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Last night I was on my way home on a relatively remote stretch in eastern Idaho that's 30 minutes from the nearest EMS and came upon a head on collision that ju

Last night I was on my way home on a relatively remote stretch in eastern Idaho that's 30 minutes from the nearest EMS and came upon a head on collision that just happened. Several others not involved surrounded the scene pretty quickly and started assessing the injured. I literally finished my Wilderness First Aid certification Saturday afternoon.

sandworm101 6y ago
>> 30 minutes from the nearest EMS In even the most developed inner cities of the US, a 30-minute response time is not unusual. A car crash with injuries, blood on the street, would certainly be top of the 911 priority list other factors like traffic often mean delays. "In July 2019, it took the NYPD more than 20 minutes on average to respond to all of its 911 calls. This July, it was about 18 minutes." https://www.ny1.com/nyc/all-boroughs/news/2020/08/25/nypd-response-times-climb-this-summer https://www.ny1.com/nyc/all-boroughs/news/2020/08/25/nypd-re...
- mbostleman 6y ago
  Yes for sure. Not that it makes a difference, but this is due to 30 minutes of travel at 60ish mph. No traffic delays.
- mbostleman 6y ago
  Also, for what it's worth, we have really good helicopter support in this region too. Both medical transport as well as short haul / wilderness extraction. So response can be a lot faster if necessary.
  - sandworm101 6y ago
    Helicopters are tricky things. They move very quickly but from call to helicopter taking off can often be a long time. Even in the military/coast guard context, the process of authorizing a flight, turning a helicopter on, and actually getting the thing in the air can easily take 30+ minutes.
    - jschwartzi 6y ago
      I was told once when doing a WFA practicum that if search and rescue were called it would take several hours before I could expect to see a helicopter or have a team at the trailhead. This is mostly because it's a volunteer organization and whoever is at the phone doing dispatch has to call people and get them to go from where they're at to the headquarters to get gear, and then from there to wherever they're needed. Because of typical weather conditions in Washington it's also not unusual for the helicopter to not be able to take off or search. So a medical emergency on a day hike or climb could easily turn into a frantic overnight in the backcountry. So you have to be able to control arterial bleeds and take care of lots of stuff that in the city you may not need to worry about because an ambulance will be there in 30 minutes.
      - mbostleman 6y ago
        That probably depends on the team and the level of resources. I'm on my local SAR team and we can generally have the first hasty team at the trailhead in less than an hour assuming good coordinates and details on the situation. But I think wilderness SAR in general is assumed to be a long process of getting to the ambulance at the trailhead.
      - sandworm101 6y ago
        In the pacific northwest, helicopters are almost never used for searching. The are just too expensive/dangerous and often useless as they cannot see through fog/cloud/trees etc. Everyone heading into that backcountry should be prepared to spend a night or two in the woods. That doesn't mean hauling a tent but it does mean hauling some warm rain gear, a proper flashlight (not a cellphone) boots and some basic first aid training.
        jschwartzi 6y ago
        Yeah this was my point.They do have a helicopter at the Snohomish County SAR but they advised us that we shouldn't count on it and that we especially shouldn't count on it being sortied very quickly relative to a suburban ambulance service. I think that's one of the reasons cited for Emergency Shelter being part of the 10 Essentials. If you have to do extensive first aid or one of your party is incapacitated you will probably be overnighting in the backcountry here even if you're on a day hike or climb.
- phobosanomaly 6y ago
  So, part of that is that even when an ambulance gets there, what happens next? The nearest hospital in rural areas is guaranteed to not be even a level II trauma center. So it takes 30 minutes for an ambulance to get on-scene, then maybe it's an hour drive to a trauma center (optimistic), or they're going to need to get a helicopter, which can easily be another 40 minutes of waiting. That urban EMS crew might be shooting to load-and-go with the patient inside of ten minutes. That means even with 20-min response time they can deliver the patient to a trauma center within an hour. Out in the boondocks, the golden hour is laughable. https://en.wikipedia.org/wiki/Golden_hour_(medicine) https://en.wikipedia.org/wiki/Golden_hour_(medicine)
  - throw0101a 6y ago
    > So, part of that is that even when an ambulance gets there, what happens next? […] Out in the boondocks, the golden hour is laughable. In the province in Ontario, where we have a few density populated communities often surrounded by large stretches of wilderness, folks are transported by helicopter in emergencies: * https://en.wikipedia.org/wiki/Air_ambulance https://en.wikipedia.org/wiki/Air_ambulance * https://en.wikipedia.org/wiki/Air_medical_services https://en.wikipedia.org/wiki/Air_medical_services * https://sunnybrook.ca/content/?page=rooftop-helipad https://sunnybrook.ca/content/?page=rooftop-helipad If you look at the list of heliports in the province, you'll see quite a number of them are at hospitals: * https://en.wikipedia.org/wiki/Category:Heliports_in_Ontario https://en.wikipedia.org/wiki/Category:Heliports_in_Ontario Including ones, like St. Mike's and Sick Kids, in high density areas where they're often at the top of high-rise towers: * https://www.youtube.com/watch?v=-OtDwkg-jGI https://www.youtube.com/watch?v=-OtDwkg-jGI There are also non-emergency patient transportation services: * https://en.wikipedia.org/wiki/Ornge https://en.wikipedia.org/wiki/Ornge
