Two ambulance crews respond to two different incidents simultaneously. Both crews are highly skilled practitioners, both crews are halfway through their shifts, both crews are using specialised vehicles to make the journey, and both crews will take approximately 70 minutes to get on scene. The dispatch information sent to one crew indicates that they are responding to a bear attack on a remote property whereas the other crew is sent information from dispatch that they are responding to a jellyfish sting at a remote beach. Both of these situations are equally critical, and both involve a person’s life hanging delicately in the balance. One has occurred in subzero temperatures, and one has occurred during a heatwave. One has occurred in the morning, and one has occurred in the afternoon, but these cases have occurred simultaneously. This is paramedicine at its finest, this is remote paramedicine at its extremes.
This is a simultaneous response of two ambulance crews who have worked together in the past, but who are now separated by hemispheres and continents, and whilst most people will assume that working remotely in Canada and Australia are polar opposites (pun intended), you may find that when you unmask the crew’s experiences, responding in the rural context can be more similar than you think.
Northern Exposure Verses Down Under
Geographically both Canada and Australia are huge, and whilst much of Canada experience rather cold winters and much of Australia experience long hot summers, the climates can vary considerably. There is actually a greater area of snowfall in Australia than Switzerland. Yep – don’t believe us you can google it, and Canada can get bleeding hot. But for the purpose of this discussion in rural health care, we will focus on two individual states, Saskatchewan in Canada, and Queensland in Australia.
Believe it or not, the coldest day recorded in Saskatchewan was a frighteningly low – 42.6°C. Now if a Queensland paramedic has ever experienced temperatures that low they must have been stuck inside an industrial freezer at the local supermarket. But it does get cold in Queensland where the lowest temperature recorded hit a scary (by Queensland standards) −10.6 °C. On the other end of the mercury, the hottest day recorded in Saskatchewan soared to 45°C, and the hottest day recorded in Queensland saw the mercury rise to 49.3°C. Whilst there are similarities we should note that the winter temperatures in Queensland only last approximately 3-4 months whereas in Canada these can last 8-9 months. Interestingly all of these temperature extremes have been recorded in rural areas, where clinicians are limited by resource availability, and apparently also mother nature. This means that regardless if you are going to work in either rural Saskatchewan or rural Queensland in an ambulance, you should be prepared to either freeze or cook to death.
The 2016 Canadian census identified Saskatchewan with a population of 1,098,352 and a total land area of 588,243.54 km2. When compared to Queensland, the 2016 Australian census identified Queensland with a population of 4,703,193 [2,3] and a land area of 1,729,742 km2. This gave Saskatchewan a population density of roughly 1.9 people per square kilometre or five people per square mile for those nonmetric folks, and Queensland roughly 2.5 people per square kilometre.
Whilst these are similar population densities with wide open, wild landmasses to respond in, there are similar aspects of paramedic practice delivery but in contrasting ways. For instance, whilst the goal is to stabilise the patient and transport to further care, in Saskatchewan working outside the ambulance is kept to a minimum so that patients can be attended to in the truck where the environment is more controlled (not freezing). Whereas working rurally in Queensland, emphasis can be placed on stabilising the patient before extrication because there is less fear of freezing. That said, during summer, the emphasis is also placed on getting the patient into the climate-controlled ambulance with air conditioning.
Same Same but Different
Climatic environments cause weird things too. There is an increased demand for linen for patients in Saskatchewan due to the cold and attending officer require excessive layers to insulate themselves which reduces the mobility of the paramedics, however, in Queensland there is less demand for linen and less requirement for layering. It’s also not uncommon in Saskatchewan for gloves to freeze instantly (yep instantly), if they are not donned before getting out of the truck however in Queensland, the heat reaps havoc on sweaty hands making gloves more susceptible to tears. Both of these instances can leave you and your patients more vulnerable in both instances.
Although services are private in Saskatchewan and state-run in Queensland, they both operate with rural paramedics having a home station in which to respond from. Whilst these bases have a reduced volume of calls due to the reduced population, thus a reduced number of paramedics covering, they experience longer response times and longer transport times than a metropolitan crew. The lengthening times also challenge the attending crews by a lack of resources. In either area, the rural crew is often isolated on scene for long periods of time that require extensive experience and additional skills. The Humboldt & District Ambulance Service in Saskatchewan use larger ambulances equipped to drive in freezing conditions that were stocked with significantly more equipment regardless of the qualifications of the crews. Likewise, the rural ambulance stations in Queensland also exhibit fewer and larger ambulances than those used in metropolitan areas including 4×4 vehicles with appropriate tyres suitable for driving through sand or dirt and shallow water. In both locations, the ambulances include similar resources regardless of qualifications required to utilise them due to the limited availability for back up and extended transport times.
As was previously mentioned, the availability for back up in rural areas is limited by access and time. The fire and rescue services in Saskatchewan may be dispatched to medical calls in an attempt to minimise the time taken for the patient to receive treatment which differs from Queensland. In Queensland, the fire rescue service will only attend medical calls if there is a fire, trapped patient, or on a specific request from the paramedics. In both locations, helicopter or fixed-wing flight medical services are required for transport to a suitable hospital where ambulance transport is simply unrealistic. Helicopters may also be used to extricate patients in difficult surroundings for instance a snowmobiling accident in Saskatchewan or a fall whilst hiking in the mountains of Queensland. Moreover, Saskatchewan and Queensland have two of the longest-serving and strongly developed fixed-wing services for rural areas in STARS Air Ambulance and the Royal Flying Doctor Service respectively. Community paramedics in Saskatchewan and low acuity response units in Queensland follow the same model yet are not utilised in rural communities due to the already reduced call volume. Although not obliged or required to by any means, paramedics also assist in the local hospitals during high tempo times. This on opposite sides of the world.
Although Saskatchewan and Queensland represent two significantly different parts of the world on the surface, the challenges rural paramedics can face and measures put in place to address them are essentially similar. In either case the challenges of working in a rural ambulance service should not be underestimated. From Jellyfish to bear attacks and managing a chest pain in – 40°C or +40°C, that is the unique nature of ambulance work that is somewhat amplified in the rural context. Now, who is up for an exchange?
- Statistics Canada. (2016). Census Profile, 2016 Census. Retrieved from https://www12. statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/page.cfm?B1=All&Code1=470245&Code2=47&Data=Count&Geo1=DPL&Geo2=PR&Lang=E&SearchPR=01&SearchText=Gravelbourg&SearchType=Begins&TABID=1
- Australian Bureau of Statistics. (2016). 2016 Census QuickStats. Retrieved from https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/3?opendocument
- Australian Bureau of Statistics. (2011). 2011 Census QuickStats. Retrieved from https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2011/quickstat/3?opendocument
- Geoscience Australia. (2020). Area of Australia – States and Territories. Retrieved from https://www.ga.gov.au/scientific-topics/national-location-information/dimensions/area-of-australia-states-and-territories
- Reaburn, G., Zolincinski, R., & Fyfe, S. (2017). Rural paramedic practitioner – a future model of care. Australasian Journal of Paramedicine, 14(1). doi: 10.33151/ajp.14. 1.513