it.’  This is like 2% of my reason behind doing this.  I’m 2% vicious.  Please don’t get fixated on it.
~ Most of all, it’s because I can ~ I know I’m physically and mentally capable of doing this job and, being self-employed, my life is structured in such a way that I have the time and ability to help my community (and travelers passing though) in this way.  How could I not?

Why EMT instead of vet tech, fire fighter, tutor, etc?
Interesting question, and though this was not part of my conscious decision-making process, the answer is: the fire dept is pretty healthy (lots of volunteers), the school system is pretty insular and I made too many waves when I was there for certain members of the administration to welcome me back (I was a substitute teacher for about 18 months before Charlie), and there are a number of vets in the area and most of them host interns from veterinary schools across the country.  On the flip side, there are currently only four EMTs in my town.  Four is not enough, especially when those four might be unable to respond if they are sick or working cows or doing errands out of town or what have you.  That number will more than double when our class finishes.  Everyone in town is thrilled about this.

Will this be a full time gig? Are you on call for certain days out of the month with days off?  How many people report to a call?
No, this is not full time.  It is volunteer.  It is unpaid, and without a set schedule.  There are no on-call days or days off  ~ if you can show up, you show up.  If you can’t, you don’t.  There could be six people who respond to one call, and only one on the next.  If more people are needed, you call in for assistance and sometimes they have to come in from the next town, which can take upwards of half an hour or more.  This, again, is why it’s so important to have a number of certified EMTs in this rural area.

Are there limits to what an EMT is allowed to do?
There are three levels of EMT: Basic, Intermediate, and Paramedic.  I am in Basic training, and there are limits to what I am trained in and allowed to do, such as administering an IV ~ one must have Intermediate status to administer an IV.  Paramedics go even further.

Do you have to have prior medical background? How long is the training? Is there any lab training with the course?
No medical background is required.  EMT Basic training is 160 hours; the hours for Intermediate and Paramedic training jump exponentially.  There’s no cadaver work, if that’s what you’re asking, but there is a ton of hands on training ~ we do everything to ourselves in class.  Getting strapped into the stair chair and rolled down a long flight of cement steps by two of my classmates taught me more about how to do that well on a call than any book could!

Is your county divided into sections, so you are only responsible for covering a portion of it?
Yes.  There are two towns in my county, my little town (population 300) and the neighboring big town (population 5000) where the hospital is.  There is an ambulance service for each town, but they work together as needed.  My classmates are from both parts of the county.

What is the average number of calls for Emergency Services each year?
For my little town, there are about 50 calls per year.  My town covers the mountain highway and area ranches, along with the little town.  About forty of those calls are trauma (car wreck, motorcycle wreck, horse wreck, etc) and ten are medical.  For the big town, there are 500+ calls per year; of those, about 50 are trauma and the bulk are medical.

How close is the nearest hospital?
The hospital is thirty miles away from my town.  But town is just town.  It can be an hour’s drive, or even more, to the hospital from many of the ranches around here and from the highway that crosses the mountain (scene of many crashes).

How will you respond quickly if you live in the middle of nowhere?
That is precisely the point.  Everyone out here lives and works in the middle of nowhere.  It’s a 45-minute to two-hour wait for the life flight helicopter.  The more EMTs that are scattered around the countryside, the greater the chance of someone arriving on scene quickly enough to make a difference.  I’m five minutes away from a number of people.  Another EMT might live or work at the other end of the valley, thirty miles away from me, but they are five minutes away from everyone on that end of the valley.

What is the signaling system?
It’s a pager kind of thing.  Kind of a hybrid between a pager and a radio.

How often do you have to renew your certification?
A certain number of hours of continuing medical education have to be completed every two years (over the course of those two years) in order to remain certified.

Any chance you’ll take this further?  Med school?  Vet school?
I doubt it.  Though perhaps I’ll go further within EMS.

I’m curious about how you are learning CPR – the Red Cross had put out something saying they were recommending people only do chest compressions, not mouth-to-mouth?
We do compressions + ventilations (mouth-to-mouth, though we use a little mask to separate the mouth of the patient from the mouth of the practitioner, along with other techniques such as the bag valve mask and using supplemental oxygen).  We were told that the “compressions only” notice from the Red Cross was in response to the fact that, these days, bystanders are less likely to give any assistance because they are (justifiably) wary of the diseases that can be transmitted via mouth-to-mouth.  So the Red Cross said, Do Compressions Only! because that can buy a tiny bit of time and maybe help someone, rather than doing nothing.  EDIT:  But this may not be the whole story – see the links in the comment section for more info on this!

