Archive for the 'EMS Issues' Category

13
Aug
07

A FAILURE TO CARE……

Call it a sign of the times or whatever you like, but I call it despicable.

I am talking about how bad hospital emergency departments have become. Now, I know I’m painting with a broad brush here, but hear me out. I can only discuss opinions based on my own experiences. And my experiences with our local hospitals has, at times, been appalling.

Of course there are some very good, professional, caring folks in these EDs. There are people there who really care about their patients and do their best to make your visit and care as good as it can be.

But there is a growing amount of discontent and piss poor attitudes from emergency room personnel. Did you hear the story of the women who bled to death while laying on the floor of a Los Angels emergency room? Of course this incident is an extreme, but it’s where we are all headed if attitudes do not change soon.

I don’t know exactly why this failure to care is occurring, but I have some theories. Some folks may point to issues like an overwhelmed system of emergency medicine. A lot of EDs are being used today as an alternative to using a private family physician. People show up to an emergency care facility with sniffles, fevers and other common symptoms and ailments that do not need specialized emergency care. The result is that these facilities and the people who work in them become overworked and burned out.

Or it could be due to the current nursing shortage that the industry faces. There is such a shortage of nurses right now that experts are convinced we will never dig ourselves out of it. Yes, every nursing school is full to the brim right now with students and yes, there are waiting lists years long to get into these same programs. But the issue is that the shortage has gone on for so long that there are not enough teachers and instructors to produce enough graduates. This issue is made worse by adding in the baby-boomers who are now getting to the ripe older ages and need more and more medical care. All this together suggest that society will never catch up with the demands of medical care. The failure to care issue is worsened due to the shortage. A good portion of candidates who are now allowed to enter and complete nursing programs are getting in to the profession for the wrong reasons and lack the compassion required to really nurse.

Even though I agree that the above mentioned items are all factors, I choose to point to a different culprit. From my perspective as a pre-hospital emergency care provider, the reasons that so many ED staff members have lost site of compassion and care is that the hospitals themselves have changed their focus on why they exist. Specifically, what is hurting most emergency departments today is the fact that they have become for-profit organizations.

The corporations and their fat, cigar smoking executives, who now run most of our hospitals don’t care one bit about compassion. All they care about is their financial bottom-line. Of course, that is their job. They have been groomed and designed to penny pinch, set unrealistic profit margins and bring in as much cash out of our pockets as they possibly can. But this is not how people who are supposed to deliver patient care are wired. Care givers are created differently. They are designed to be compassionate, caring and nurturing. But when the folks at the top of these now for-profit corporations send down the message that money is what we are really about, it clouds, confuses and distorts those care givers.

I see the affects of this profiteering everyday in my work as a Paramedic. It begins as soon as I enter the ED with a patient. The eyes roll and nearly every nurse and doctor in the room tries to ignore and dismiss our presence. I guess they think if they don’t make eye contact with us or acknowledge us then maybe we’ll go away. There is an air that you can cut with a scalpel towards our arrival as if we were purposely bringing to their emergency department another patient just to make their life miserable and their work-load even greater. Oh, excuse me! I did not call 911 and ask for an emergency, advanced life support crew to come into my life, treat me so that I am stable and then transport me to the closest hospital. When 911 is called, for any reason, we respond. That is how the system works. If our patient wants to go to the hospital then we transport them. We do not have a choice.

And this attitude affects the relationship between EMS crews and hospital staffs. When I walk into an ED, I can feel the negative and arrogant vibes. There is a prevailing attitude that the folks in the emergency departments are superior to any care provider who practices outside of the hospital. This negativity has affected, and this is the most important point I am trying to make, the hospital’s ability to deliver quality, emergency patient care.

Just ask the patient I treated, stabilized and delivered to one our local medical facilities recently who was having the big one, the widow maker of a heart attack. This guy had all the classic symptoms and a 12-lead ECG that showed classic signs that his heart was dieing. When I have a patient this critical, I transmit the ECG to the hospital while we are on our way to their facility. I do this so that the ED staff can see what I am seeing and activate their cardiac catherization lab. We are trained that, in heart attacks, time is muscle. Anything that can speed up the process to get the patient to definitive care (cath lab in this case) is considered good and proper.

The nurse who answered my call to the hospital in this case has particularly strong negative feelings towards EMS for reasons only God knows. Long story short, he coped an attitude during our phone conversation because I had the nerve to suggest that my patient needed the services of their cath lab. As I walked in the ED I expected an easy-pass right to the cardiac lab. Get this guy where he needed to go to save his heart and his life. Instead what I received was a wave from this nurse who stated across the department that my patients ECG was “alright” and we could place him is room 5. I insisted that my patient needed a cardiac catherization pronto which of course made the nurse even more incensed. How dare a lowly Paramedic tell a nurse with a two year Associate degree how to treat a patient. So the nurse proceeded to make this about turf and power which meant that my patient did not receive the treatment he should have had immediately. Instead, it was an hour before the decision was made by someone at the hospital that this patient did need a catherization.

