Our EMS Site

So here is a question for all of you in the medical field. Or anyone who is politically inclined.

I know, at least here in Texas, we are feeling the pinch of Obamacare. Medicare and Medicaid as well as the insurance companies are not paying sufficient. All EMS transports seem to be being rejected without any cause just to prevent payment. Fraud, while being attacked, is still running rampant. Hospitals are struggling to make a profit. It is true that many no longer want to deal with Medicare patients, home health agencies and even nursing homes are taking only so many Medicare patients if they take any at all, at the same time many with insurance can’t pay for treatments they need because of deductibles and their portion of the payments.

Emergency services are struggling. It is true that for a long time there was fraud in EMS and there still is, the problem now is there are insufficient funds to cover expenses for even legit running companies. A south Texas county, Hidalgo county, has close to 100 different ambulance services. From ambulance services that run with the bare minimum required to get a state certification to ambulances that are running with top of the line equipment. Regardless many of the medics have trouble cashing their check due to insufficient funds.

I do not know what the correct course of action is but I am seeing a breaking point approaching.

I don’t know the exact specifications of Obamacare but I did understand that Romney thinks it is spending too much money.

So how’s cutting more into medicare and government funding going to be the solution to an already strained system? Are tax cuts for hospitals and insurance companies going to be enough to set our health care reforms in order?

I think we need more fraud enforcement in all sectors, but will that be enough to benefit the citizens. Any thoughts?

I am starting to study for my chance at challenging the Certified Flight Paramedic (FP-C)examination. I am lucky that my company is having a training session and is willing to pay for our examination. I have looked at some of the information and think this will be one of the most challenging tests I have ever taken. I hope I am up to the challenge. Any thoughts on what I should study by any of you that have gone through it in the past?

Greatness
No really great man ever thought himself so. - William Hazlitt

I recently heard this quote and it struck something in me. The person that was saying it was talking about Greatness and what that means. He goes on to talk about overcoming one’s self is usually the hardest part.

This is so true it actually hides itself in plain sight.

I have seen it in all facets of life. From the neighbors who race to beat each others yard. The teens who need the latest sneakers or cell phone just to fit in. The church member who has to be the one chosen to help or they’re upset.

In reality they should be focused on self improvement rather than a meaningless race against a non-opponent.

They say the first step is the hardest but in reality sometimes every step on a journey is tough. First, second, middle, and last. But greatness isn’t achieved easily. You don’t get to greatness with a few easy steps or a half assed few tries.

You plug away at it. You feed that need to become better. You stumble, sometimes you fall.

But greatness comes from getting up, learning from our failures and pushing on.

Don’t start next week, don’t start tomorrow. Let’s start today.

A 12 year old girl who was driving in a vehicle with her grandfather had to think fast and act quicker. While driving down the highway her grandfather had a heart attack and died. His foot pressed down on the gas peddle and began to accelerate reaching speeds of approximately 80 miles per hour. Miranda Bowman, the 12 year old, then moved into action and began to steer and try to apply the brakes. She did crash but was able to do so without harming others or herself.

Fox ran the story here: Fox News

The girl later said her quick thinking was due to her father. Her father is an EMT and she says his teaching helped her keep a level head and react.

I’m sorry for the loss of her grandfather in such a shocking and sudden manner but I praise her quick thinking and desisive action that not only saved her life, but at those speeds most likely saved the lives of others.

I will probably be writing a piece on this article in the near future but for now just check it out. Very well said.

EMS World Occupy EMS.

The Art of Self-Reliance

No man who is not willing to help himself has any right to apply to his friends, or to the gods.- Demosthenes

