So. Yeah.

So, it’s been a while.  How’s everyone been?  I’ve been too busy lazy to write for quite sometime.  Also, I’ve just not been that inspired enraged.  Between the general EMS stuff that just never changes and private EMS agencies claiming they’re better than fire or other governmental run EMS with no real proof of benefit.  Yeah, yeah there’s Detroit and DC and their messes, but they get on the news because they are run by the government.  And poorly.

But the question that is begging to be asked is, for every Detroit Fire/EMS that’s out there, how many private EMS agencies are there providing as bad or worse service and not getting the press because they’re not 1) in Detroit, 2) publicly funded and thus subject to scrutiny as directed by our elected leaders politicians  individuals?

So the question I have for right now, and will probably talk about again later at length is why is private EMS considered superior to public EMS?  Is it just all the recent public sentiment against the government, or is there some actually legitimate reason?

Nostalgia

Now, don’t get me wrong.  I’m all in on science and evidence based medicine and research.  I believe we can always be improving upon the care that we provide.

Why is it then that our local poo flinging monkeys “leaders” insist on always changing the way that things are done at least every 6 months?  How are we supposed to actually do anything approaching research into effectiveness in that period of time?  Why do we listen to consultants that insist that no matter what we’ve done in the past, it’s wrong!  Some of the things we’ve done are wrong, sure, I get that, and as such we should certainly abandon them and replace with better things.  Some of them however are good, and I’d argue a good number of things we do are neutral and don’t need changing just for the sake of change or minimal money savings.

To me it seems like the consultants out there that I’ve run across in the world of EMS have one of fixing problems. Their solutions to me all seem to be just like the Bobs from Office Space.

But, are they really fixing the problem?  Or are they just creating a whole new problem?

And here I thought, apparently mistakenly, that if you took care of the patient, you couldn’t go wrong.  I’m such a simpleton.  Time for more Kool-Aid from the vat of high performance EMS apparently.

 

 

 

Standards

So, I remember a time growing up when if your mother asked why you did something incredibly stupid and the answer almost all kids gave was “all the other kids were doing it” and then you’d get the standard response of “if they jumped off a cliff, would you do it too?”

Which brings me to my current rant.  All those years of parental wisdom of not just following the herd for the sake of following the herd.  And now, in the infinite wisdom of these high performance EMS liars disciples, and we all need to do all these “standards” simply because they’re standards.  And when you ask them, why are they standards, they reiterate that they’re standards and when really pressed they’ll tell you the rest of the industry is doing it all as well.

So, Mr. couldn’t hack it as a paramedic EMS manager, you’re telling me that because all the other acolytes experts in chicanery high performance EMS say that we need to do A, B, or C then we do?  Where’s the proof?  Where’s the science?  Where’s the evidence?  Where’s the proof that what you’re doing doesn’t violate the principle of primum non nocere?

We pretend to be scientists, and if Rogue Medic has taught us nothing else we should aim to be that, but, if we’re capable of nothing more than circular logic that is at best faulty, then are we even worthy of pretending to be that?  We should all be ashamed of ourselves for putting our patients, our communities, even our families at risk just so we can follow these standards.

Maybe someday, we’ll come to our senses, get out of this 80’s mindset and start thinking about something other than “me”.  I mean, it’s been 20+ years since the me decade.  Maybe it’s time to do like Burned Out Medic, and think about others.  Just once.  Maybe…

What is the right model?

So here’s the ever present question.  What is the right model for EMS?  Is it private for profit? non profit? hospital based? municipality? fire? third service?  PUM?  I think, unfortunately, that the stereotype of private EMS has a lot of credence to it.  Like the saying goes, stereotypes exist for a reason.

I think unfortunately, a lot of the stereotypes of private EMS are true.  But, not due to the fault of the medics/EMTs.  I think it rests more on the shoulders of those in charge of these groups.  They are the ones driving how these groups respond react to changes.

Maybe if they’d remember how to take care of the patients.  This emphasis in private EMS on customer service is ridiculous.  Perhaps we go back to the old adage of do the right thing for the patient and it will all work out.

