Friday, October 31, 2008

Differing opinions are healthy

A Colorado state senator from Denver wrote a very interesting letter to the Denver Post recently.

This ex-medic and politician makes some points which seem to be supported by recent literature--that more medics on the street may not be the answer. Denver is struggling with response times. The letter is a bit long to post here in its entirety. Here is a highlight:

But I have to tell you, I would rather wait ten minutes for a skilled
paramedic who can start the process of saving my life than have one by my
side in three minutes who does not have the necessary skill or experience.

I know there is controversy. I know there is currently an audit in process.
I spent nine years as a CPA, so I understand the auditing and accounting
procedures well. Unfortunately, you are on a path to lower the quality of
your emergency medical service because, I submit, you are counting the wrong

Response time is important, but it is only one component. Making decisions
based on response times alone is irresponsible. Look at the whole system.
Look at the amount of time spent on the scene. Look at the save rates for
viable patients.

I think this is a very positive letter. I don't know enough about the issues in Denver to form an opinion, but I do like the fact that someone will look at things differently. This is how we grow. It is essential to stop reactive, emotional, non-research based opinions to move EMS forward in both practice and professionalism.

It is important to read the whole article. It seems that there are other intertwined issues--such as the fire department taking over EMS--so it is equally important to get get all the facts. Senator Morse concludes:

You have one of best trauma systems in the country. Rely on the experts who
work there, not the auditors and the politicians who know nothing of trauma

One more thing,, be wary of those who would move the paramedic response to
the fire department.

That solution would nearly double the cost and significantly reduce the
quality because each fire paramedic would see hundreds fewer patients every
year and their skills would atrophy-paramedic skills are perishable.

Keep them fresh even if you have to wait an extra minute or two for them to

Several years ago in Kennebunk I unpopularly argued that clinically competent, community-based EMT-Intermediates may be better for the system overall than bringing in out-of-town per diem medics.

I had a bit of a flashback here...

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