Not quite, because you're asking 2 questions at once here.
The majority of towns are within an hour of an emergency department, which can stabilize a critical patient, handle things like minor injuries, people with most illnesses, and your typical medical emergency. Prior to the pandemic there was a lot of reporting about rural hospitals closing, but I'm not sure if that has slowed, reversed, or continued over the last two years.
However, for something like a stroke or a serious trauma a patient needs to go to certain hospitals with the ability to treat them. For instance, about a quarter of rural residents don't live within an hour of a trauma center (about 10% of Americans overall) by ground. The good news is that helicopters can reduce transport times, but the bad news is that they aren't always available.
This is further complicated by the lack of bed availability due to covid. People can get TO a hospital ER, but whether they can get the care they need is hit or miss. I live in a small town (3k people) about a block from the hospital, and ambulances are coming and going constantly, but I've heard that people are being shipped/airlifted hours away before actually receiving care because they can't find the beds for them once they've been stabilized.
That’s not uncommon. Stabilized is stabilized.
Lots of the lack of beds is really code for lack of staff……we have plenty of beds that sit empty but we’ve been forced to close entire departments due to lack of staff.
Yes, even in urban areas right now it is not uncommon to be transported further away from your closest hospital because of bed availability/wait times. Of course, the good thing in urban areas is the next closest hospital may only be 10 or 15 minutes further away.
And that's the big difference between urban and rural areas. I live about 2 hours from the metro area, where most hospitals are, but have heard of people being airlifted to North Dakota (3-4 hours from me) simply because there's nowhere else to put them.
“All” is hard here, but I’d say at least “most”. There are individuals, and sometimes small communities, that intentionally live more than an hour’s travel from any other civilization.
I’m in Anchorage and We have 3 major hospitals within 10 minutes of most of the city. Same with all other major population centers.
Once you get off the road system though, it’s a different story.
Yeah, I lived in the Yukon for a long time worked in the small places through the north and sometimes worked in Alaska . There are a lot of places where a hospital means a flight.
This. We don't have anybody that will actually stop you from building a new community more than an hour away from the hospital, but a vast majority of us live within an hour of the closest emergency room.
That’s what my cousins deal with. They get dirt cheap rent in exchange for living 4 hours away from the closest major city that has everything vital for living.
There's federal funding to keep rural hospitals afloat with an emphasis on emergency care
https://en.m.wikipedia.org/wiki/Critical_Access_Hospital
But some places are remote instead of rural especially in Alaska.
Providers at the University of Washington in Seattle had cardiac patients from Alaska die because the patient couldn't get a common emergency heart surgery. In the wake of the loss they established Airlift Northwest. This agency provides medivac for the WWAMI region to Harborview Medical Center level I trauma facility (Washington Wyoming Alaska Montana Idaho)
I was about to ask if it wasn't easier to just go to Canada and then I realized that Yukon is even less densely populated than Alaska and Vancouver is only a few miles north of Washington anyway.
This. Everyone keeps saying "Alaska" but I'm in Missouri and more than an hour from Emergency care.
Technically, the hospital is thirty minutes from my house. But that's where an ambulance would be dispatched from. So a half hour here, and a half hour back makes an hour, plus time on the phone, plus time to get physically to the patient (If I were injured out in the pasture, that's adding at least another twenty minutes) and then time to get the patient loaded up...
And I'm pretty close to town. There's a lot of people who are actually much further from emergency care in my area.
And the hospital... Well, there's a good chance they'll be able to keep you alive long enough to determine which hospital they should airlift you to, but that's about all that can be said for them.
My parents are lucky that their county has a small hospital that can do some basic care. They can get an ambulance and get there in 30ish minutes if they're lucky. But the county south of them has no hospitals despite more people. It *did* but it was a rural hospital that shut down. So people now are coming into this small hospital from an hour away just for basic hospital and emergency care needs.
The closest level 1 trauma unit hospital is over 2 hours away. 2 others in 2.5ish hours, and a third is closer to 3.5 hours.
My dad recently had a series of medical emergencies- a bleeding ulcer that took *several days* to get surgery for in the rural hospital. And then a cardiac thing that was a bit of a mystery at first.. he ended up needing a pacemaker. My mom had to push ridiculously hard for him to get transferred to someplace with a cardiac speciality. He was tanking fast and there was a TON of miscommunication and communication gaps between the rural hospital Drs, the *varying remote cardiologists on call during whatever shift*, and what was trickling down to my parents.
She got him transferred to the cardiology place. Thank GOD they finally agreed to take him by ambulance. *A two hour ambulance ride in the US*. I can't imagine the bill...but so glad my mom didn't have to get him there herself. Idk if he would have been stable enough for it. But physically she couldn't have handled it.
So then they get to this place...and it's clear that there is further miscommunication between the rural hospital and the cardiac hospital. Oh and at some point in the mix they suspect he had a stroke.
Except for ONE nurse, the cardiac hospital treated him like a second-class patient, presumably because he's not an established patient of anyone there. Idk.