    - x86_64Ubuntu 6y ago
      We have air ambulances in the US. With it being the US and the community being largely rural and poor, it's more economic to die than be flown to help. Most families can't swing a $40,000 cost for a life flight, and insurance in some cases won't cover it. https://www.washingtonpost.com/business/economy/why-the-flight-to-the-hospital-is-more-costly-than-ever/2019/07/01/9dd66736-99dc-11e9-916d-9c61607d8190_story.html https://www.washingtonpost.com/business/economy/why-the-flig...
- NovemberWhiskey 6y ago
  That's a bit misleading: FDNY's average end-to-end response time for something like a vehicle accident is just about nine minutes based on recent data. That's from the moment you finish dialing 911 until the point where the fire truck/ambulance arrives, and includes the time that you spend talking to the 911 operator etc.
  - bluGill 6y ago
    problem is after some accidents seconds are counting. In some cases they have less than a minute from the time of the accident (not finish dialing 911) to get a transfusion started. Such cases currently all die, but the medical knowledge of how to save them exists just not a means to apply it in time.
  - dkn775 6y ago
    There are several “times” in a 911 call FYI, it’s not always clear what ones are being used for response time, which is better reported as a median as well. 1. Call time - at 9am Joe calls 911 and reports their cat has fell out of a tree. 2. Dispatch Queue Time - ideally, at 905am or quickly after the call to 911 time, Dispatcher puts this call into the stack for the police officer that works on Joes beat (let’s say normally that is Officer111). This is accompanied by a call out over the radio to Officer111 to see what he’s doing. 3. Officer acknowledge time - usually along with the radio call-out from dispatch, 905am, the event record for Joe and his cat appear on the screen for all the officers in the district. Let’s say Officer111 is at a car crash, and cannot respond. The event record is still on all Officer screens, and Dispatch asks one of the district officers to go help Joe and his fallen cat. Nearby Officer112 “accepts” the call (via radio and on their laptop). It is 906am when Officer112 accepts the task. He is are now enroute (at 906am) 4. Arrival time - it takes Officer112 14 minutes to get to the scene because it is not his beat and he was in traffic. He pulls up at 920am. 5. Clear time - at 930am, the cat is taken off in an ambulance, and Officer112 tells dispatch over the radio to clear him off the fallen cat call. Dispatch delay - diff between call recieved and being put into the queue Response time - time from Officer acknowledgement in the queue to arrival time. In some cases it will be recorded with a timestamp when Officer says enroute. Cleared time - arrival to clear. My point is the response time is often tricker than it seems. May be straightforward in this case, but mainly wanted to point it out for other readers.
- leetcrew 6y ago
  I'd guess this is a case where the average (especially arithmetic mean) is misleading. suppose a hypothetical fire department gets four 911 calls in a day. three are for life threatening traffic accidents, and they get a vehicle on-scene in six minutes. the last call was for a cat stuck in a tree. the cat isn't going anywhere, so they take an hour to get there. they responded pretty quickly to the most serious calls, but their average response time for the day was about 20 minutes. a single outlier for a low priority situation can severely skew the arithmetic mean.
  - phobosanomaly 6y ago
    I can't find a specific breakdown of time differentials between the two groups of calls, but dispatch times should be separated between 'Code 3' dispatch, which is lights and sirens for an immediate threat to life and limb, and 'Code 2' dispatch, which is no lights and sirens.
phobosanomaly 6y ago
Those wilderness medicine classes are awesome. Highly recommend keeping going for Wilderness First Responder. It's really, really fun.
- mbostleman 6y ago
  For sure. I'm looking in to a WFR that can be done on nights and weekends instead of 2 weeks off work.
  - hindsightbias 6y ago
    In Bay Area: https://readysf.com/course/wilderness-first-responder/ https://readysf.com/course/wilderness-first-responder/ My memory is that there are classes with two all-day weekends and evenings during week. But I can't find the detailed schedule. So ~10 days.
    - mbostleman 6y ago
      Nice. Yes, it's 80 hours.
zatel 6y ago
Highly recommend you keep going with it when time allows. I got my wEMT license a few years back and although it's lapsed now it was a really fun and educating experience. For those who don't have one near them I recommend SOLO school in new england -> https://soloschools.com/ https://soloschools.com/
TimesOldRoman 6y ago
My family in Southern Idaho are a good 30 min from the nearest EMS, and probably 45-60 from a major hospital. Pretty normal stuff out in the sticks.

