Archive for the ‘Politics’ Category

Detroit EMS – Government Healthcare at It’s Best

August 25th, 2010 Sean

After reading about the budget shortfalls and response time issues with Detroit EMS, I am left to wonder why they haven’t considered contracting the service to a private ambulance provider? This is just another example of what happens when government is in charge of providing healthcare. Obviously Detroit’s issues go much deeper than EMS. As a matter of fact, their EMS service probably isn’t the problem at all. It’s the lack of funding and support that has put them and their citizens in this unfortunate position. Keep in mind, this is a service that not only bills the patients but receives tax dollars as well.

Had this problem come up with a private provider, they could put the contract up for bid and get someone else in who is capable of fulfilling the needs of the community. For those of you that argue that private EMS is bad because they can go out of business, then just read these articles. This sounds like a service that NEEDS to go out of service so someone can come in who isn’t subjected to cuts and do the job.

Our response time is atrocious. At any given point, day or night, consecutively for the last few months, there were no units available. That means if you call 911, it may be an hour, it may be two.

Emergency workers told Local 4 that they’re already understaffed, but come July 1, 33 more EMS positions will be eliminated.
The cause of the layoffs comes from a planned $1.8 million cut to the city budget.

Rationing care? That nonsense could never happen here!

I feel for the EMT’s, Paramedics and patients that have unfortunately been subjected to this. I really hope this gets better for them.

http://www.jems.com/article/news/budget-cuts-hit-detroit-ems

http://www.allvoices.com/contributed-news/6550028-chaos-continues-in-detroit-ems-workers-frustrated-over-lack-of-units

http://www.jems.com/video/news/detroit-ems-relying-crwon-vics

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Assembly Bill AB2456 Hurts California EMS

August 17th, 2010 Sean

Assembly Bill AB2456 recently passed through the state Assembly and is now making its way to the Senate floor for a vote. What does this mean to us as California EMTs and Paramedics? Well….lots of things. Some known and some unknown. The proposed bill aims to virtually eliminate local EMS agencies and give ultimate governing authority to our wonderful State EMSA. That’s right, the same agency that takes 90 days to process your license renewal, doesn’t return phone calls and takes years to complete investigations. Yep, those guys.

Mark my words, THIS WILL AFFECT YOU NEGATIVELY.

The sponsors of this bill want to see statewide protocols as opposed to the county system that we currently have in place. Sure I get the reasoning behind this, but do you really think that they are going to adopt aggressive and cutting edge protocols? No, because that would require them to fund mandatory training for the majority of the counties around the state that still play “mother may I” instead of para-medicine. Instead you would see everyone “dumbed down” to the level of the county with the tightest standards. I hope you don’t mind taking a few steps backwards because thats where we are headed.

Such a wonderful plan must come with a price right? Nobody eats for free in this world. The proposed legislation will add at least $800,000.00 to the state budget. That’s right, the budget that our legislators haven’t passed on time AGAIN. But don’t worry folks because it wont add to the current deficit. No, instead we the EMS professionals will pay for it in the form of fees tacked on to our license renewals.

The authority may develop and, after approval by the

commission pursuant to Section 1799.50, adopt a schedule of fees

to be collected from each certifying entity, and an increase in fees

pursuant to subdivision (d) of Section 1797.172, in amounts

sufficient to support the authority’s actual additional costs to

promulgate regulations pursuant to paragraph (1). The fees shall

be imposed proportionally between the certifying entities, and

through EMT-P licensure fees, based on the number of EMT-Is

and EMT-IIs Advanced EMTs certified by certifying entities and

the number of EMT-Ps licensed by the authority.

Translation: We are going to take as much of your money as we see fit.

Our current EMSA is under-staffed and under-funded. Do you really think that they are equipped to handle the task of managing EVERY agency in California? Imagine how much money it would take to hire the staff, buy the equipment, establish committees and do studies to formulate a statewide set of protocols. All of that money will come from you and me.

If you are interested, you can download and read the legislation by clicking on the link AB2456. See it for yourself.