Do you get any training/preparation for the psychological effects of coming upon accidents/trauma?
Yes ~ that’s actually what our class covered first, before learning anything about helping others.  I have a weird philosophy – well, I don’t know if it’s weird because people don’t generally talk about this stuff.  I’ll try to explain it.  OK, I just tried typing it out and could not do a decent job of it.  I’ll put this on the list of things to try to work out well in writing.  I can say, that as the weeks go by, the class is becoming more like a unit, a team, there’s a closeness growing.  And I think that will be really important and valuable in working through tough calls, both on scene and after the fact.


46 Responses to “The Rural EMT”

  1. Kelley giffen
    February 14th, 2011 @ 11:03 am

    Goddess bless you Shreve!

    My husband has a EMT-B but he’s not working as one, because of his disabled veteran status.

    yes we need EMT’s… any help of any kind is better than none.

  2. Shelley
    February 14th, 2011 @ 11:14 am

    As a former EMT (NY State 1975) I can tell you that you won’t really know how you’ll react to any situation until it’s upon you. I discovered I could handle the trauma calls, but not illness. Also, driving the ambulance opened my eyes to it’s difficulty, especially people’s laconic response. Good luck to you, it’s very rewarding work.

  3. catherine
    February 14th, 2011 @ 11:18 am

    Now that is a broken arm Xray all right !!!!! OUCH ! Ouch
    We have the same deal here with emergencies and we have to register with the helicopter service to be lifted out to the nearest hospital.
    Completely OT, I did not know you were a aficionado.
    Who is your favorite this season? Loved “North Hollywood” and you will understand and appreciate I am sure. So cool.

  4. Amanda
    February 14th, 2011 @ 11:24 am

    Hey, first of all, I adore this website. You’re an amazing photographer and I look forward to new posts from you popping up in my Reader. I just tend to lurk. :-)

    My husband is a paramedic/firefighter, so I’ve heard a lot of discussion about the CPR controversy. Compressions only CPR actually has been proving in multiple studies to save more lives than traditional CPR with mouth-to-mouth. I know it’s very controversial because we’ve been doing the mouth-to-mouth kind for so long, but lots of folks in the medical industry were very disappointed this last year when the American Heart Association didn’t commit fully to compression only CPR. Here’s some interesting reading:

  5. Dawn
    February 14th, 2011 @ 11:32 am

    Because I can… damn that’s AWESOME! My fave.

  6. Chris Ballard
    February 14th, 2011 @ 11:36 am

    Thanks for your caring to do this!

  7. SDC
    February 14th, 2011 @ 11:50 am

    “If I know how to fix it, I’ll know how to break it” “I’m 2% vicious” (heh) I love it! Again, you’re a class act!

  8. Lisa
    February 14th, 2011 @ 12:06 pm

    My EMT class was many many years ago–and my MICT class just a few years after that. There are so many things I learned that I will never forget, and you;’re right, being the “patient” for each other teaches you too.
    Good luck–and the first time you have a call that you know you made a difference will always be special to you!

  9. ~~Silk
    February 14th, 2011 @ 12:18 pm

    My town had a population of a hair over 8,000. Before I volunteered, I had assumed there’d be maybe 3 callouts a week. During training, no one would commit to a number, “Oh, it varies” was as far as they’d go. Then when I started riding the ambulance, I was shocked to find that we got 3 to 5 calls EVERY DAY! Most of ours were elderly patients who suddenly crashed, or overdoses or falls at the college. You’d be surprised how many college kids fall out of bunkbeds.

  10. danielle
    February 14th, 2011 @ 12:48 pm

    Very cool about becoming a rural EMT. Recently my older brother (he’s 30), made a career change and went through EMT training; he’s now in fire school.

    Honorable choices for anyone to make.

    Also, have you ever made a contact print of an X-ray? I did a couple of years ago on a whim, and it turned into, hands down, one of the coolest prints I’ve ever made. It is amazing the level of detail that shows up in the print (like surface of the bone detail).

  11. Peggy
    February 14th, 2011 @ 12:55 pm

    emt’s are ‘giants’ in my eyes. Five years ago this month I frantically requested help for my husband, on our homestead miles from the hospital.
    The ambulance arrived and the staff worked quickly to stabilize then transport to the emergency at the hospital. Some of the young folks remained, one assisted when possible until he was gone. At the memorial service they all came to remember this giant man in our community. Those young folks are ‘giants’ in my eyes.

  12. hello haha narf
    February 14th, 2011 @ 12:56 pm

    i might live in a city, but i am still grateful for all who serve their community. thank you!