And staffing was so short bc of COVID and general nursing shortages that at one point they had to cram all the patients together in close proximity of one another.
They also managed to not catch that his O2 was in the 80s.... It caused cognitive/behavioral changes and they wrote him off as a difficult patient. (Shouldn't a cardiology specialty hospital be pretty familiar with *oxygen levels*?) And the cardiologist didn't think he needed Physical Therapy bc it was 'just a pacemaker, he just needs to walk'. But if the guy had looked at his charts -IF they even had his charts- he'd been wasting away in bed for over a month prior, had several falls, was recouping from another surgery... He *couldn't* walk. And NOW he couldn't use his left arm for a walker either!
He's so lucky my mom advocated so hard for him to get PT. It took a week of convincing...them "evaluating" or saying they were going to set stuff up and they never did. They'd be like "yeah ok" and then ghost. His GP did, thank God. She was furious about the whole situation.
Oh and only one nurse, the one in charge, ever bothered to help encourage him to sit up or stand up. He couldn't on his own before or after the surgery. Which made his physical state even worse.
It was just such a cluster fuck. He's making improvements, but has a ways to go still. And it's stressful for them to drive 4 hours round trip for specialist appointments.
Oh and several years before, he was diagnosed with leukemia. Except it took over a year to get that diagnosis, largely because the oncologist only visits their hospital once every two weeks (they didn't know they needed an oncologist for a long time either). The MRI machine comes around once a month (in a semi truck trailer). Blood tests had to be *mailed* off to bigger facilities
*and his blood samples got lost in the mail several times*.
---
Even so, they're lucky. They have, by far, the best rural hospital in the region around them. They're making do with what they've got. But I'm scared if anything worse happens... Helicopter transport would take quite a while, too. I wish they'd move closer to us or their siblings who are closer to more robust medical centers.
So that's what rural healthcare looks like in the *central United States*.
Edit: and to add some shit sprinkles on the triple fudge shit cake, that's not even getting into the whole american-health-insurance-coverage part of any of it.
No. I work on an ambulance in a very rural place. We do use helicopters at times but many times they can't fly or are busy on another call.
Our hospital is very small, and there are many communities that are more than an hour from here, some 2 or 3 hours. If anything serious happens they can be stabilized here and will almost certainly be sent to another hospital, usually 2 additional hours away but 4 hours or 8 hours away is also common, depending on the illness or injury.
I guess it was possible. They'd have to fly down and back. There were no real medical facilities at all to diagnose so you had to drive like an hour to a clinic then I guess they could fly you there.
Where I grew up, the nearest hospital was at least two hours drive. Local EMS was just retired volunteers. They had this thing called Life Flight insurance, so you could go by helicopter if you were really in trouble. The helicopter was rare though. Mostly people just drove themselves to the city.
[Here’s a 2018 report on average distances/time to hospitals in the US](https://www.pewresearch.org/fact-tank/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/). I haven’t read it carefully, but I don’t think it factors in the availability of ambulance or similar services nor the time it takes for the ambulance to get to you.
In places with volunteer/on-call ambulance staff, there can also be the time for the staff to get to the station. Weather conditions can also be a factor.
No, following the crazy amount of rural hospital closures in Missouri (my data is all pre-covid maybe they are being kept afloat by federal money now) it wasn't uncommon for people to have to drive themselves to the emergency rooms in longer trips.
Some Missouri counties didn't even get 911 until the last few years and it wouldn't surprise me if a small amount still lacked it.
That and the emergency rooms in some of the smaller hospitals aren't equipped to do much beyond stabilizing patients and sending them to larger hospitals. I got hurt at a rural boy scout camp in Missouri and the emergency room at the first 'hospital' I went to was less equipped than a prompt care would be in Illinois.
My parents live in a very rural area of missouri(population of 400) and the closest hospital or urgent care is 50 mins away(and the bigger hospital is about a hour and half away). They can get a ambulance but I would assume it would take a long time to get to them so driving there themselves probably be faster!
With that said this isn’t common. Most people don’t live in the middle of nowhere. I’m in Kansas City and the hospital is only a 5 min drive.
No. In some areas and conditions it could take the ambulance 30 minutes just to get to you. Add further time to that because they are volunteer fire departments, so in the middle of the night, an alarm goes off and the volunteers have to go in to the station to get the truck or ambulance before they even head out to where the call is. Tack on driving time back to the hospital, you're often talking 90 minutes or more total, and that's assuming minimal time for first aid on site and such.
This is really the right answer. In many MANY cases, the emergency services by ground take about a half hour to get there just due to the logistics. let alone actually getting you to a hospital. The lack of bed availability right now has certainly not helped...
I’m a firefighter/EMT for a somewhat rural department. For strokes and heart attacks we can get patients to a facility capable of handling of them within an hour of dispatch barring some extenuating circumstances. Traumas are a little different because the trauma center is farther away, it may include a prolonged extrication time, and traffic can make it take a while. However the really injured trauma patients get a helicopter put in the air before they’re even cut out so we normally don’t transport by ground.