It’s time to act

If we do nothing, this bill will pass with flying colors. Maybe we don’t have a perfect system, but lets not let the legislators in Sacramento decide what IS best for us. You can help kill this bill by calling not only your local senator, but every senator out there and voicing your opposition. It doesn’t take much time and it’s really easy. Just call them, tell them your name, zip code and the fact that you are an EMS professional and explain that you OPPOSE this bill. We have to get people from all over the state lighting up their phones to get the message through.

Follow this link for a list of all the Senators and their phone numbers. California State Senate

Please don’t let this pass. Make the calls, talk to your friends, and write letters. Lets work together to bring EMS forward, not backwards.

If you have any questions regarding this bill, you can e-mail me at sean@medicamdness.com. I will answer any questions I can in a timely manner.

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Should EMS be Allowed to Carry Weapons?

June 22nd, 2010 Sean

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

2nd Amendment - United States Constitution

All of us that work in EMS know that our job comes with it’s fair share of risks. I think most of us would argue that we put ourselves in harms way far more that than the average citizen. But what mechanism do we have in place to protect ourselves? …….anyone?

Every ambulance service I have worked for has strict rules against carrying weapons of any type while on duty. This includes guns, knives, pepper spray, etc. Every time I have heard these policies questioned, it is typically addressed with a general “we are not cops” statement. And they are right. We aren’t cops. We don’t enforce laws and we don’t track down bad guys. But we DO deal with the same people that law enforcement does. We run drug overdoses, assaults, homicides, suicides, etc. We find ourselves in the middle of trouble almost on a daily basis.

So back to my previous question.

What mechanism do we have in place to protect ourselves? Well for starters we have a dispatcher who decides whether or not the scene is safe to enter based off a 30 second phone call. Our next line of defense is a radio to call for help. And lastly we have the ability to run away. Criminals beware!

I’m going to come right out and say that I believe that EMS professionals should be allowed to carry concealed weapons in the name of personal defense. As a citizen the United States Constitution grants me to the right to keep and bear arms. So should my employer be allowed to deny me this right while I’m on duty?

Now I must play devils advocate for a minute. To look at this issue from an employer’s prospective, I can see where they might have issues with their employees carrying and possibly using a weapon. This opens up the doors to legal action and liability in the event that one of their employees acted inappropriately and killed someone. Employers have the right to tell us how to dress, speak, act and even cut our hair. In exchange for following these rules, we get to stay on board and receive a paycheck every 2 weeks. If we don’t like the rules, then we are free to leave at any time.

I guess where I am going with this is that while I believe that I have a right to protect self on and off duty, I don’t think that employers should be told they HAVE to allow their work force to carry weapons. Having said that, I think that liability should not be placed on an employer in the event that an EMT or Paramedic had to exercise their rights and harm someone in the name of defense. When my life is placed in danger to the point where I have to draw my weapon and kill the person who is trying to kill me, I am no longer acting as a Paramedic. I am acting as Sean Eddy. A human being that is trying to do what I can to make sure I make it home to my family. At that point I have taken all responsibility for my own actions AS A PERSON, not as a Paramedic.

Anyone disagree with me? I would love to hear your thoughts.

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The pros to fire-based EMS

June 2nd, 2010 Sean

For those you that have been reading my blog for any amount of time, this title probably comes as a shock to you. As you know, I make it no secret that I prefer a private-based EMS system. Perhaps it’s my conservative, pro private-business background that has molded my opinion on the matter. Regardless, I have yet to publicly acknowledge that other types of systems can be beneficial. Well today the pigs are a go for take-off, because I am going to take some time to talk about the benefits of fire-based EMS.

So here it goes, my list of the “pros” to fire-based EMS.

Training

For the most part, fire crews are running less and less fire calls and more medical calls. This being the case, they typically do a lot of training for medical-related emergencies and drill often to try and keep their knowledge and skills up. This is something that many private providers have lacked for a while.

Funding

Fire departments have done a wonderful job of securing funds at the state, local and federal level for a long time. This allows for high-quality equipment, better salaries and more resources. In areas where the fire service also provides ambulance transport, they are able to bill for their services as well to increase revenue.

Selection

With high pay, good benefits and an unbeatable retirement package, fire departments have qualified applicants lining up for miles for a job opportunity. This of course allows the department to be more selective when they hire personnel.

Health and Fitness

Firefighting can be a very physically demanding line of work. So naturally, fire personnel must work hard to stay healthy and physically fit. Regular exercise is something commonly seen amongst the profession. This leads to better concentration and less chance of injury.