sandworm101 6y ago

>> 30 minutes from the nearest EMS In even the most developed inner cities of the US, a 30-minute response time is not unusual. A car crash with injuries, blood on the street, would certainly be top of the 911 priority list other factors like traffic often mean delays. "In July 2019, it took the NYPD more than 20 minutes on average to respond to all of its 911 calls. This July, it was about 18 minutes." https://www.ny1.com/nyc/all-boroughs/news/2020/08/25/nypd-response-times-climb-this-summer https://www.ny1.com/nyc/all-boroughs/news/2020/08/25/nypd-re...

mbostleman 6y ago
Yes for sure. Not that it makes a difference, but this is due to 30 minutes of travel at 60ish mph. No traffic delays.
mbostleman 6y ago
Also, for what it's worth, we have really good helicopter support in this region too. Both medical transport as well as short haul / wilderness extraction. So response can be a lot faster if necessary.
- sandworm101 6y ago
  Helicopters are tricky things. They move very quickly but from call to helicopter taking off can often be a long time. Even in the military/coast guard context, the process of authorizing a flight, turning a helicopter on, and actually getting the thing in the air can easily take 30+ minutes.
  - jschwartzi 6y ago
    I was told once when doing a WFA practicum that if search and rescue were called it would take several hours before I could expect to see a helicopter or have a team at the trailhead. This is mostly because it's a volunteer organization and whoever is at the phone doing dispatch has to call people and get them to go from where they're at to the headquarters to get gear, and then from there to wherever they're needed. Because of typical weather conditions in Washington it's also not unusual for the helicopter to not be able to take off or search. So a medical emergency on a day hike or climb could easily turn into a frantic overnight in the backcountry. So you have to be able to control arterial bleeds and take care of lots of stuff that in the city you may not need to worry about because an ambulance will be there in 30 minutes.
    - mbostleman 6y ago
      That probably depends on the team and the level of resources. I'm on my local SAR team and we can generally have the first hasty team at the trailhead in less than an hour assuming good coordinates and details on the situation. But I think wilderness SAR in general is assumed to be a long process of getting to the ambulance at the trailhead.
    - sandworm101 6y ago
      In the pacific northwest, helicopters are almost never used for searching. The are just too expensive/dangerous and often useless as they cannot see through fog/cloud/trees etc. Everyone heading into that backcountry should be prepared to spend a night or two in the woods. That doesn't mean hauling a tent but it does mean hauling some warm rain gear, a proper flashlight (not a cellphone) boots and some basic first aid training.
      - jschwartzi 6y ago
        Yeah this was my point.They do have a helicopter at the Snohomish County SAR but they advised us that we shouldn't count on it and that we especially shouldn't count on it being sortied very quickly relative to a suburban ambulance service. I think that's one of the reasons cited for Emergency Shelter being part of the 10 Essentials. If you have to do extensive first aid or one of your party is incapacitated you will probably be overnighting in the backcountry here even if you're on a day hike or climb.
phobosanomaly 6y ago
So, part of that is that even when an ambulance gets there, what happens next? The nearest hospital in rural areas is guaranteed to not be even a level II trauma center. So it takes 30 minutes for an ambulance to get on-scene, then maybe it's an hour drive to a trauma center (optimistic), or they're going to need to get a helicopter, which can easily be another 40 minutes of waiting. That urban EMS crew might be shooting to load-and-go with the patient inside of ten minutes. That means even with 20-min response time they can deliver the patient to a trauma center within an hour. Out in the boondocks, the golden hour is laughable. https://en.wikipedia.org/wiki/Golden_hour_(medicine) https://en.wikipedia.org/wiki/Golden_hour_(medicine)
- throw0101a 6y ago
  > So, part of that is that even when an ambulance gets there, what happens next? […] Out in the boondocks, the golden hour is laughable. In the province in Ontario, where we have a few density populated communities often surrounded by large stretches of wilderness, folks are transported by helicopter in emergencies: * https://en.wikipedia.org/wiki/Air_ambulance https://en.wikipedia.org/wiki/Air_ambulance * https://en.wikipedia.org/wiki/Air_medical_services https://en.wikipedia.org/wiki/Air_medical_services * https://sunnybrook.ca/content/?page=rooftop-helipad https://sunnybrook.ca/content/?page=rooftop-helipad If you look at the list of heliports in the province, you'll see quite a number of them are at hospitals: * https://en.wikipedia.org/wiki/Category:Heliports_in_Ontario https://en.wikipedia.org/wiki/Category:Heliports_in_Ontario Including ones, like St. Mike's and Sick Kids, in high density areas where they're often at the top of high-rise towers: * https://www.youtube.com/watch?v=-OtDwkg-jGI https://www.youtube.com/watch?v=-OtDwkg-jGI There are also non-emergency patient transportation services: * https://en.wikipedia.org/wiki/Ornge https://en.wikipedia.org/wiki/Ornge