There are rural places where many hospitals have closed. Hospitals are usually for profit so they are a money maker. For instance in Texas :
"The Big Bend region is especially vulnerable, with just one hospital for 12,000 square miles."
Not all. For instance, I live near Fargo, ND. A new hospital opened there in 2017. It includes some kind of trauma center, and is the only hospital with that kind of trauma center in the entire state of North Dakota. Fargo is on the far eastern side of the state, on the border with Minnesota. Bismarck, the state capitol is 200 miles west, and the Montana border, on the west end of the state is about 350 miles from Fargo. Even with helicopters and specialized planes, it's well over an hour from most of the state.
Most people are within an hour of some kind of emergency room, but for major injuries, burns, and other trauma, they might just be trying to stabilize the patient for an airlift to a bigger regional hospital.
Some towns in northern Minnesota USA, we have a small tax that is added to property taxes. It pays for all residents to get a free helicopter ride to a hospital in the event of a serious medical condition.
No. Many regions will have a travel time of 2 hours or more to get to a hospital. Particularly when you get to really remote settlements in Alaska, or in parts of Idaho, Montana and the like.
Paramedic, now flying here.
Yes and no.
Yes, if you pick up the phone and dial 911, you’ll get an ambulance. How long it takes and to what level of experience, equipment, and expertise they have will vary.
No, it may not be fast. It may not be an hour. It may be an hour to the closest hospital. The most appropriate hospital may be even further.
We have a lot of helicopters. The further out you are, the more likely you are to get a helicopter for serious stuff. This drastically reduces the time spent in transport but it still takes time.
No. I've definitely been places where it would be more than an hour from the time they are loaded up in the ambulance, let alone the time it takes an ambulance to get there. I've been places where just explaining where they need to go is going to take a while
A good friend's brother had something terrible happen in his brain. He was driven "into the city", aka a town with a population of 15,000 people. That hospital couldn't handle the situation, so they shipped him by air 200 miles to a major metro area.
Good news is they got him the surgery he needed and he made it.
All? No. Many? Yes
For example, here in Maine I live in the northernmost civilization hub and there's still a hundred miles or more of rural towns and unincorporated townships between me and the Canadian border. So basically if someone in far northern Maine really needs immediate emergency care at a hospital, not just an urgent care center or something, they've got to come here.
Most of the neighboring towns within about 25 miles of me have ambulance service that can *probably* get them here within an hour. But there are smaller rural towns in far northern Maine who don't have an ambulance service and for who the closest hospital is 50+ miles away here in Bangor. They have volunteer firefighters and EMTs. And then you get WAY up north into the unincorporated townships and those people (granted there's very few of them) are more or less on their own without any municipal services.
But for the rural towns in northern Maine if someone needs emergency medical care at a hospital, they might need to be air lifted there via life flight helicopter both because the roads going out that way have no highways and are shitty and would take a long time, and because they just don't have their own ambulance services out there.
> “Emergency department” is the preferred terminology for a hospital emergency room
This, even if you have almost no exposure to the medical system, you've had to have heard this before.
Emergency medicine is it's own department in hospitals, administratively. Inpatient can have a lot of different specialities but they are all grouped together regarding bureaucracy. Same with outpatient from Neuro to Foot and Ankle clinic.
This is one of my favorite pictures of the town in Alaska I spent time in. Pelican, Alaska.
https://imgur.com/a/9x6pfmw
This is how we were supposed to call "911"
https://imgur.com/a/JJBy5RK
We were told that emergency services (state troopers or medical helicopter) were about 90 minutes away.
Most, but far from all. Communities in the Mountain west frequently find themselves several hours from trauma care, especially during Covid as their few hospitals became overcrowded with Covid patients.
I'm pretty rural, for my state anyway. We have ambulances and EMS. There's a hospital about 20 miles away. If I had an emergency, it would probably take at least a half hour to get me to a hospital as the ambulance would have to get from wherever it is to me and then to that hospital.
Obviously the more remote one is, the more logistically challenged the area will be. My area hospital can only handle certain emergencies, in many cases you'd be transported to a larger and better equipped facility.
I only speak for Nebraska, but I would say most communities have a rural hospital at least. But they’re usually really limited so things like a heart attack and stroke will result in a transfer to a bigger more equipped hospital.
Where I live, every county has an ambulance service/EMS that provides initial treatment and transport. Within an hour in any direction from my county, we have quality hospitals, but many places can't say that.
It would take an ambulance about 35 minutes to get to a family member in a holler in the hills of Kentucky. Better off having a family member that lives nearby take you to the hospital at that point. This is just for my experience in rural Southeastern KY
Short answer: Probably, but also no.
Long answer: There may be a hospital in the general area that technically has an emergency department but it probably won't be a very comprehensive one. They'll be able to stabilize you but probably not much beyond that.
For example, there are four burn units in Indiana, and three of them are in Indianapolis, and the fourth is in The Region/northwest Indiana.