  13. Elizabeth
    February 14th, 2011 @ 1:19 pm

    I think it’s so great that you’re doing this! You’ve made me start thinking about doing EMT training…

  14. Chris
    February 14th, 2011 @ 1:56 pm

    Thanks for filling in the details about your new work. It’s difficult for those of us in urban areas to grasp the relative isolation of rural life; writers like you help bridge that gap.

    A friend and I once drove an accident victim to the nearest hospital from my family’s ranch (fortunately only a light injury). Took a good forty minutes; as quickly as the road and my skill allowed.

    Your comments about being part of a team are good ones. It sounds like you have made bonds that will help in many ways when it comes to the real thing.

  15. Joanne
    February 14th, 2011 @ 2:01 pm

    I’m laughing at myself because I misread your tweet. I wondered why you wanted a t-shirt that reads “I’m 2% VISCOUS”.
    Shreve, I have your book “The Daily Coyote” in both hardcover and paperback. I have given away at least 12 copies as gifts. And I just bought the Kindle version, so now I have it with me all of the time!
    YOU ROCK!!!

  16. Steve
    February 14th, 2011 @ 2:33 pm

    For anyone who hasn’t had a refresher in a while, here are a couple of videos showing the newer recommended way to do chest compressions.

    Mayo Clinic doctors show how to do CPR –

    Sarver Heart Center (Arizona) doctors show how to do CPR –

  17. Sarah
    February 14th, 2011 @ 3:30 pm

    yes, i would love to have a 2% viscous shirt.

  18. Beth aka EweMama
    February 14th, 2011 @ 4:04 pm

    Shreve, I’m concurring with others – your decision to become an EMT is awesome and a great service to your area / county. That said, due to my curiosity, do you happen to know who had that broken arm? Is that a simple or a compound fracture? And what caused it; was the victim possibly stepped on or kicked by a cow, bull, steer, or “elf”?

  19. carmen
    February 14th, 2011 @ 4:34 pm

    I find it very awesome that you are doing this.

  20. bekka
    February 14th, 2011 @ 5:01 pm

    i commend you and all you do and the emt thing is amazing. my aunt who lives in wyoming had a emergency years ago, and if it werent for my uncle being on the sheriffs dept. at that time i doubt she would have made it. they lived way out at the base of the mountains, one of his jobs was to check on the people who lived up there, but that also meant there was no one there when they needed help. so i understand when you say that its better if all of you are more spread out. i hope you the best in your life shreve, you are an amasing woman, mike is a lucky man.
    p.s. off topic…the charlie part of my tatto is complete. he took around an hour, i’ll send you a pic when the design is done, since its a whole back piece the background still has alot of time involved to be finished.

  21. LEISEL
    February 14th, 2011 @ 5:07 pm

    Shreve, What you’re doing is incredible, but I am overwhelmed, also, at the time you took to answer all those questions! Thanks, I learned a lot!

  22. Meg A.
    February 14th, 2011 @ 5:10 pm

    Very interesting! Thanks for sharing!

  23. mhaithaca
    February 14th, 2011 @ 5:33 pm

    I love that you say you’re 2% vicious. :-)

    Also, I love that you’re training as an EMT, as well as why you’re training as an EMT. I first took a first aid and CPR course as a freshman in college, continued with advanced first aid, and have done a CPR refresher just about every year since.

    My workplace is a major university in a small city setting surrounded by rural area, so I’ll hardly ever be somewhere without an ambulance and real professionals a few minutes away. However, I’m often in public settings where that few minutes could make the difference between survival or not, so I know there’s value to as many random people as possible knowing what to do even in populated areas. (Just ask the folks in New York City who needed ambulances that couldn’t reach them through snow- and traffic-snarled streets this winter.)

    Do I relish the thought of having to use my training, if I ever need to? No. But I’m still grateful that I could, and more than one of my aging colleagues has said they’re grateful that I could, too.

  24. Marina
    February 14th, 2011 @ 5:37 pm

    Thank-you for caring…

  25. Sherry
    February 14th, 2011 @ 5:38 pm

    Is that your arm? my gosh, what an x-ray. That poor, poor person.

    this was SUCH interesting reading. thank you for typing all this up – it is just SO interesting! I feel like I learn so much from you.

    go 2%!!!!!

  26. S
    February 14th, 2011 @ 10:06 pm

    My dad is a volunteer SAR for several orgs (technical and otherwise) in the southwest Their work is invaluable, and in the few years he’s been involved, I’ve hear many tales of lives saved and lost. I’m quite proud of him. They also have multiple levels of EMT training and cert. Kudos to you for getting involved. It’s so crucial in rural areas.