I teach occasionally. The first thing I start with when I teach any first aid or CPR courses is explaining how important it is for everyone to be self-reliant. At least to a degree. Now let me explain, I’m not talking about having 6 months worth of food in a bomb proof underground bunker (if I could afford it I might consider it) what I’m talking is about being self-reliant with the basics of survival. I’m talking about everyone knowing basic CPR, yes the no breaths version is perfectly fine. Everyone should know the basics of the Heimlich maneuver. Everyone, and I mean everyone, from Elementary school to adults should know the basics of controlling a bleed. I have been called to assaults where a small laceration to the temple area have made people look like they were shot with a 50 cal just because no one on scene decided to apply pressure. The times that a tourniquet needs to be used on an artery or venous bleed are far less common and so I don’t consider them extreme necessities but they do occur and I don’t understand why people wouldn’t want to have this skill. It’s one of those skills that I would rather have and never need than need one day and not have. What about anaphylactic reactions? Come on people, every day there are more and more people having allergic reactions to a wider and wider range of items. Learning simple symptoms can save someone’s life. Learning the difference between an allergic reaction and an anaphylactic reaction could give a person a fighting chance. I’m not talking about the technical terms either, just know if someone is showing a lot of itching, trouble breathing, hives, swelling or a sudden case of wheezing they are having an anaphylactic reaction. Knowing that over the counter Benadryl (diphenhydramine) can help but is not the definitive treatment if it’s a true anaphylactic reaction is also crucial. Or what about this one, get called out to a residence for possible MI, because the person has left sided paralysis and they’ve already administered aspirin. Knowing the difference between a heart attack and a stroke is pretty extreme. Even so I see many people mistake the two. Know that weakness to one side of the body, facial drooping and slurred speech is a sign of a stroke and remembering that the time of onset of the symptoms is vital to a possible recovery. A heart attack usually presents with pain to the chest radiating somewhere and does not improve with breathing or position of the body. Both have time fighting against them, but each has their own treatment protocols. Aspirin should not be given to a possible stroke patient under any circumstances unless a physician is ordering it for that specific patient. Another common problem is dehydration and heat related emergencies. Just because young kids have tons of energy and are able to run around like if they’re never going to run out of steam doesn’t mean parents should let them. Knowing that dehydration is something easier prevented than dealt with once you are having symptoms is important. Once someone that is dehydrated begins to vomit it is going to get more difficult to get him hydrated. If, however, parents, coaches and trainers can remember to keep everyone hydrated during exercise, sports events or just a hot day out in the park you can avoid any problems. What if the kid doesn’t want to drink water during play? Make it mandatory in order for them to continue to play. The main thing about being self-reliant is also knowing when you are reaching your limit. I have touched a few times on the misuse of the 911 system and in the future will be trying to look at that issue further, for now however, I am going to say that while self-reliance has it’s purpose there is also a limit. Everyone needs to know that there are certain things that we are going to need help with, such as a real injury, an ongoing stroke, an active heart attack, and a thousand other things that should prompt us to call the emergency number. No one should ever wait to see if the left sided paralysis they are feeling is going to wear off. No one should see if that chest pain that is causing them to have shortness of breath and dizziness will be helped by an Rolaid. It’s crazy that sometimes the people that least need an ambulance call for one and the patients that should have called wait until hours if not days later to call? Self-reliance, at least to a moderate degree, should be something all of us strive for. We never know when it might come in handy.

True Heroes

I was recently reding a blog post on Too Old to Work Too Young to Retire about a Swedish report detailing the lack of an EMS response to an emergency situation due to their over the phone triage. I was intruiged both by his story as well as hers which you can find here: The Local.

Rebecca Ahlfeldt wrote the initial story and in the response to her two things stood out to me. The first is when Ahlfeldt makes this claim:

While an emergency operator undoubtedly has a tough job, one piece of it sounds fairly straightforward: if someone asks for an ambulance, in most cases, they probably need it.

The response is:

Obviously, she never read this blog, Ambulance Drivers, or many other EMS and Emergency Medicine blogs. The problem in our country the opposite of what she describes here. We send ambulances, often with lights and sirens, to trivial problems. The difficulty is in knowing what is going on. Nor is there much evidence that EMTs and paramedics are all that good in deciding if someone really needs to be in the hospital. That doesn’t count the blatant system abusers, of which there are many. The problem is that if we miss ONE patient and that patient dies, the entire system comes under scrutiny. So, we are incredibly risk averse. While that might be good, it’s incredibly expensive. Plus a lot of people get free health care, including EMS, and have no incentive NOT to abuse the system. (She misses the point)

I have talked to medics from many different states in the US and read many different blogs and articles about EMS and it seems many different people from many different areas agree that many calls we get are non-emergent. 

 Now I am not talking about elderly patients or non-emergency transfers. We understand that as the population ages more and more of our calls are going to be for the elderly (have you heard that EMS now stands for Elderly Management Service?). We also know that transfers are a fact of life for many in EMS. Not only does it provide a sometimes life sustaining function when transporting a patient to a facility that has the resources to service that patient, the income, however little it might be, is vital to many EMS companies. Some city services are starting to see this and are working to get reimbursements for their efforts. 