Even though the outcome for this one patient was positive (no thanks to this nurse), it could have ended very differently. I ask why? Just to feed the ego of a nurse, or worse yet, an entire hospital emergency department? What was the bottom-line here? Were they trying to save a few bucks by not activating the cath lab until it was absolutely necessary?

I don’t know the answer but I do know my patient did not receive the care he should have. He did not die, bleeding on the floor of this ED like the women in LA did. But if the hospital corporations do not change their attitudes and send a strong message down to all of their staffs that patient care is rule number one, it’s only a matter of time before your loved one will.

03
Aug
07

GET READY TO PAY MORE!

Man I would love to have a deal like the one the medical insurance companies have.

This is something that really burns me because it shows how out of control the power that the insurance companies have has gotten. Earlier this summer, my squad and others around the Commonwealth of PA received notice from AETNA that they were, reducing the rate at which it reimburses ambulances that provide their communities with emergency medical service.”

In other words, AETNA has decided to cut the amount of money they’ll pay to ambulance squads after their services are used by their customers. End of story, no debate, no discussion. AETNA just arbitrarily makes a decision that will effect hundreds of private, non-profit, ambulance services. And they get away with it. Don’t you wish you could decide how much you would pay for every service you need? I think the next time I go out to eat with my family I’ll wait until after we eat and then tell the waiter how much I’m going to pay his establishment. Our economy would crumble if this practice was acceptable.  So how in the world can insurance companies do this?

Keep in mind that as a 911 response ambulance, you do not have a choice as to whether you take a call or not or treat and transport a patient or not. We have a duty to serve and we serve regardless of the type of or quality of insurance you may have. The same skills and treatments we provide can cost a fortune in a hospital. Our equipment is expensive to purchase and maintain and our people are trying to make a living while serving their communities.

So where to does AETNA get off deciding to drop the amounts they will pay us for our services?

What this means to you as a consumer, besides the fact that many 911 squads could go out of business, is that if you are an AETNA customer and you use 911, you will be billed for the remaining amount that AETNA has decided not to pay. That seems fair doesn’t it? Your premiums are jacked up for no reason every year, sometimes bi-yearly. And now they want to stick you with more of the bill if you have a traumatic or medical emergency and they don’t even have enough backbone to send you a letter informing you of this increase in your costs.

It is only a matter of time before the other insurance providers decide to do the same thing. Where is big government when it comes to correcting this type of indiscretion? Why are the legislators of PA not screaming and yelling at the top of their lungs over this issue? Who do they represent anyway? Do they represent you and me or do they represent the very powerful medical insurance institutions?

The answer depends on how our State Representatives react to this event.

02
Aug
07

911 USE OR ABUSE?

As people go through their day, I’m sure, like me, the last thing on their minds are being caught up in a medical or traumatic injury emergency and having to summon responders to help them.
That is just how EMS works. It is there when you need it but, pray God, you never, ever do!

Reading about the bridge collapse in Minnesota got me to thinking about that event from the perspective of the people who needed help and the Paramedics and other responders who arrived to assist them. Just think, one second you are driving your car across a bridge spanning the Mississippi river, a task you have done a million times over the past few years. You are heading home to relax with your family after a hard days work. When all of a sudden, your car violently shakes and begins falling towards the rowdy, roaring river water below. All around you, cars and people and items, that are not suppose to be flying through the air, are flying through the air. Your mind just can’t seem to grasp what the hell is going on. By the grace of God, you have survived the ordeal. But many folks around you are injured and need help. You wipp out your trusty cell phone and dial the three most important numbers in the world of emergency care, 911.

When you dial those three infamous numbers you do it with confidence knowing that on the other end of the phone are trained professionals waiting and willing to respond to help in this, or any other emergency. That is the way it works. You don’t have to think twice about getting help. Just pick up a phone and dial and people will arrive within minutes.

But if that wasn’t the case? What if, when you called for help the response from the emergency dispatcher was more along the lines of, “um, let me see sir. Let me see if I can find an ambulance that is available to assist you in your emergency.” Or, what if the response was more like, ” well Ma’am all of our emergency crews are busy a the moment. We’ll send someone your way as soon as we can, okay?” Of course, this is ridiculous and totally unacceptable. But what if, on the most tragic, scary day of your life, the people you rely on the most for help could not respond quickly and efficiently?

I am here to tell you that this is a real possibility. There are several elements that are affecting our ability to respond as quick as possible. Some of these reasons include political manipulation of response areas by county EMS managers and a very serious Paramedic shortage.

But the reason I have chosen to write about is the abuse of the 911 system. Of course people should not hesitate to call 911 in an emergency. In busy areas with a lot of population, the number of 911 calls for a pre-hospital medical crew (ambulance) will occasionally stretch the resources that are available. This is especially true when a large event like the bridge collapse occurs. All surrounding crews are focused on the big event and a lot of the regular 911 calls get a delayed response from squads father away.