  27. Danielle
    February 14th, 2011 @ 10:14 pm

    You are such an amazing person, in all that you do. People such as yourself are what make the world a wonderful place. Thank you for being you!

  28. Janet H.
    February 14th, 2011 @ 10:29 pm

    Thank you for taking the time to answer all of these questions. And for taking the time and making the effort to learn to help your neighbors in this way. You’re 2# vicious and 98% awesome!

  29. Janet H.
    February 14th, 2011 @ 10:30 pm

    That should be ‘2%’–no 2 lbs! LOL

  30. jmelinski
    February 14th, 2011 @ 10:46 pm

    Hi Shreve…

    Long time lurker of both Daily Coyote, and Honey Rock Dawn, but first time commenter…

    I just wanted to say that I wish I had known a long time ago about your interest in x-rays! In my previous job as an office manager/vet assistant for a small animal vet, one of my regular duties was to purge our old x-ray files (i.e., animals that we had euthanized, hadn’t seen in an extended period of time, etc, etc..) I would have loved to have sent you some of the more interesting finds that I came across!

    PS, Love your blogs. Thank you so much for sharing so much of your life with those of us lucky to have found your sites :)


  31. regina ellis
    February 14th, 2011 @ 10:47 pm

    Good for you, Shreve. I was a ACLS Paramedic for about 10 years in both urban and rural communities. I was paid in the rural setting and a volunteer in the urban. It was one of the most rewarding things I ever did. I was both a paramedic and a law enforcement officer and finally had to choose. I chose to go with law enforcement and had a wonderful career. I’m retired now and am so glad to see all you young people taking on this giant responsibility and committing to it. Go Shreve!

  32. SuburbanPrairie
    February 15th, 2011 @ 8:36 am

    Hey, how’d you get my x-ray? Well, okay, that’s not my x-ray, ’cause it’s the wrong arm… I had that (almost) exact fracture to my *left* radius & ulna, when I was 10 years old. Now I have a lightning-bolt scar on my arm, that’s a great conversation-starter! :-) Shreve, good for you, helping your community in this way. When my Dad passed away at home two years ago, EMTs were the first responders. They were the most wonderful, compassionate people; and in those first moments of shock and confusion, they calmed and soothed us, and helped us get started on our grieving paths. Heaven bless all you First Responders out there – know that just *being there* in those terribly frightening moments in a person’s life is a HUGE help!

  33. Nathalie
    February 15th, 2011 @ 9:07 am

    I think this is a very noble thing you’re doing. Being so remote out there and the possibility of not having someone to help, it can be the difference between life and death for some. You’re living my dream, girl, keep up the great work. I love the area you live in and can’t imagine actually “being” there.

  34. Marisol
    February 15th, 2011 @ 3:32 pm

    I bet That hurt just a little? Nice Clean break. After 15 years in the public safety field (FF/Paramedic) it never gets old to see REAL trauma. It is a career in which you will become immune to seeing awful (and incredible)Trauma. You will develop a black sense of humor in order to deal with the situations. otherwise, you will bring everything home will you. My department runs approximately 40,000+ calls a year. If we did not dealt with everything we see, we would be some seriously cranky and depressed firefighter/paramedics.

    Good Luck!!! You will be an awesome addition to your towns emergency responders team.

  35. Corrie
    February 15th, 2011 @ 6:07 pm

    That’s funny, Joanne! I “pre-read” vicious as viscous, too. Ha!

    My first flash-thought (you know how kooky those can be) was, “Gee, maybe Shreve learned something really cool about the human body that I never knew!” But then I thought, “No way is the human body only 2% viscous. It’s far ookier than that with all its weird secretions.”

    I think I need to stop thinking. ‘Nuff said! :)

  36. Lindsay
    February 15th, 2011 @ 10:09 pm

    Hah! I love the x-ray photo! When I was 6 I fell and broke my arm almost exactly like that. I didn’t fall hard or far, but it was just the way I landed that it snapped like that. I actually laughed at the time, until I realized what my arm looked like with another “elbow”. I was such a weird kid (probably still am…)

    Thanks for sharing your experiences and thoughts about the EMT training!

  37. Cory
    February 16th, 2011 @ 4:27 am

    That’s great; I come from many generations of firemen and my mother was an EMT. I was in a car wreck once at around age 16. We discovered then I had no talent for serving well in an emergency. All that adrenaline made me into an irritating chatterbox. I did learn when I moved here to Wyoming that I do have emergencies in my blood, though. Every siren and set of lights gets me going. As a journalist I followed them for miles and miles to get my story. That’s as close as I’ll ever get. Thanks for stepping in.

