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…

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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.

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;.