I regularly interact with fire based, private, hospital based, even municipal based EMS providers. That being said it seems like the only ones that actively try and avoid work are the private providers.  You look at their rigs and how sadly equipped/supplied they are.  Look at the lack of attention to detailing of their vehicles exteriors.  Look at their ragtag looking uniforms. More so I watch these fire guys hustle in and out of the ER.  Same with the other municipal types and even the hospital based.

The private guys?  Not a chance.  Hanging out.  For excessive amounts of time.  And when is the only time they leave?  When one of two things happen.  Either they are finally ready to leave, or they’re being forced back out for something they feel is beneath them.

Now private guys out there, don’t get me wrong.  I’m sure you went into this with the best of intentions and wanted to help sick and hurting people.  Alleviate morbidity and mortality, all that good stuff.

What was that broke you?  Is it the soulless crushing monotonyhigh performance EMS system? Is it the endless parade of frequent flyers that even the fire systems don’t want to transport?  What is it?

Now for the fire guys, to be fair and all.  What is it with only giving the unwashed masses to the private guys for calls?  Why can’t we just send the closest car in multi service systems?

Better yet, why can’t we just actually issue contracts with actual teeth and consequences.  One provider is easier to control.  And if you write a good contract that’s fair those in “leadership” can make their precious profits and provide high quality, not “high performance” EMS.

Maybe someday we can get it right.  And stop burning out good medics.  Then maybe we can stop losing good medics to becoming RNs, MDs, MBAs, lawyers, etc.  And then we can finally move forward as an industry and become a true profession instead of just a skilled trade.

 

Rant done.

Missing the forest for the trees

Coming up on EMS week 2014 and I was having a thought.

So, we see these nice stories in the academic EMS journals 10th grade reading level glossy magazines aimed at the adrenaline junky, hero craving portion of our industry. All about things like aeromedical and how they truly matter and such. And always, hidden away somewhere is some story about something that really matters. About these places that truly get it and have stopped placing patients in the torture, abuse treatment known as spinal immobilization.

There’s some halfhearted attempt at making it sound, rightfully so, like that should become the standard. And you talk to any of these so called high performance EMS despots leaders and you get some politician worthy lip service about how they’ll look into it.

If we want to be worthy of this years’ EMS week theme of “Dedicated. For Life” then maybe we should try and live up to it. Let’s lose the hero tag, lose the adrenaline junky tag. Let’s get past the “leaders” that crave nothing more than to be a media darling and some good old career advancement.

Instead, let’s drop all that. Drop the ridiculous posturing and turf wars. Drop the “we’ve always done it that way” arguments. Let’s stop missing the forest for the trees. Let’s treat our patients. Treat them fairly, correctly, with science and not always what they or someone else wants, but what they need.

Let’s stop missing the forest for the trees.

Why are we doing this more and more?

So, the inimitable CCC over at Captain Chair Confessions got me thinking with his recent post These people got lights and siren responses  

Why is it, roughly 40 years into this grand experiment called EMS, that we seem to be responding more and more frequently to all manner of nonsense in a code 3 response?

This seems to fly in the face of reason, logic, and science.  I am just wondering why it is that we have many studies that seem to at the minimum, imply that increased use of emergency response proves to rarely provide a benefit and yet it goes on.

We are supposed to use science and reason and all manner of things, but we seem to flaunt it just as often.  I find it pretty damning that many times over the years we’ve even seen Jeff Clawson, of MPDS fame/infamy depending on your mindset, decry the overuse of code 3 responses.  If we have all this evidence pointing to less use of code 3 response, why do we feel the need to adhere to such silly things as 8 minute response time “standards”?  Especially when that “standard” isn’t the same from municipality to the next?

Maybe if we’re going to have all this science and evidence we could use it.  Just maybe.

Clawson, Jeff. “Unnecessary Lights and Siren Use: A Public Health Hazard.” International Academies of Emergenct Dispatch. N.p., Oct. 2002. Web. 11 Mar. 2014. <https://www.emergencydispatch.org/articles/uneslightnsiren.pdf&gt;.