  38. ihermit
    February 17th, 2011 @ 9:18 am

    Way to go Shreve!
    When you live in a rural community, everything helps. In the small town I live in in ME, many stand out. Tim is a plumber by trade, an EMT on the volunteer force, a fire fighter on the volunteer Fireman’s, a building inspector, the animal control officer, and the village constable. His pay for that was $800 a year. He is now fire Chief and Assistant town manager. Yes he is still everywhere
    Tom my former boss ran a building company, is still a volunteer firefighter, an EMT, and now runs Life Flight here in Maine. Oh Yes he is also a musician. If you can find “Different Shoes” it is worth a listen.
    Every one who worked on the building crew was all in the fire department or a EMT, except alas I. I have a EMC but somebody’s has to build houses when the calls go out!

  39. ihermit
    February 17th, 2011 @ 9:34 am

    Oh for those who may not know, back in the day the system was EMT1 , EMT B, and EMT C. I have lived in the same house for off and on since 1979 and the address has changed 5 times….go figure.

  40. Marianne
    February 20th, 2011 @ 12:28 am

    Are the Paramedics and Intermediates volunteer as well? How admirable!

    The “x-ray fetish” is crackin me up… but they are fascinating to look at!

    Two summers ago, I decided on a whim to move the rail road ties that bordered one of my raised garden beds. They were too heavy for me to pick up entirely, but I was able to pick up an end and drag. During the course of this project, I managed to drop one end of a tie onto my big toe. As I was wearing only flip-flops (duh!), my unfortunate digit’s bone splintered into 7 pieces. Later, while in the ER, suffering as much or more from embarrassment than pain, I found some solace in looking at my X-ray. If anything, I was grateful for the distraction,as the X-ray arrived well before the pain meds. I also think that I was able to objectify the injury via the X-ray and stop feeling so sorry for myself. All in all, seeing what a big toe bone shattered into 7 pieces looks like was pretty interesting and if I come across the X-ray, I’ll be sure to make a copy and send it your way.

  41. Rachel
    February 21st, 2011 @ 10:27 am

    I had an MRI of my brain back in 2003 for some headaches I was having and I have about 10 Huge sheets of x-ray/mri prints of my brain. It is the Weirdest thing I have ever seen. Fascinating to look at your own brain, and very surreal. I will keep them forever.

    It’s even cooler too because now they just give out CDs with the MRI information on it for you to give to doctors, no more giant sheets to look at.

  42. Janet M
    February 21st, 2011 @ 11:46 am

    I grew up in a city, and my grandparents lived on a farm. I could not imagine why anyone would not want to live in the city, with all the modern conveniences. Now that I am older (much, much older) I can’t imagine why anyone would want to live in a big city. Medical care is often the only advantage to life in a city. I think that it’s great that you are willing to do EMT training to help out in your community. That is an advantage of living in the country, self-sufficiency.

  43. kit
    February 22nd, 2011 @ 10:32 pm

    I dispatch police, fire, and medical for a small community about the size of your neighboring “town,” in an area where the “second out” ambulance has to come from a neighboring city 30 minutes away. We LOVE our EMTs, not only for what they do for others, but for us as well. (I got to be one of their patients, and they even came to visit me at the hospital.) The ambulance crew is always willing to go, but there are not enough of them. We often have to tap out the fire department EMTs to sit with a patient until an ambulance can get to the scene. Whether you’re from a tiny town in Wyoming or a much bigger city, we all need each other and need to work together. I add my thanks to the others offered to you.

  44. shreve
    February 22nd, 2011 @ 10:42 pm

    Kit ~ I sat in on dispatch – talk about intense! You guys are amazing.

  45. Olli Odom
    February 26th, 2011 @ 10:47 am

    This is so crazy! I work at an animal hospital & recently was given a multitude of dog/cat xrays to cut up & throw away. However, thinking I could create something AMAZING with them, I kept all. But now I don’t know what to do with them haha, any good suggestions? Perhaps you’d even like a few? Let me know :)

  46. Julia
    February 28th, 2011 @ 10:54 am

    FYI the Ontario government has a series of posters out that use xrays of people who have been injured on the job. The headline says “don’t let this be the last picture someone takes of you” and the xray shows the injury in wincing detail.
    I walk by a construction site every day and there is a large poster like that there, tacked onto the fence. I find it very effective and I don’t even work there.

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