Let’s take a look at just a normal response day and what can affect a medical crews response to your emergency. First and foremost, the number one abuser of the 911 system is, believe it or not, doctors offices. Here is why. Let’s say you have an elderly parent or grand parent living with you at home that you take care of. On this particular day, your elderly family member says they don’t feel good. You try to get specifics but they are stoic and tell you they’ll be alright, just leave them alone. They seem to be alert, breathing normally and their mental status appears normal to you. But you are concerned so you call their private physician to schedule an appointment for a check up. You tell the receptionist on the line exactly what is going on and what you want. The problem is the doctor can’t see your loved one for over a week. So the receptionist tells you, as she has been trained to do, to call 911 if you are concerned and don’t want to wait. You don’t feel that you have an emergency, but you are concerned, and the doctors office did tell you to call 911, so you call and an advanced life support medical crew is dispatched and arrives at your home in due time. They check out your elderly loved one and do not find any life threatening events but, as we are trained to do, suggest that the family member be taken to the hospital for further evaluation.

By the time the pre-hospital medical crew has performed all the appropriate assessment and treatment skills per local protocols, transported the patient, given a full report to the receiving hospital, restocked all of the supplies, gotten all the needed signatures and traveled back to their first due area, it has taken nearly two hours before they are finally back in service. During that two hour period, the community that this crew is serving is without their designated advanced life support ambulance. Was this an appropriate use of the pre-hospital emergency medical system?

I argue that it was not. I am not saying that this elderly patient should not have been assessed by a doctor either at the office or the hospital to rule out anything that might be going on. I am saying that this patient did not need an ambulance. There is a huge difference between, “I don’t feel good” and a medical emergency. The bottom line here folks is that Medics are trained to treat life threatening traumatic and medical conditions. Yes, we are trained very extensively in physical assessment for medical and traumatic problems. But we are not equipped to look past the life threats to see why a person doesn’t feel good today. That is the role of the doctors in the hospitals and offices with all the expensive machines. Of course when you call them and they can’t see you for a while they are going to tell you to call 911. They have to because if something bad happens and they don’t, you will most likely sue them.

Here is another very common scenario. You have a child, lets say he’s two years old. This child develops a fever. You give them the appropriate dose of Ibuprofen but the fever continues. You call the doctors office but, same story as before, the doctor cannot see the child for a couple of days or even a week. You are concerned because the child is lethargic and the fever is not going down. So you call 911 and the EMS crew arrives quickly. They assess the child and reveal that, yes, he is febrile. No immediate life threats present. Of course they are glad to transport the child to the hospital for further evaluation and you take them up on the offer. No harm, no foul, right?

Well what if, while the crew was assessing and transporting the child, a cardiac arrest occurred in their first due area? Now, an ambulance from a surrounding squad has to respond to the cardiac arrest which means a longer response time. Time is of the essences in a real emergency so this is an important consideration. What if, because the crew is now out of their normal coverage area, they get lost or cannot find the address of the arrest? This means that more time will laps before the much needed advanced life support is delivered to the cardiac patient. You see my point?

Allow me to dispel a popular myth about going to the hospital via an ambulance. You will not be seen faster by the ED doctor just because you arrive by ambulance. You will still have to wait your turn and fall behind patients who arrive after you but who have life threatening situations.

Please believe me when I say, I am not advocating not using 911. I am only saying that before you dial those important emergency numbers, please put your problem in the proper perspective. Do you really have an emergency? Please think of others who may have a real emergency while a crew is busy evaluating yours. When in doubt, especially with chest pain, accidents, respiratory problems or fainting, call 911. These are true, possibly life threatening, emergencies.

If you can safely drive your friend or loved one with a non-life threatening condition to the hospital, then do so. You’ll save them a large medical bill for the transport and you may help save someone else who is in the middle of an emergency.

30
Jul
07

My Introduction

Hello world!
My name is Dave and I am a Paramedic in the northeast. This blog is my way to discuss and educate the public about issues that effect my world, the world of pre-hospital emergency medicine.
Just a little about me first…….
My first career was in journalism, or at least it started out as such. I have a BS in communications with emphasis on broadcast journalism. I worked in TV news for nearly 25 years until I had had enough. News is NOT journalism any more. It turned right before my very eyes from an important service into a money grabbing business.
So…. I found a way out, re-trained myself to do something that I believed was worthwhile, and now serve my communities as a Paramedic.
Once a journalist, always a journalist………
Now that I’ve been in the middle of emergency medicine for several years, I’m feeling lead to share some insights that I hope will educate the public about EMS. My intension is not to rip anything or anyone down. My hope is that my comments will spark debate, re-educate and help to elevate the very worthy and rewarding profession of being a Paramedic. TKO in my business means “To Keep Open.” We use this term when discussing IV access. I use it for this blog to remind you to keep your mind open.

I have a lot of observations and opinions about the profession and how it is perceived from within and from without. I think you’ll find it interesting how we tend to be our own worse enemy at times when it comes to improving or elevating our profession and how these perceptions affect our ability to become a respected part of the emergency medical care continuum.

I look forward to sharing and hopefully making a difference to TKO your mind.




August 2017
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