  - x86_64Ubuntu 6y ago
    We have air ambulances in the US. With it being the US and the community being largely rural and poor, it's more economic to die than be flown to help. Most families can't swing a $40,000 cost for a life flight, and insurance in some cases won't cover it. https://www.washingtonpost.com/business/economy/why-the-flight-to-the-hospital-is-more-costly-than-ever/2019/07/01/9dd66736-99dc-11e9-916d-9c61607d8190_story.html https://www.washingtonpost.com/business/economy/why-the-flig...
NovemberWhiskey 6y ago
That's a bit misleading: FDNY's average end-to-end response time for something like a vehicle accident is just about nine minutes based on recent data. That's from the moment you finish dialing 911 until the point where the fire truck/ambulance arrives, and includes the time that you spend talking to the 911 operator etc.
- bluGill 6y ago
  problem is after some accidents seconds are counting. In some cases they have less than a minute from the time of the accident (not finish dialing 911) to get a transfusion started. Such cases currently all die, but the medical knowledge of how to save them exists just not a means to apply it in time.
- dkn775 6y ago
  There are several “times” in a 911 call FYI, it’s not always clear what ones are being used for response time, which is better reported as a median as well. 1. Call time - at 9am Joe calls 911 and reports their cat has fell out of a tree. 2. Dispatch Queue Time - ideally, at 905am or quickly after the call to 911 time, Dispatcher puts this call into the stack for the police officer that works on Joes beat (let’s say normally that is Officer111). This is accompanied by a call out over the radio to Officer111 to see what he’s doing. 3. Officer acknowledge time - usually along with the radio call-out from dispatch, 905am, the event record for Joe and his cat appear on the screen for all the officers in the district. Let’s say Officer111 is at a car crash, and cannot respond. The event record is still on all Officer screens, and Dispatch asks one of the district officers to go help Joe and his fallen cat. Nearby Officer112 “accepts” the call (via radio and on their laptop). It is 906am when Officer112 accepts the task. He is are now enroute (at 906am) 4. Arrival time - it takes Officer112 14 minutes to get to the scene because it is not his beat and he was in traffic. He pulls up at 920am. 5. Clear time - at 930am, the cat is taken off in an ambulance, and Officer112 tells dispatch over the radio to clear him off the fallen cat call. Dispatch delay - diff between call recieved and being put into the queue Response time - time from Officer acknowledgement in the queue to arrival time. In some cases it will be recorded with a timestamp when Officer says enroute. Cleared time - arrival to clear. My point is the response time is often tricker than it seems. May be straightforward in this case, but mainly wanted to point it out for other readers.
leetcrew 6y ago
I'd guess this is a case where the average (especially arithmetic mean) is misleading. suppose a hypothetical fire department gets four 911 calls in a day. three are for life threatening traffic accidents, and they get a vehicle on-scene in six minutes. the last call was for a cat stuck in a tree. the cat isn't going anywhere, so they take an hour to get there. they responded pretty quickly to the most serious calls, but their average response time for the day was about 20 minutes. a single outlier for a low priority situation can severely skew the arithmetic mean.
- phobosanomaly 6y ago
  I can't find a specific breakdown of time differentials between the two groups of calls, but dispatch times should be separated between 'Code 3' dispatch, which is lights and sirens for an immediate threat to life and limb, and 'Code 2' dispatch, which is no lights and sirens.

phobosanomaly 6y ago

Those wilderness medicine classes are awesome. Highly recommend keeping going for Wilderness First Responder. It's really, really fun.

mbostleman 6y ago
For sure. I'm looking in to a WFR that can be done on nights and weekends instead of 2 weeks off work.
- hindsightbias 6y ago
  In Bay Area: https://readysf.com/course/wilderness-first-responder/ https://readysf.com/course/wilderness-first-responder/ My memory is that there are classes with two all-day weekends and evenings during week. But I can't find the detailed schedule. So ~10 days.
  - mbostleman 6y ago
    Nice. Yes, it's 80 hours.

zatel 6y ago

Highly recommend you keep going with it when time allows. I got my wEMT license a few years back and although it's lapsed now it was a really fun and educating experience. For those who don't have one near them I recommend SOLO school in new england -> https://soloschools.com/ https://soloschools.com/

TimesOldRoman 6y ago

My family in Southern Idaho are a good 30 min from the nearest EMS, and probably 45-60 from a major hospital. Pretty normal stuff out in the sticks.