 What I am talking about are the calls to 911 that are a blatant disregard for what 911 was meant for. In the past few weeks alone there have been calls for a little girl who drank her water too fast and had a coughing fit, so obviously she needed a pair of paramedics to check her out. A baby who coughed up some milk, yup that was a medicaid transport because the mom said, “I have medicaid so they will pay you to take me.” A woman with a splinter she couldn’t get out of her finger, a Veteran who was fighting with his sons so a few hours at the ER should do the trick, you guessed it he said, “I’m a Vet so the government will pay for the trip.” Abdominal pain on a 45 year old male after he ate spicy food and drank beers with a history of GERD, “it happens all the time I eat spicy food, it feels exactly the same as before but I don’t want to risk it.”

 And the ever classic, “I called 911 because we get seen faster at the emergency room that way.”

 The question that occurred to me is how much are these 911 calls that are unnecessary costing? How big of a burden are these abuses putting not only on the individual EMS company or system but also on taxpayers in general? Has there been any real study into what is more wasteful, the financial risk with denying transport to someone that doesn’t need transport or the burden of having to transport the same frequent flyer to the ER some 10 times a month?

 Any thoughts?

 The second thing that got me, and this one really got under my skin was the last line of Too Old To Work, Too Young to Retire blog, 

You can have it fast, good, or cheap, pick two.

This is the Holy Grail of truth right there. Why is it that a city will understand that a police force needs funding that it cannot expect to recuperate, a fire department will require funds for it to function and yet an EMS system will sometimes be auctioned off to the lowest bidder. Of course the greed of some EMS companies will make them push their bids down as low as they can go, only to then suffer when trying to make ends meet. 

There is a city locally to where I am that is going to go out for bids, again. They switched from one provider because that provider was costing too much. Not because that provider was not performing well, not because that provider was not showing up to calls, not because that provider was behind in technological advancements in emergency care, they switched because a group of commissioners looked at the budget and had to shave off a few percentage points. 

The first service that came in did well in the beginning, and then steadily began to lose their grip on financial situations. Late responses and lack of resources infected the entire system.

A second company came in, after a few months they began to have trouble responding in a timely manner to calls. People died, calls with CPR in progress waited 20 minutes before an ambulance would arrive. Sometimes longer. Commissioner meetings became circuses where people would line up protesting the EMS service. 

So of course they were replaced, with someone that obviously could do the job, for a quarter of what the other companies were doing it. Really, does this seem feasible? Instead of realizing that maybe, just maybe, your getting what you pay for your going to risk more lives and your citizens safety on yet another private provider that is promising the world on a platter for next to nothing? 

The time has come for another set of meetings in that town, once again they are having massive delays on 911 calls. Other EMS systems in the surrounding areas are going into that city to help. Solutions are called for, something must be done. 

A request has been sent out and all potential EMS providers are to submit their lowest bid to the city. 

You can have it fast, good, or cheap, pick two.

You can have it fast, good, or cheap, pick two.

This should be chanted to anyone that complains about EMS. Imagine if that city did the same thing for their fire service, imagine their police department being run like that! 

Never, no way! Why? Because those are necessary services! Guess what, EMS is a public service that in the time of a real emergency is just as vital, if not more so than those other two. 

Many of us remember vividly where we were and what we were doing the day the Towers fell in New York. I hope to one day visit them when they reopen.

Today the final beam was lifted on 4 World Trade Center along with a US flag attached to the bottom. The new building is set to open in the Fall of next year.

Final Beam Lifted at the World Trade Center

A news story caught my eye, and really how could it not, WOMAN MADE TO SIT NEXT TO CORPSE ON INTERNATIONAL FLIGHT. I read a little into it and found that there was an isle separating her from the dead body. For 10 hours!!! I sure hope the A/C was turned up.

And people complain about a medic being slightly cranky in the early morning hours when they call 911 for something they’ve been living with for weeks.

Woman made to sit next to corpse on flight

Well at least the lady did get half of her flight refunded. Next question, what does it take to get a full refund? Do you need to literally move the body around?!?

Just thought I would make this since the last few calls have all been “rides”. Got to love the job.