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)

> 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_medical_services

* 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

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

There are also non-emergency patient transportation services:

* https://en.wikipedia.org/wiki/Ornge

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-flig...

Weird, the article talks about air ambulances being billed as out of network. I thought that after Obamacare passed insurance companies were required to treat all emergency care as if it were in-network. Does that not apply to transportation? Or are helicopters being used in situations that insurance doesn't think are emergencies?

The point is that nobody knows the answer to this. Good luck fighting the insurance company in court.

In Ontario (and Canada) the majority of healthcare costs are done via taxes through our single-payer systems (health is provincial jurisdiction, hence plural; though there are federal equalization payments).

That's fine. Just don't tell them you're poor until after the flight.

That depends on the nature of the ambulance service. In the US/Canada, ambulances cover basic stabilization and transport the nearest trauma center. We in NA have a culture whereby minimally-equipped ambulances are tasked to deliver patients to hospitals asap. That approach isn't universal, nor is it necessarily the best. In France, some ambulances bring docs with them to do things beside the road that in the US would only be attempted at a trauma center. That could mean stopping the ambulance by the road so the doc can work. Helicopters also act differently, often taking the patient not to the nearest hospital but to the one that is best equipped for the case (ie the one with an MRI for suspected stroke).

My first time through first aid training was just after princess Diana died. The trainers from the local level one hospital were convinced that if the accident had happened in the US she would have lived. They even had a local case of a very similar accident just a month before where those involved lived, in large part because it wasn't on doctor in the ambulance trying to do things it was over a dozen doctors specializing in different things working on their part at the same time.

Of course the point of all the above is call 911 (or the local emergency number) ASAP, the faster you can get experts involved the better.

There are plenty of stories/opinions one way or the other. What occasionally comes up are situations where doctors unexpectedly arrive at accident scenes, take over, and apply procedures that the ambulance crews are totally untrained for.

"Dr. Mark Forrest knew he had to act fast to save the life of a man he watched go into cardiac arrest after a motorcycle accident — so he opened up the man's chest right there on the road and brought him back from the dead."

https://www.cbc.ca/news/canada/british-columbia/doctor-who-s...

Which is great if you have the right training for what is needed. If you are a great heart surgeon and arrive at the scene of a stroke you don't have the right training to do anything useful other than basic first aid.

That’s a fascinating story. I wonder what procedure was actually performed.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Are those helicopers lacking IR capability? They should have it, and that should work in most conditions.

Even in perfect weather at popular locations not far from major services. At Eagle Creek in Oregon a hiker ran past me headed to the trailhead (no cell coverage) at around 2pm after a hiker fell into a ravine at Seven Mile Falls. While there were multiple doctors who happened to be hiking, the rescue crew and paramedics didn't arrive until after 10pm.

Yes for sure. Not that it makes a difference, but this is due to 30 minutes of travel at 60ish mph. No traffic delays.