Emergency Care in Japan

I picked up this article from The Japan Times on my daily EMS news feeds.

It seems like Japan is having hospital diversion issues similar to the US--and the rest of the world. From the article:

The deterioration of emergency medical services has become a nationwide worry. In October, a pregnant woman transported by ambulance was refused admission to eight hospitals in Tokyo and died after giving birth. In December, an elderly woman seriously injured in a traffic accident died after she was refused admission to six hospitals in Fukushima and Ibaraki prefectures.

The Fire and Disaster Management Agency's 2008 white paper says that, in 2007, an ambulance took an average of seven minutes to pick up a patient — 0.4 minute more than in 2006 — and 26.4 minutes to take the patient to a medical institution that accepted him or her — one minute more than in 2006. Both times were the worst ever. The 26.4 minutes to transport a patient was 6.5 minutes longer than 10 years ago.

Medics, muscle cars and Margolis

Scott Snyder out at the San Francisco Paramedic Association sent me a link thinking it would be good "blog fodder." He was right:

Paramedics get muscle cars

There are two things I find interesting. First is the "muscle car" reference. It doesn't seem to fit with my thinking on EMS. And lets be real, we could all drive 4 or 6 cylinder vehicles but we'd beat the crap out them and they wouldn't last 18 months. Couldn't take the beating.

I just hope nobody crashes one. The lawsuit will certainly bring out that headline in a negative light.

OK, stereotypes dealt with, I then noticed the reference to advanced practice paramedics. You may recall how that was initially one of the levels proposed in the early EMS Scope of Practice drafts. It was considered impractical, before it's time and taken out relatively quickly.

I remember presentations given by Gregg Margolis about the process and the advanced practice paramedic. We also had personal conversations. I had the good fortune to work for Gregg at The George Washington University. Gregg was an advocate for the APP. I think that it is important to note that the advanced practice paramedic concept has resurfaced.

I think most changes in EMS will be evolutionary, not revolutionary. Gregg was looking for a revolutionary change. One that would have given EMS increasing professionalism, more training and responsibility and perhaps most importantly, a career path.

Gregg worked on a revolution and didn't get it the first try. But when someone tries for something lofty but worthy, people notice. It is like planting a seed. The APP concept in Raleigh likely isn't the full scope of the original concept, but it is a sprout from the seed Margolis (and others) planted.

I just thought it was important to mention this evolutionary step toward a revolutionary vision. Good happens slowly. Sometimes imperceptibly. But it seems to be happening here.

Thanks, Gregg. You are good for EMS. Revolution or not.

EMS in top 5 worst jobs

I was watching CNN on the plane this morning (Go JetBlue!) and saw a report on the best and worst jobs. You'll be happy to know that EMS landed at number 5 in the top 10...WORST JOBS.

10 worst jobs

Well, at least we aren't lumberjacks...

EMS lost a friend

John Pryor, MD, a Major in the Army Reserve was killed in Iraq on Christmas day. His funeral service was yesterday in Philadelphia.

I don't call this out because we lost a soldier or because a family lost their father--although this is certainly and painfully the case. I call this out because EMS lost a true friend and advocate.

I first heard of this through the National Collegiate EMS Foundation. I lurk on their Facebook page because I feel it is an important organization. They sent out an email immediately after Dr. Pryor's death. It seems Dr. Pryor heard of the NCEMSF and "adopted" them.

I really can't begin to post a eulogy here but I'll provide a few links that do. Please take a moment to look these over and pay respect to a man who gave so much--even before he gave his life.

Philadelphia Inquirer
National Collegiate EMS Foundation
Dr. Pryor's faculty profile at Penn

And finally, An editorial in Dr. Pryor's own words.

Theodore Roosevelt, our 26th President, delivered a speech which became known as "The Man In The Arena"
at the Sorbonne in Paris, France on April 23, 1910. It is my favorite of all time. The part of this speech that many of us in the emergency services relate with is most appropriate at times such as this.

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.

In Memoriam and Honor of
John P. Pryor, M.D. 1966-2008

Happy New Year!

I hope your holidays were happy and your New Year is filled with hope and opportunity.

No resolutions here--I'm going to continue my efforts to be more active in blogging.

A few bits and pieces for the New Year:

The New York Times agrees with my thought on California's recent interpretation of the Good Samaritan Laws:

I'll have to call my lawyer

There have been some changes to the NIMS. Nothing I would call sweeping but it might be helpful to take a look:

NIMS Changes 2008 (PDF download)

2008 was the big EMS social networking year with several sites popping up including two by the EMS magazines:

JEMS Connect
EMS United

And you can now find almost everyone (including me) on Facebook

Bryan Bledsoe posted his Top 10 EMS research papers on jems.com recently. These are definitely worth a look:
Bledsoe's Top Ten

Now, for those of you that know me, I have not only been in EMS for 31 years, I also spent quite a bit of time in police work. I am including this photo of yours truly as a rookie police officer in 1984 for the obvious laugh factor, to point out the benefit of Explorer Posts (I was a member of a police and fire post prior to getting on both jobs) and to remember the close friends and wonderful experiences I had as a police officer in Colonie, NY. Here I am with Neil Leach, a great friend for over 30 years.



I sincerely hope that your experiences in the emergency services are as rich and wonderful as mine have been over the past 31 years.

Happy New Year!