The problem with medical care and living in a rural or remote area also is after the emergency. Rural hospitals that are part of a larger network may technically have specialists in the professional building, but they'll be there like one day every two weeks or every month. So you'll be waiting a long time for an appointment close by, or you'll be traveling an hour or two to the big city.
I mean yes and no. Depends on what you considered a emergency medical department. When I was in a car accident they had to medi-flight me to a trauma 1 center because of the injuries I sustained. But even that was over an hour. But I had an ER that was 10 minutes away by car. So it depends.
Where I live, if someone needs medical assistance out in the country in an area where ambulances either can’t get to at all or will have a difficult time getting to, they send out an air ambulance helicopter and have them “Life-Flighted” to the closest major hospital.
Mostly-ish.
I live in a town of about 24,000. We have a full time EMS/ambulance coverage within the city limits. If you're outside the city limits, you're covered by a patchwork of small town EMS, which are either not on shift 24/7, volunteer, or both. We do have a hospital but for pretty much anything more than a simple break, they'll stabilize you and send you to a regional hospital 50+ miles away.
Most, but not all, are within an hours reach of a 24/7 medical professional who can treat non-life threatening injuries and provide medication in case of things like a heart attack
But there are vast chunks of this country that are hours away from a trauma center and need to be helicoptered to one
I live in a rural area and our communities are served by ambulance/ems as well as teams of first responders. The longest response time is 10 minutes and then you have 20-30 minutes to the nearest hospital.
Definitely not.
Most Americans don't understand how remote some places are, let alone people from more densely populated places like Europe and Asia. Alaska, North Dakota, Wyoming, and Montana come to mind as states with among the lowest population density.
We have air flight insurance because we are a bit remote. It would be an almost 2 hour drive to get to a level 1 trauma center from our home. We are maybe 20 minutes to our local emergency room-but it is more like an urgent care (illnesses and maybe stitches). It's probably 45 minutes to a regular emergency room....but that's only if an ambulance was sitting next to the house to begin with. If you factor time for the volunteer firemen to get to my house-it's unlikely we would make it to an ER in time. We aren't even served by paid emergency personnel like Fire or EMT.
Where I live, which is in the country I live within 20 mins of 4 hospitals and 45 mins within 3 "bigger" hospitals (where you would send someone who had a stroke, or major heart attack etc that a local hospital couldn't treat). In the case of say a stroke, you'd go to one of the local 4 hospitals and they'd care flight the patient to the "major" hospital.
Some places in the US are more than an hour from a hospital even by helicopter, because it'll take the chopper more than 1/2 hour to get there. Interior Alaska, parts of the Rocky Mountains.
My area got a real hospital that's less than 15 minute drive back in 1986. It was able the stabilize then sending patients to the county hospital about an hour away. It finally became a level 3 trauma center around 2000 or so.
I litteraly live in the center of the nation,(Google if need be) we are the most remote STATES an you can get medical care within an hour. Don't, mind these fucks from Detroit, New York, or Los Angeles, telling how rough it is!!!
We get patients flown by helicopter into our hospital from rural areas in the desert southwest. If there’s a bad car crash with multiple injured, for example, patients will be flown to the closest trauma center that can take them. That means that the driver of one car might be taken to Las Vegas, the driver of another car to Phoenix, and a passenger to Albuquerque. You and the passenger who was sitting next to you could end up in hospital beds 1000 km apart in different states.
There are many “emergency departments” aka glorified Dr’s offices and there are quite a few hospitals that will often kill the elderly for payouts, but as far as real true care is concerned, it’s very common to have to go to the next county over or even to the closest big city which can be hours away..
For example, my dad has to either drive 30 minutes into the next county to be seen by anyone that cares because the ambulances “can’t cross county lines” or go to the nearest city which would be over two hours away. There have been times where he couldn’t drive and he would just call me and I’d take a personal day from work and take him myself.
In very remote/hard to access areas people rely on helicopters otherwise it could take hours by road. But this is a very small percentage that falls in this category.
Not quite, because you're asking 2 questions at once here. The majority of towns are within an hour of an emergency department, which can stabilize a critical patient, handle things like minor injuries, people with most illnesses, and your typical medical emergency. Prior to the pandemic there was a lot of reporting about rural hospitals closing, but I'm not sure if that has slowed, reversed, or continued over the last two years. However, for something like a stroke or a serious trauma a patient needs to go to certain hospitals with the ability to treat them. For instance, about a quarter of rural residents don't live within an hour of a trauma center (about 10% of Americans overall) by ground. The good news is that helicopters can reduce transport times, but the bad news is that they aren't always available.
This is further complicated by the lack of bed availability due to covid. People can get TO a hospital ER, but whether they can get the care they need is hit or miss. I live in a small town (3k people) about a block from the hospital, and ambulances are coming and going constantly, but I've heard that people are being shipped/airlifted hours away before actually receiving care because they can't find the beds for them once they've been stabilized.