Non-profit

In order to write this section, I must take some time to lock my stubbornness in the other room so it doesn’t interfere….so hang in there a minute.

…..ok still there? Good, here it goes.

I will admit that there is benefit to making decisions concerning equipment purchases, in-field practices and system management when making a return on your investment isn’t a priority. This is why you will commonly see fire services take on new procedures and protocols with open arms. They don’t typically have to worry about reimbursement.

So there you have it. My list of pros to fire-based EMS.

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EMS 2.0 – Be careful what you wish for

May 30th, 2010 Sean

I had a great conversation with a fellow EMS blogger last night over Skype. We discussed several ways to implement changes to our “broken” ems system and how EMS 2.0 could not only fix our industry, but improve healthcare as a whole. All was good as we were fixing the world and saving lives all through the wonders of internet phone calls. This was of course, until we came to a shocking realization of what EMS 2.0 could actually mean for us as an industry. I’ll get to that in a minute.

If you have worked in EMS for any period of time, you are no stranger to 911 abuse. People using 911 to seek routine, non-emergent medical care have tied up paramedic ambulances, increased costs and delayed response times. The “you call we haul” system that we have in place decreases liability as everyone is transported to an ER physician, but it doesn’t exactly use resources efficiently. As Justin Schorr mentioned on the Happy Hour, “putting more paramedic ambulances on the street is like putting more tow trucks at a dangerous intersection. We need to fix the intersection”.

Everyone has probably heard this rant from me or any of my fellow EMS bloggers at some point in time. Regardless of the specific solution we have in mind, we can all agree that we want patients to be routed to appropriate care. Not just the ER via paramedic ambulance. One thing me and @Jeramedic discussed was the possibility of using advice nurses in conjunction with EMS dispatch to properly route these people to appropriate care. A tactic that HMO’s have been doing for years. Here is a great article on a service that has already attempted to implement such a system.

So now for the scary part.

Let’s say that one day we woke up and our dreams came true. Patients are being routed to appropriate levels of care. Paramedics have the ability to refer non-emergent patients to urgent cares, clinics, etc. Now our ALS ambulances are only being used to transport the truly ill and injured patients to the ER. Sounds great right? We have successfully decreased the workload on our EMS system. There is only one problem. What are we going to do with all those paramedics that were once responding to 12+ calls a day? If we are only transporting truly emergent patients, wouldn’t that significantly decrease the demand for paramedics? Would this leave a bunch of paramedics looking for work?

I’ll use the fire service as an example. Over the years, fire prevention and regulations have worked so well that fire departments aren’t exactly putting out fires anymore. At least not very often. They damn near prevented themselves out of jobs. Is this what we are doing to EMS?

Fire departments did a great job of overcoming this problem by integrating fire suppression with EMS response. It has done wonders for fire services around the nation. This is actually a great example of how we as EMS professionals can use EMS 2.0 to our advantage and not only advance our career, but increase demand. Programs like community-based paramedics, and advanced-care paramedics would open up a whole new world of opportunity for EMS professionals to advance in the profession. This would also be an opportunity to increase educational standards, scope of practice and improve EMS salaries. You would see EMS turn from a stepping-stone job to a life-long career.

If you haven’t had a chance to listen to Episode 88 of the EMS Garage, you should do so now. We had some great discussion on this very topic. Hopefully Justin will hijack another show in the near future so we can get further into this discussion.

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Run it like a business

March 31st, 2010 Sean

It’s that time of year again for the county hospitals to start complaining about budget cuts and threatening to close their doors. I get that times are tough and the amount of people paying taxes decreases every day. What I don’t understand, is how organizations that bill for their services, in addition to receiving subsidies can be doing so bad?

The first complaint I typically hear is; “We get all the bums, drunks and non-paying patients”. I absolutely agree. However, there is no reason why they should be the place that all the people with no insurance go. They are fully functional and capable hospitals just like the private-based hospitals in the same area, who don’t receive subsidies.

Why don’t these hospitals adopt specialties, advertise, secure HMO contracts, and expand, just like every other hospital? The mentality that only people without insurance go to county hospitals is ridiculous. They need to be in competition to increase their revenue. Start convincing the 58 year-old with chest pain and insurance that the county hospital is the best place to go.

