Have you ever…?
- Worked alone when 7 unrestrained passengers of a MVC arrive by 2 ambulances, unannounced, for assessment and care?
- Worked a 12 hr shift, gone home for 3 hrs, been called back to transfer a woman in labour, delivered a baby in the back of the ambulance, and arrived back just in time to start your next shift?
- Run a marathon and found out the hard way that you have a rare disposition to hyperthermia?
- Thought your son was over his asthma only to realize at 4 am he has no airway and his puffers were left on the mainland?
- Unexpectantly gone into labour at 29 weeks and had to take the boat to the non-designated obs rural hospital?
- Orientated a new co-worker and taught them how to effectively go back and forth between the care of a trauma patient and laboring woman at the same time?
- Been fishing with your Dad who collapses due to a massive coronary while pulling in a big salmon?
- Prioritized and divvied up between yourself and your only co-worker the care between 3 hold-over ER patients, a delirious man who is somehow naked and upside down in his Geri chair, the remainder ward patients needs, and prepped for an MVC caused by a tourist who stopped to take pictures of a black bear?
- Been dragged by your head from your sleeping bag by a wolf?
- Sent a chainsaw crew out ahead of a transfer ambulance to break up the trees that were down in the road during a windstorm?
- Traveled to a different province only to realize the brain tumour you had was much worse than you thought; to have a seizure and lose function of your legs on the beach?
- Lost/mangled digits when your hand got caught in your surfboard leash? How about a commercial fishing line?
- Driven off the end of a dock?
- Captured the demise of a fetus on the toco due to placental abruption while waiting for a helicopter to arrive? Or tried to express the urgency of the situation to air ambulance dispatch from the room next to the patient without raising your voice AND still try to prevent HER fatality?
- Found a confused elderly patient out in the street at 4 am one December eve because the doors of your hospital don’t lock?
- Bagged a major trauma patient with a basilar skull fracture and spinal cord injury for 14 hrs while waiting for the flight team? And after which still had to justify repeatedly the need for a ventilator.
- Been told you must be wrong when seeing runs of asystole in a young woman with a high cervical injury? And because you are wrong, despite the associated symptoms and ECG printout, transport won’t be considered until the morning. (We weren’t wrong and a pacemaker was inserted quickly upon arrival to the trauma center.)
- Switched over air tanks in the middle of an infant resuscitation twice because your hospital had no piped in medical air and the ITT wasn’t expected to arrive for another 6 hrs?
- Met the coast guard boat at the dock with a bucket of supplies under your arm to manage the care of someone who was scalped by a cougar? Why were you at the dock? Because the helipad was decommissioned at the hospital and was now located 20 minutes out of town. It was dusk so the flight crew was running out of light for travel and asked you to meet them there. Also, this scalped cougar attack victim was a friend of yours.
- Had a young female patient with a HgB of 25 who was told she was too sick to transfer? And you have no blood products to initiate a major hemorrhage protocol?
- Waited for your understaffed, undertrained, and highly dedicated ambulance crew to return from a transfer only to find out they were killed in a MVC and now at the bottom of a lake?
- Had to be the medical provider caring for your mentor, co-worker, and best friend as she dies of cancer? And then care for everything else that came into the hospital that shift too?
- Helped to rehab the physical and emotional needs of a woman after a plane crash in which she lost her son and then helped to deliver her next son?
- Felt the powerful energy of an elder’s death in one room while their great grandchild is born in another room less than an hour later? Have you cared for both a palliative and laboring patient at the same time?
- Been a passenger of a whale watching excursion as it was hit broadside by a rogue wave throwing all 27 passengers into the cold North Pacific without lifejackets? Have you ever experienced cold immersion? Have you been trapped in the bottom of the overturned vessel swimming with a broken leg to keep your head up to breath in the small air pocket? Or watched as the tiny hospital triaged the minimal equipment to care for all survivors?
If you have experienced any of these situations as a medical provider, patient, or their family, then you know a small part of what happens in a rural/remote setting. These sites are typically nursing run and operated. Given the vast areas of service delivery and knowledge expected of these nurses does it not make sense to support their ongoing education and equip the sites to properly care for these patients?
(All of these points, and many more, have occurred during my 17 years at Tofino Hospital. I am honoured and proud to be a rural RN.)