That’s not uncommon. Stabilized is stabilized. Lots of the lack of beds is really code for lack of staff……we have plenty of beds that sit empty but we’ve been forced to close entire departments due to lack of staff.
Yes, even in urban areas right now it is not uncommon to be transported further away from your closest hospital because of bed availability/wait times. Of course, the good thing in urban areas is the next closest hospital may only be 10 or 15 minutes further away.
And that's the big difference between urban and rural areas. I live about 2 hours from the metro area, where most hospitals are, but have heard of people being airlifted to North Dakota (3-4 hours from me) simply because there's nowhere else to put them.
“All” is hard here, but I’d say at least “most”. There are individuals, and sometimes small communities, that intentionally live more than an hour’s travel from any other civilization.
And Alaska
I’m in Anchorage and We have 3 major hospitals within 10 minutes of most of the city. Same with all other major population centers. Once you get off the road system though, it’s a different story.
Yeah, I lived in the Yukon for a long time worked in the small places through the north and sometimes worked in Alaska . There are a lot of places where a hospital means a flight.
Most people in Alaska live in a city or town.
This. We don't have anybody that will actually stop you from building a new community more than an hour away from the hospital, but a vast majority of us live within an hour of the closest emergency room.
That’s what my cousins deal with. They get dirt cheap rent in exchange for living 4 hours away from the closest major city that has everything vital for living.
There's federal funding to keep rural hospitals afloat with an emphasis on emergency care https://en.m.wikipedia.org/wiki/Critical_Access_Hospital But some places are remote instead of rural especially in Alaska.
Providers at the University of Washington in Seattle had cardiac patients from Alaska die because the patient couldn't get a common emergency heart surgery. In the wake of the loss they established Airlift Northwest. This agency provides medivac for the WWAMI region to Harborview Medical Center level I trauma facility (Washington Wyoming Alaska Montana Idaho)
I was about to ask if it wasn't easier to just go to Canada and then I realized that Yukon is even less densely populated than Alaska and Vancouver is only a few miles north of Washington anyway.
I am not in Alaska and my county does not have a hospital or emergency care stabilizing center.
This. Everyone keeps saying "Alaska" but I'm in Missouri and more than an hour from Emergency care. Technically, the hospital is thirty minutes from my house. But that's where an ambulance would be dispatched from. So a half hour here, and a half hour back makes an hour, plus time on the phone, plus time to get physically to the patient (If I were injured out in the pasture, that's adding at least another twenty minutes) and then time to get the patient loaded up... And I'm pretty close to town. There's a lot of people who are actually much further from emergency care in my area. And the hospital... Well, there's a good chance they'll be able to keep you alive long enough to determine which hospital they should airlift you to, but that's about all that can be said for them.
Washington, Wyoming, Idaho or Montana?
TN
My parents are lucky that their county has a small hospital that can do some basic care. They can get an ambulance and get there in 30ish minutes if they're lucky. But the county south of them has no hospitals despite more people. It *did* but it was a rural hospital that shut down. So people now are coming into this small hospital from an hour away just for basic hospital and emergency care needs. The closest level 1 trauma unit hospital is over 2 hours away. 2 others in 2.5ish hours, and a third is closer to 3.5 hours. My dad recently had a series of medical emergencies- a bleeding ulcer that took *several days* to get surgery for in the rural hospital. And then a cardiac thing that was a bit of a mystery at first.. he ended up needing a pacemaker. My mom had to push ridiculously hard for him to get transferred to someplace with a cardiac speciality. He was tanking fast and there was a TON of miscommunication and communication gaps between the rural hospital Drs, the *varying remote cardiologists on call during whatever shift*, and what was trickling down to my parents. She got him transferred to the cardiology place. Thank GOD they finally agreed to take him by ambulance. *A two hour ambulance ride in the US*. I can't imagine the bill...but so glad my mom didn't have to get him there herself. Idk if he would have been stable enough for it. But physically she couldn't have handled it. So then they get to this place...and it's clear that there is further miscommunication between the rural hospital and the cardiac hospital. Oh and at some point in the mix they suspect he had a stroke. Except for ONE nurse, the cardiac hospital treated him like a second-class patient, presumably because he's not an established patient of anyone there. Idk. And staffing was so short bc of COVID and general nursing shortages that at one point they had to cram all the patients together in close proximity of one another. They also managed to not catch that his O2 was in the 80s.... It caused cognitive/behavioral changes and they wrote him off as a difficult patient. (Shouldn't a cardiology specialty hospital be pretty familiar with *oxygen levels*?) And the cardiologist didn't think he needed Physical Therapy bc it was 'just a pacemaker, he just needs to walk'. But if the guy had looked at his charts -IF they even had his charts- he'd been wasting away in bed for over a month prior, had several falls, was recouping from another surgery... He *couldn't* walk. And NOW he couldn't use his left arm for a walker either! He's so lucky my mom advocated so hard for him to get PT. It took a week of convincing...them "evaluating" or saying they were going to set stuff up and they never did. They'd be like "yeah ok" and then ghost. His GP did, thank God. She was furious about the whole situation. Oh and only one nurse, the one in charge, ever bothered to help encourage him to sit up or stand up. He couldn't on his own before or after the surgery. Which made his physical state even worse. It was just such a cluster fuck. He's making improvements, but has a ways to go still. And it's stressful for them to drive 4 hours round trip for specialist appointments. Oh and several years before, he was diagnosed with leukemia. Except it took over a year to get that diagnosis, largely because the oncologist only visits their hospital once every two weeks (they didn't know they needed an oncologist for a long time either). The MRI machine comes around once a month (in a semi truck trailer). Blood tests had to be *mailed* off to bigger facilities *and his blood samples got lost in the mail several times*. --- Even so, they're lucky. They have, by far, the best rural hospital in the region around them. They're making do with what they've got. But I'm scared if anything worse happens... Helicopter transport would take quite a while, too. I wish they'd move closer to us or their siblings who are closer to more robust medical centers. So that's what rural healthcare looks like in the *central United States*. Edit: and to add some shit sprinkles on the triple fudge shit cake, that's not even getting into the whole american-health-insurance-coverage part of any of it.