Perhaps I’m just a dumbass, narrow-minded, paramedic who has no idea what he’s talking about, but doesn’t it seem reasonable that if these hospitals ran themselves like a business, that they might succeed like a business? Couldn’t this make a difference in the cost of healthcare all together? Any insight to this matter would be much appreciated.

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Abuse – behind the scenes look at healthcare costs

March 29th, 2010 Sean

Everyone seems to be talking about how we can fix our “broken” healthcare system. Yet, nobody seems to talk about why healthcare is so expensive in the United States. You can blame it on insurance or the government. But what it really all comes down to is abuse and law suites.

Abuse and law suites are like siblings when it comes to health care. Massive amounts of people abuse our emergency rooms, ambulance services and even clinics. This is allowed to happen because these people can’t be denied medical care as the medical providers will find themselves in legal trouble.

Of course the people abusing our medical system typically have government aid, or don’t pay at all. Medicaid and Medicare programs are only reimbursing 20-30 cents on the dollar right now. That’s pretty bad considering what it costs to do business in healthcare. So what do the providers do to make up this lost revenue? They raise their prices! Which ultimately means that the private insurance companies get shafted with the high rates. When people abuse the system and don’t pay their bills, the healthcare providers lose money on supplies, wages, procedures, etc. It’s no wonder that the majority of private doctors offices and clinics don’t accept government insurance programs. Why would they?

Law suites closely follow abuse on the “rising healthcare costs” scale. Excessive medical malpractice suites have driven malpractice insurance through the roof. Once again, the doctors have to make up this loss somewhere. It is actually rare to find a doctor who has yet to have a malpractice suite filled against them. Whether the suit is legit or not, it is typically easier and cheaper for the insurance companies to just settle and pay up rather than fight it out in court. Excessive malpractice suites then lead to “defensive medicine”. Ordering expensive unnecessary tests to “cover their asses”. Once again, only contributing to rising medical bills. Doctors wont follow their training and instincts in fear of legal repercussions.

Does this mean that a doctor who shows gross negligence shouldn’t be held liable for their actions? Absolutely not. But suing your OB/GYN because your baby came out with 6 fingers isn’t what I would call reasonable.

Throwing more money at the problem doesn’t fix anything. We need to attack this problem from the ground up. Hospitals need to be able to deny treatment to non-urgent patients. They crowd our emergency rooms and eat up useful resources. Perhaps some public education and readily available low-cost clinics and urgent cares would tackle a good portion of this problem. The other thing that needs to be addressed is the idea that being transported by ambulance will get you seen faster. One of the big ideas behind EMS 2.0 is that EMS professionals could offer other solutions, rather than just transport to an emergency room. These are just a couple things that could significantly reduce the cost of healthcare.

Let’s quit covering up these problems and attack the real issues. Think of it like treating an illness. You can treat the symptoms and give some temporary relief. Or you can correct the core of the problem and fix it all together.

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Oh, so do you drive?

March 16th, 2010 Sean

Ever heard that phrase? If you work in EMS then you probably hear it every time to tell someone that you are an EMT or Paramedic. If you are anything like me, then you probably used to respond by explaining exactly what you do. After answering that question enough times, you have probably broken down and just say “yep” with hopes that the conversation doesn’t go the “what’s the worst thing you have ever seen?” route.

To this day, I am absolutely amazed at how everyone in the world seems to be completely clueless as to what we as EMS professionals do. It’s so bad that people who have been transported by ambulance still think that we just drive. While getting my hair cut a little while back, the lady cutting my hair told me that she had been transported to the hospital twice. She then went on to ask if we “just drive the ambulance”. Of course I asked her if the crew just showed up and gave her a ride, or if they treated her injuries.

Perhaps TV is to blame for this problem. It’s rare to flip through the channels and not see a show about cops. Shows and movies about firefighting are not as common, but still out there.  Shows that focus on EMS are far and few between and they typically flop. Hollywood hasn’t exactly done us any favors either. Sure, “Mother, Jugs and Speed” was a hit, but what else do we have? “Bringing out the Dead” just made us look like a bunch of burned out, delusional drug addicts. OK……maybe not far from the truth.