The problem with private EMS

So, I happened across a quote from Dr. Steven Nessen while watching the film Escape Fire: The Fight to Rescue American Healthcare.  “When medicine became a business then we lost our moral compass.”(1)

It had a large amount that wasn’t really all that completely believable, including some leanings toward witchcraft voodoo alternative medicine.  That aside, in regards to the current system of reimbursement, I think he hit the nail on the head.  And I think that private for profit EMS is one of the best examples of being guilty of it.  That is one of those things that I wish we could find a way to change.  But so long as private EMS exists, and is reimbursed only for transporting, they puppy mills medic schools will keep churning them out by the dozen and we’ll keep just following the dictate of “You call, we haul” rather than actually providing good medicine.

Maybe someday we’ll be allowed to adequately care for our patients by having the right education, experience, leadership, resources and payments.  Just maybe….

 

 

(1) Escape Fire: The Fight to Rescue American Healthcare. Dir. Susan Froemke and Matthew Heineman. Perf. Dr. Steven Nessen. 2012. Online. Amazon.com. Web.

Science

So, we claim to believe in science and the best for our patients. And yet, day in and day out, we apply cervical collars, backboards, prophylactic IVs, prophylactic oxygen, prophylactic code 3 response, etc, etc.

I don’t understand how we can pretend to be looking out for their best interest when the best we can come up with is analogous to witchcraft, voodoo or superstition.

Yet daily, we perpetrate these crimes on our patients, all the while telling them it’s in their best interest, or the all time favorite “just in case…” We are overseen by physicians, who are supposed to be scientists and believe in logic, reason and proof.

Why then does this august body of educated individuals demand that we abuse these patients all in the name of…..I don’t know what. But it surely isn’t science. Will we someday do what it is right, or we will continue doing this abuse forever? Discuss

MPDS

So, this is simply an opinion, no facts really to back it  up, just anecdotes from myself and many I know across the country.  Why is it that we are constantly running Code 3 to all this nonsense.  There’s this graduated response system built into MPDS and you know that Joe blow is calling because he’s drunk and wants a sandwich.  You make it an Omega, you still send us, and you send us Code 3?

So, when we go through that red light and the kid jumps from behind the parked car and we can’t stop and kill him, how’s that going to look on the 11 o’clock news?  “Ambulance kills child while responding to local drunk”.  Sure, we can say you could drive slower, etc.  But, in so many systems, if you don’t make the times, your service gets penalized, usually monetarily.  And, if you’re the only responsible one, that means you get to be the sacrificial lamb eventually.

Integrity? Principles?  Those are all great, but let’s face it, most people in Fire/EMS don’t have a lot of responsibility with money and such, and as such we usually can’t afford to be without a job.  So the employer wins.

 

Therein lies today’s question.  Are we really here to do what is the best for the patient?  Or are we here to be a PR machine/appease the lawyers and accountants, medicine and science be damned?  I know this is EMS heresy, and frankly I don’t care.

And we say we provide customer service….

I saw this article, http://www.nytimes.com/2013/12/05/health/think-the-er-was-expensive-look-at-the-ambulance-bill.html?_r=0 , recently and it made me wonder.

In the realm of private EMS, it seems like all the rage these days in high performance EMS is about customer service.  Now if you’re in any other business and the salesman doesn’t have all the information, he isn’t going to do very well.  Somehow though, in EMS sending out the salesman(medic), performing what amounts to scare tactics followed by lack of information is not only considered acceptable, it’s the preferred method.

I’ve seen very few places, maybe I’m not looking in the right places, that inform their medics of all the various charges that the patient may encounter.  Now, if I go into other businesses, I can easily be shown the charges up front prior to being provided with the service.  Even in other medical realms if you ask nicely, you’ll get the costs up front.  But routinely in EMS I’ve seen where you can’t seem to get any sort of straight answer other than we can only tell you how much it’ll cost after you take the ride.  Sounds kind of like the oft quoted statement from Congresswoman Nancy Pelosi “…we have to pass the bill so that you can find out what is in it…”

Not really the way I’d want to run a business or provide great customer care.  But I’m probably not running those places for some reason beyond my ability to comprehend.  And all along I thought we were here for the patients….my bad.

Rosenthal, Elisabeth. “Think the E.R. Is Expensive? Look at How Much It Costs to Get There.” The New York Times. N.p., 4 Dec. 2013. Web. 4 Dec. 2013. <http://www.nytimes.com/2013/12/05/health/think-the-er-was-expensive-look-at-the-ambulance-bill.html?_r=0&gt;.