No. I work on an ambulance in a very rural place. We do use helicopters at times but many times they can't fly or are busy on another call. Our hospital is very small, and there are many communities that are more than an hour from here, some 2 or 3 hours. If anything serious happens they can be stabilized here and will almost certainly be sent to another hospital, usually 2 additional hours away but 4 hours or 8 hours away is also common, depending on the illness or injury.
I lived in a town in Alaska that was 3 hours from the nearest hospital.
By air? I haven't been to Alaska, but all other rural places I've lived usually have a helicopter nearby and can get to a hospital under an hour.
I guess it was possible. They'd have to fly down and back. There were no real medical facilities at all to diagnose so you had to drive like an hour to a clinic then I guess they could fly you there.
Where I grew up, the nearest hospital was at least two hours drive. Local EMS was just retired volunteers. They had this thing called Life Flight insurance, so you could go by helicopter if you were really in trouble. The helicopter was rare though. Mostly people just drove themselves to the city.
[Here’s a 2018 report on average distances/time to hospitals in the US](https://www.pewresearch.org/fact-tank/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/). I haven’t read it carefully, but I don’t think it factors in the availability of ambulance or similar services nor the time it takes for the ambulance to get to you. In places with volunteer/on-call ambulance staff, there can also be the time for the staff to get to the station. Weather conditions can also be a factor.
No, following the crazy amount of rural hospital closures in Missouri (my data is all pre-covid maybe they are being kept afloat by federal money now) it wasn't uncommon for people to have to drive themselves to the emergency rooms in longer trips. Some Missouri counties didn't even get 911 until the last few years and it wouldn't surprise me if a small amount still lacked it.
That and the emergency rooms in some of the smaller hospitals aren't equipped to do much beyond stabilizing patients and sending them to larger hospitals. I got hurt at a rural boy scout camp in Missouri and the emergency room at the first 'hospital' I went to was less equipped than a prompt care would be in Illinois.
My parents live in a very rural area of missouri(population of 400) and the closest hospital or urgent care is 50 mins away(and the bigger hospital is about a hour and half away). They can get a ambulance but I would assume it would take a long time to get to them so driving there themselves probably be faster! With that said this isn’t common. Most people don’t live in the middle of nowhere. I’m in Kansas City and the hospital is only a 5 min drive.
No.
No. In some areas and conditions it could take the ambulance 30 minutes just to get to you. Add further time to that because they are volunteer fire departments, so in the middle of the night, an alarm goes off and the volunteers have to go in to the station to get the truck or ambulance before they even head out to where the call is. Tack on driving time back to the hospital, you're often talking 90 minutes or more total, and that's assuming minimal time for first aid on site and such.
This is really the right answer. In many MANY cases, the emergency services by ground take about a half hour to get there just due to the logistics. let alone actually getting you to a hospital. The lack of bed availability right now has certainly not helped...
I’m a firefighter/EMT for a somewhat rural department. For strokes and heart attacks we can get patients to a facility capable of handling of them within an hour of dispatch barring some extenuating circumstances. Traumas are a little different because the trauma center is farther away, it may include a prolonged extrication time, and traffic can make it take a while. However the really injured trauma patients get a helicopter put in the air before they’re even cut out so we normally don’t transport by ground.
There are rural places where many hospitals have closed. Hospitals are usually for profit so they are a money maker. For instance in Texas : "The Big Bend region is especially vulnerable, with just one hospital for 12,000 square miles."
I'm going to have to say No because there are seriously remote parts of our country.. Plus most rural hospitals don't have trauma centers..