So how do we improve public awareness? I would hate to think that the only way to gain respect from the public is to make a TV drama series. I really wish I could end this post with some intelligent solution to the problem. Instead I’m asking for ideas. We really need to make the general public aware of what we do. We provide a valuable service to the community that deserves recognition. But more importantly, we need to make the elected officials that are making decisions truly aware of what we do. Perhaps doing so might change the way our legislators think when it comes time to cut funding for programs and reimbursement.

Any comments or suggestions would be greatly appreciated.

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Consider yourself lucky

March 5th, 2010 Sean

During times of a recession, it’s a wonder how any ambulance service can survive. With more and more people becoming unemployed, reimbursement for emergency services is at an all time low. This also means that less people are paying taxes to provide services like fire, police and EMS. Medicaid and Medicare programs have always had a history of cutting reimbursement during tough times. It’s now to the point where ambulance providers are only getting pennies on the dollar for what they bill.

All over the country, private ambulance services are going out of business or selling to larger providers. EMS jobs are not as abundant as they used to be. I happen to be fortunate as I work for a private ambulance service that remains financially stable right now. This of course has given me an opportunity to see what some people are willing to do get a job. We have paramedics not only moving from out of town, but out of state to work for us. It is unlike anything we have ever seen.

Now you would think that people working a secure EMS job would appreciate it, being that they can see whats going on around them. That isn’t exactly the case with everyone. I still hear attitude with crews when they are dispatched on a call for a skilled nursing facility or an inter-facility transfer. Sure, nobody enjoys those calls, but they are keeping services like us alive. While the 911 call for a stabbing is certainly exciting, it doesn’t pay the bills. As a matter of fact, 911 calls for the most part are a money loser.

If you are fortunate enough to be employed right now, remember that the calls you are running is the very thing keeping you in a job. When your employer cuts overtime, remember that it’s better than getting laid off. It’s far better to take a small hit now to ensure that you still have job in a year.

For those who are interested, I have another article I wrote a little while back about how a recession affects EMS.

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Do as I say, not as I do

February 25th, 2010 Sean

I was teaching a CPR class a couple days ago to a group of EMT students. While I was explaining the 30 compressions to 2 breaths ratio, a student raised her hand and asked me if I actually count or even follow the AHA guidelines when working in the field. Believe it or not, this is the first time any student ever asked me that. I was honest and told the group that I do not always follow compression ratios. As a matter of fact, I probably never do. As you can imagine, the class was full of comments and questions after that answer.

Of course, I explained the science behind the AHA guidelines and why they recommend fast and hard compressions. The hard part was explaining why me and most of my coworkers don’t follow them. Being a paramedic, It’s easy to explain that my focus is around ALS interventions. Being that I have plenty of BLS providers on scene with me, I don’t typically have to worry about doing CPR. However there isn’t really a good excuse as to the large number of EMS providers that just “pump and blow”. It kind of makes me wonder how much of the Heart Associations studies actually included pre-hospital cases. More importantly, it makes me wonder if it really makes a difference.

….which brings me to my next point.

It seems like every time I teach a class, whether it be CPR or an EMT class, I always find myself having the “when you get into the field” talk. There seems to be this big separation of what you learn in the classroom and what you learn on the streets. I get that there are many things that experience teaches you that a textbook just cant. But why can’t our education be more realistic? It almost seems that we do everything BUT prepare our EMT and Paramedic students for real life scenarios.

We don’t tell people in CPR classes that bagging patients for any period of time usually leads to abdominal distention and regurgitation. Sure if you “properly ventilate”, that shouldn’t happen. But throw in the “bouncing ambulance” factor and the “2 people trying to do five things” factor and you got yourself a gurney caked with used hot dogs.

We don’t seem to tell our paramedic students that Mr. Homeless on 4th street only calls 911 complaining of chest pain because he knows you will give him Morphine, a bed and a hot meal. Is it that the people writing the books are so far disconnected from pre-hospital medicine? Or do we just think it’s too “politically incorrect” to tell our students that our patients lie to us?

All I’m trying to say is that we as EMS educators and providers need to put more emphasis on teaching our students the reality of working in this field. I would like to see us try and close this gap between classroom and field learning.

Anyone beg to differ?

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