Rural EMS has it’s challenges, not the least of which are the low pay and long hours. I believe that the lives of those in the sticks are just as important as the lives of those in the city and that rural folk need paramedics too. This is a fictional letter with a very real message. It could be written by a lot of paramedics and EMTs to a lot of people who live out in the sticks and I could have written this letter once when I left my small town EMS service to seek my EMS fame and fortune out there in the Big City. Now that I’ve come full circle and I’m once again working rural EMS I’m starting to wonder when I might have to write this letter again.
Mr. and Mrs. Penry
1212 Gravel Road
Dear Mr. and Mrs. Penry,
My name is Chris and I am a paramedic working for your local EMS service. I live here on Mulberry St. in SmallTown and my parents and grandparents live out here as well. I’ve seen you on the street, at the local café, and pretty much anywhere in town for most of my life. I went to high school with your son, Johnny and thought about dating your daughter once but could never work up the courage to ask her out. I wanted to take her to the prom but I ended up taking Mary Buckrop instead. We sure got us in some trouble with the Sheriff when he caught us out by the lake, but he ended up letting us go. Thank goodness that he turned out to be so nice. He was one of the people that helped me through Paramedic school. He kept telling me that we needed good people for the ambulance out here in SmallTown and I’ve found out that he was right. We do.
That’s why I’m having trouble writing this letter to you, Mr. and Mrs. Penry. I’ve taken it upon myself to write a personalized letter to everyone in the SmallTown EMS district because I’m facing a hard decision that I’d like you all to know about. I’ve been a paramedic now for the last ten years. I became an EMT and started volunteering with the SmallTown EMS District right out of high school and did that while I worked down at the Grain Elevator and put myself through college over in MidSizeTown. It was there that I decided that I wanted to be a paramedic and I completed my paramedic training at St. MidSize Hospital. I immediately fell in love with the work and I knew that it was something that I always wanted to be a part of. I continued volunteering with SmallTown EMS while I worked a full-time job for MidSizeTown Ambulance Service. I worked there for seven years and got a good bit of experience. I also worked part-time at St. MidSize’s Emergency Room. I still do.
Three years ago when the voters approved SmallTown EMS District’s referendum to hire full-time paramedics, I jumped at the chance to come on board. This is my home. As cheesy as it may sound, I feel a connection with the people here in SmallTown and I feel that it’s my duty and my calling to protect them with my Paramedic skills. I’ve always studied and trained hard throughout my career to be the best paramedic I could be because I’ve felt it was my duty to be my best. I felt very good about coming on board with SmallTown EMS to protect my Neighbors, family, and Friends here in my hometown.
Rural EMS is different than is EMS in the city. Sure, we may not be as busy out here in SmallTown as we could be if we were a bigger city, but that doesn’t make it easier on us. People out here don’t have access to primary care since Doc. Walters closed up his shop. While they can drive out to see the clinic in MidSizeTown, that’s thirty miles away. Most people don’t make the drive as often as they should and since people aren’t getting regular checkups and primary medical care they tend to let their minor and chronic conditions get so bad that when they finally call us, it’s because they don’t have anything else they can do. A lot of the time, their minor condition has become life threatening because it got out of hand. We can take them to St. MidSize ER, but they don’t have the capability to do things like perform cardiac catheterization surgeries to fix heart attacks, or to take care of trauma patients that need surgery right away, or to handle complicated patients in their inpatient wards. Their “ICU” is staffed by some dedicated people, but it only has two beds. This means that we have to bypass St. MidSize ER for the bigger hospitals in BigTown and that’s an hour away for us running Lights and Sirens. Because we have such long transport times and because our patients tend to be pretty sick when they call for us, we have to provide critical care level interventions. We carry more medications with us than do the big city ambulances and we can do more things than they can. That’s because ambulances in the city don’t have to be with their patients for as long as we do. They have a hospital within ten to fifteen minutes transport time of anywhere they may be. We have one within thirty minutes to an hour away. The fact that we’re so far away from hospital care forces us to be on our game all the time. We also have to be on call a lot to cover the duty ambulance when it’s away transporting a patient to the Big City. A normal call can take two hours. A critical call can take three or four. If we didn’t listen up, the calls that happen while the duty ambulance is away wouldn’t get a paramedic. I try not to let that happen.
Here’s the deal, Mr. and Mrs. Penry, I’m not complaining about my job. I love it. I love the work and I really don’t mind all of the hours that I have to put in. While it’s hard on my family to have me gone so often, they have always understood. My wife Mary supports me in my desire to cover the town we grew up in. She has since Prom night. She’s been great. However, we’ve got our new little boy that just turned three this last month and he doesn’t understand why Daddy has to be gone so often. He also is starting to get very expensive, as kids do, and the meager salary I get working in town isn’t covering all of my bills. I took a pretty hard pay cut to come here. I wanted to and thought that I could keep my part-time job at St. MidSize to make ends meet. Unfortunately, since I’m always on call for SmallTown, I can’t hardly work any hours at St. Midsize. We don’t get paid to be on call, only for when we’re on duty and I’d say no to covering… but then someone in town might die because I’m not here to take the second call. I answer the second call all the time, like I did the night of Johnny’s car accident. I’ve heard he’s doing better but I can tell you that he probably wouldn’t be had I not decided to stay home and cover that night. Mary had plans to go to dinner in MidSizeTown but I just wanted to stick around for an hour to make sure the duty truck was back in town. I’m sure glad I did.
I’m going to come right out and say it. There’s a job opening in BigCity EMS that would pay me twenty-thousand dollars a year more than I make here in SmallTown. I’d be able to work one job and wouldn’t have to put in so many hours away from my family. We wouldn’t have to skimp and save to pay the bills nearly as hard as we do now. I’d love to stay here and take care of my home town but the pay is just too low to survive on. A lot of good people have left since we went full time when they realized they couldn’t survive on the pay. I’ve been doing my best to train the kids that they hired to replace them, but they only seem to be coming here to use it as a stepping stone to a better job in the big city. I think that our town deserves better but I can see why the people would leave. I didn’t become a paramedic to get rich but I don’t think that I deserve to live in poverty because I choose to help my home town. People out here need experienced paramedics just as much as the people do in the big city. The lives of the people in the city aren’t any more important than the lives of the people out here. I feel strongly about rural EMS and I feel strongly about my home town… I just can’t make it anymore. The bank might come take the house and my family doesn’t deserve to suffer because I choose to help those that can’t pay me back.
So, Mr. and Mrs. Penry, I’m asking you what you think I should do. One day the unthinkable is going to happen to someone and I want to make sure that there are good people to take care of them when it does, but I can’t have my family suffer financially anymore. My kid needs his daddy and my wife needs her husband. The bank needs the mortgage and my student loans need paying off. It’s a tough decision I’m facing and I’m asking the community what they think I should do.
If you need me, just call 911. I’ll come like I always do. If I’m not on the duty truck you can just stop by the house. You know how to get ahold of me. Say Hi to Johnny for me.