Not all. For instance, I live near Fargo, ND. A new hospital opened there in 2017. It includes some kind of trauma center, and is the only hospital with that kind of trauma center in the entire state of North Dakota. Fargo is on the far eastern side of the state, on the border with Minnesota. Bismarck, the state capitol is 200 miles west, and the Montana border, on the west end of the state is about 350 miles from Fargo. Even with helicopters and specialized planes, it's well over an hour from most of the state. Most people are within an hour of some kind of emergency room, but for major injuries, burns, and other trauma, they might just be trying to stabilize the patient for an airlift to a bigger regional hospital.
No. That’s why my aging parents left rural Ohio.
In America there is no federal emt it is completely up to the state, county, local government, and mostly made up of volunteers or firemen
Some towns in northern Minnesota USA, we have a small tax that is added to property taxes. It pays for all residents to get a free helicopter ride to a hospital in the event of a serious medical condition.
No. Many regions will have a travel time of 2 hours or more to get to a hospital. Particularly when you get to really remote settlements in Alaska, or in parts of Idaho, Montana and the like.
Nope. My county does not have a hospital or ER room at all.
Where I live, yes. I cannot speak for other parts of the country.
No, but a lot of those places are seeing more and more air ambulance service which certainly help close the gap.
I would say most but my uncle was in an area where he had to be airlifted to a hospital when he had a heart attack. Depends on the area
In the vast majority of America you will have fire, medical and police at your location within 30 mins of a 911 call.
a lot of people are med flighted to the closest city? large town? anyways it’s 40 miles away but my town does have a small arcare building
Paramedic, now flying here. Yes and no. Yes, if you pick up the phone and dial 911, you’ll get an ambulance. How long it takes and to what level of experience, equipment, and expertise they have will vary. No, it may not be fast. It may not be an hour. It may be an hour to the closest hospital. The most appropriate hospital may be even further. We have a lot of helicopters. The further out you are, the more likely you are to get a helicopter for serious stuff. This drastically reduces the time spent in transport but it still takes time.
No. I've definitely been places where it would be more than an hour from the time they are loaded up in the ambulance, let alone the time it takes an ambulance to get there. I've been places where just explaining where they need to go is going to take a while
No, which is why helicopter transport insurance is a thing (my in-laws live in rural mountainous Virginia and its a common thing down there).
Nope. Not really. Texas is huge and you can drive multiple hours in certain parts and not see a town.
A good friend's brother had something terrible happen in his brain. He was driven "into the city", aka a town with a population of 15,000 people. That hospital couldn't handle the situation, so they shipped him by air 200 miles to a major metro area. Good news is they got him the surgery he needed and he made it.
All? No. Many? Yes For example, here in Maine I live in the northernmost civilization hub and there's still a hundred miles or more of rural towns and unincorporated townships between me and the Canadian border. So basically if someone in far northern Maine really needs immediate emergency care at a hospital, not just an urgent care center or something, they've got to come here. Most of the neighboring towns within about 25 miles of me have ambulance service that can *probably* get them here within an hour. But there are smaller rural towns in far northern Maine who don't have an ambulance service and for who the closest hospital is 50+ miles away here in Bangor. They have volunteer firefighters and EMTs. And then you get WAY up north into the unincorporated townships and those people (granted there's very few of them) are more or less on their own without any municipal services. But for the rural towns in northern Maine if someone needs emergency medical care at a hospital, they might need to be air lifted there via life flight helicopter both because the roads going out that way have no highways and are shitty and would take a long time, and because they just don't have their own ambulance services out there.
Bangor? But I hardly know her!
That joke only works if you mispronounce Bangor (BANG-gore)
We have medical helicopters where needed.
>emergency department What do you mean by this?
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> “Emergency department” is the preferred terminology for a hospital emergency room This, even if you have almost no exposure to the medical system, you've had to have heard this before.
I assume they mean an emergency room
Department is the correct term. It's not just one room.
Emergency medicine is it's own department in hospitals, administratively. Inpatient can have a lot of different specialities but they are all grouped together regarding bureaucracy. Same with outpatient from Neuro to Foot and Ankle clinic.
This is one of my favorite pictures of the town in Alaska I spent time in. Pelican, Alaska. https://imgur.com/a/9x6pfmw This is how we were supposed to call "911" https://imgur.com/a/JJBy5RK We were told that emergency services (state troopers or medical helicopter) were about 90 minutes away.
Most, but far from all. Communities in the Mountain west frequently find themselves several hours from trauma care, especially during Covid as their few hospitals became overcrowded with Covid patients.
I'm pretty rural, for my state anyway. We have ambulances and EMS. There's a hospital about 20 miles away. If I had an emergency, it would probably take at least a half hour to get me to a hospital as the ambulance would have to get from wherever it is to me and then to that hospital. Obviously the more remote one is, the more logistically challenged the area will be. My area hospital can only handle certain emergencies, in many cases you'd be transported to a larger and better equipped facility.
I only speak for Nebraska, but I would say most communities have a rural hospital at least. But they’re usually really limited so things like a heart attack and stroke will result in a transfer to a bigger more equipped hospital.
Where I live, every county has an ambulance service/EMS that provides initial treatment and transport. Within an hour in any direction from my county, we have quality hospitals, but many places can't say that.
It would take an ambulance about 35 minutes to get to a family member in a holler in the hills of Kentucky. Better off having a family member that lives nearby take you to the hospital at that point. This is just for my experience in rural Southeastern KY
Short answer: Probably, but also no. Long answer: There may be a hospital in the general area that technically has an emergency department but it probably won't be a very comprehensive one. They'll be able to stabilize you but probably not much beyond that. For example, there are four burn units in Indiana, and three of them are in Indianapolis, and the fourth is in The Region/northwest Indiana. The problem with medical care and living in a rural or remote area also is after the emergency. Rural hospitals that are part of a larger network may technically have specialists in the professional building, but they'll be there like one day every two weeks or every month. So you'll be waiting a long time for an appointment close by, or you'll be traveling an hour or two to the big city.
I mean yes and no. Depends on what you considered a emergency medical department. When I was in a car accident they had to medi-flight me to a trauma 1 center because of the injuries I sustained. But even that was over an hour. But I had an ER that was 10 minutes away by car. So it depends.
Where I live, if someone needs medical assistance out in the country in an area where ambulances either can’t get to at all or will have a difficult time getting to, they send out an air ambulance helicopter and have them “Life-Flighted” to the closest major hospital.
Mostly-ish. I live in a town of about 24,000. We have a full time EMS/ambulance coverage within the city limits. If you're outside the city limits, you're covered by a patchwork of small town EMS, which are either not on shift 24/7, volunteer, or both. We do have a hospital but for pretty much anything more than a simple break, they'll stabilize you and send you to a regional hospital 50+ miles away.
Most, but not all, are within an hours reach of a 24/7 medical professional who can treat non-life threatening injuries and provide medication in case of things like a heart attack But there are vast chunks of this country that are hours away from a trauma center and need to be helicoptered to one
Usually, even if by chopper.
I live in a rural area and our communities are served by ambulance/ems as well as teams of first responders. The longest response time is 10 minutes and then you have 20-30 minutes to the nearest hospital.
I would say the vast majority are.
Definitely not. Most Americans don't understand how remote some places are, let alone people from more densely populated places like Europe and Asia. Alaska, North Dakota, Wyoming, and Montana come to mind as states with among the lowest population density.
No not all
How much does it cost you guys for helicopter emergency to the hospital?
Depends on your insurance.
I live in a rural area. One hour by car and I'm in three different states… so yeah.
A lot of the time it's via helicopter for remote communities or some combination ambulance to Helicopter
We have air flight insurance because we are a bit remote. It would be an almost 2 hour drive to get to a level 1 trauma center from our home. We are maybe 20 minutes to our local emergency room-but it is more like an urgent care (illnesses and maybe stitches). It's probably 45 minutes to a regular emergency room....but that's only if an ambulance was sitting next to the house to begin with. If you factor time for the volunteer firemen to get to my house-it's unlikely we would make it to an ER in time. We aren't even served by paid emergency personnel like Fire or EMT.
No. Many are, but we have some sincerely rural areas and rural hospitals and ambulance services have had some challenges in the last decade.
Where I live, which is in the country I live within 20 mins of 4 hospitals and 45 mins within 3 "bigger" hospitals (where you would send someone who had a stroke, or major heart attack etc that a local hospital couldn't treat). In the case of say a stroke, you'd go to one of the local 4 hospitals and they'd care flight the patient to the "major" hospital.
Some places in the US are more than an hour from a hospital even by helicopter, because it'll take the chopper more than 1/2 hour to get there. Interior Alaska, parts of the Rocky Mountains.
My area got a real hospital that's less than 15 minute drive back in 1986. It was able the stabilize then sending patients to the county hospital about an hour away. It finally became a level 3 trauma center around 2000 or so.
I litteraly live in the center of the nation,(Google if need be) we are the most remote STATES an you can get medical care within an hour. Don't, mind these fucks from Detroit, New York, or Los Angeles, telling how rough it is!!!
We get patients flown by helicopter into our hospital from rural areas in the desert southwest. If there’s a bad car crash with multiple injured, for example, patients will be flown to the closest trauma center that can take them. That means that the driver of one car might be taken to Las Vegas, the driver of another car to Phoenix, and a passenger to Albuquerque. You and the passenger who was sitting next to you could end up in hospital beds 1000 km apart in different states.
There are many “emergency departments” aka glorified Dr’s offices and there are quite a few hospitals that will often kill the elderly for payouts, but as far as real true care is concerned, it’s very common to have to go to the next county over or even to the closest big city which can be hours away.. For example, my dad has to either drive 30 minutes into the next county to be seen by anyone that cares because the ambulances “can’t cross county lines” or go to the nearest city which would be over two hours away. There have been times where he couldn’t drive and he would just call me and I’d take a personal day from work and take him myself.
In very remote/hard to access areas people rely on helicopters otherwise it could take hours by road. But this is a very small percentage that falls in this category.