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
beans.

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
care.

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
arrive.

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...

What would you do?

You are in a hotel room at 5:30 in the morning. (Get your mind out of the gutter--I am speaking at a conference.) The hotel's fire alarm sounds. If you ever wondered what that strobe light and speaker did...WOW...loud and bright.

Do you get up, get dressed and exit the building according to the evacuation map on the door...or do you stay in bed and wait it out? Probably a false alarm. Don't smell smoke.

This blog is read by EMS and Fire personnel as well as students. What would you do? What do you think I did?

Comments anyone?

We're not in Kansas anymore, Toto...

Picked this one up from Paul Maniscalco's EMS news listserv:

The federal Advisory Committee on Immunization Practices (ACIP) has opened the door to voluntary anthrax vaccination for first responders, revising an 8-year-old recommendation against that step.

The committee, meeting yesterday, said the risk of anthrax exposure for emergency responders is low but "may not be zero," and therefore first-responder agencies may want to offer the vaccine on a voluntary basis, according to information supplied by the Centers for Disease Control and Prevention (CDC) today.

It is worth reading the entire article.

What does this mean to us? Hmmmmm. Is there something we don't know or is someone simply confirming the world may not be the place it once was?

How long do you think it took to craft the statement "may not be zero?"

Sorry. Don't mean to be cynical. As a matter of fact I (along with many others) cringe every time I see the headline "breaking news" come across my Blackberry. In a post-9/11 world we know there are risks. Perhaps this just makes it a bit more real.

Achieving protection would require 6 vaccinations over 18 months that have some side effects. It would also require yearly boosters. It is vital to make an informed decision about this one.

How about a program for EMS, Fire and Police similar to mail carriers being issued antibiotics:

Oct 2, 2008 (CIDRAP News) – Federal health officials yesterday announced a plan to supply mail carriers with antibiotics so they will be protected and prepared to deliver the drugs to others in case of an anthrax attack.

The program will start with a $500,000 pilot project involving carriers in Minneapolis and St. Paul, which were chosen because of their extensive bioterrorism preparations, according to an Associated Press (AP) report yesterday.

"In an anthrax attack, time is of the essence," Health and Human Services (HHS) Secretary Mike Leavitt said in a news release. "By providing advance protection to letter carriers who volunteer to deliver antibiotics in an affected community, we can gain the benefits of the unique capabilities of the Postal Service to get much needed medicine to those who need it quickly."

Inhalational anthrax is usually fatal unless the patient is treated with antibiotics early. In 2001, five people died and 17 others got sick after envelopes containing anthrax spores were sent to several media offices and two US senators.

In recent years, HHS and the Postal Service ran exercises in which mail carriers in Seattle, Philadelphia, and Boston delivered empty pill bottles and explanatory fliers to residents. Carriers paired up with police officers to distribute the items, the AP reported. William Raub, Leavitt's senior science adviser, said that 50 carriers reached about 53,000 Philadelphia households in 8 hours, according to the story.

The tests were part of the Cities Readiness Initiative (CRI), a federally funded effort to equip 72 major cities with the ability to deliver antibiotics to their entire populations within 48 hours, in the name of bioterrorism preparedness.

According to the AP, the Postal Service and its unions told the government that carriers who volunteered to deliver antibiotics in an anthrax emergency would need assurances that they and their families would be protected. That led to the idea of giving carriers a supply of doxycycline to keep at home for themselves and their families. In an emergency, they could start taking the drug while the government brought in supplies that the carriers would deliver to residents.

No, we're definitely not in Kansas anymore.

The healthcare system...in France

I am determined to post at least 3 times per week on my blog. Stimulating, thought provoking items everyone will want to read and comment on. And when I can't do that I'll post a link to an article where someone else has done this for me. :-)

The article from CBS News (below) should make you think. While the pros and cons of "socialized medicine" usually cause some passionate discussions--including quality of care and access times--can you read this article and truly say to yourself that we are doing the best we can do?

The system in France is about $14 billion in debt. But I'd certainly feel better bailing out a health care system like that than I would spending a trillion to bail out the greedy, visionless bozos on Wall Street.

Enjoy...and post a comment or two.

CBS News story on the health care system in France

Where have I been?

Summer flew by and fall began with a hectic travel schedule. I had the good fortune to ride and photograph in Buffalo, NY and North Las Vegas, NV. I also taught in a workshop on the new education standards in Oklahoma City.

While I was in Las Vegas I had the opportunity to teach in the Rancho High School EMT class in North Las Vegas. While this blog often pulls in news about EMS which is less than positive, I have to say that teaching this class gave me hope for the future of EMS.

This class was full of bright and responsive students who had a clear vision on what they wanted from the future--and I'm happy to say that several are looking toward a career in EMS. They asked questions, participated and showed a genuine interest in EMS. Definitely a highlight of my trip to EMS Expo.

I would be remiss if I didn't note the kindness, hospitality and professionalism I saw in Buffalo (Thanks to Deputy Whitfield and stations 21, 22, 26 and 33) and North Las Vegas (Thanks to EMS Chief Bruce Evans and Station 51) while riding and photographing. And also to JTM Training Group for allowing me to observe some amazing tactical medical scenarios at Nellis AFB.

A few more trips are on the horizon including Topeka, Kansas and Salt Lake City, Utah before the holiday break.

Stay tuned. I'm back and will post regularly. Please drop me a note or comment to say hello.

Learning from tragedy

In June a volunteer firefighter and a sheriff's deputy were struck by a truck and killed on Rt. 17 in North Carolina near Camp Lejeune. The Marine Corps base was training with smoke which created an extremely low visibility area on the highway.

This article from ENCToday.com tells the story.

"Nobody thought how dangerous it was to enter the low visibility area," said Butch Thompson, Onslow County EMS director.

Deputies and firefighters were directing traffic in the area due to decreased visibility on the highway because of fog and smoke from a gun range fire aboard Camp Lejeune when Gene Thomas, a volunteer fireman with the Verona Volunteer Fire Department, and Steve Boehm, a deputy with the Onslow County Sheriff's Department, were struck and killed by a truck traveling northbound on U.S. 17.

Out of a tragedy comes good. Efforts are being made to help fire, EMS and police personnel who are likely to be called into the area again soon.

Does anyone out there remember the days before the scene size-up was added to the assessment process? When I became an EMT in 1980 (yes, I'm old) the mantra was "Airway is always the first priority." The article refers to this:

"We're trained to go into an emergency and we think of the victim's safety many times before our own safety - now we have to think of our own safety," said Steven Conrad, deputy division head of Onslow County Emergency Medical Services. "It's going to cause a delay in getting to patients but it's much needed to protect responders."

From a tragedy comes progress. As we remember those lost, we learn. More EMS providers are killed each year from highway crashes than from violence.

Please take a moment to visit the National EMS Memorial service site for a quick reality check.

Stay safe.

Bad news round-up

Sorry, but a lot of the news I have been seeing recently hasn't been cheery. It is important to share the bad as well as the good. Here goes:

A Maplewood, Missouri firefighter/paramedic student who had only been on the job 10 months was killed in an ambush after responding to a vehicle fire. Two cops were also shot. Here is the story from Fox News in St. Louis.

The ambush was a tactic which was originally used against cops in the 60's and 70's. An ambush can also be seen in some domestic violence and violent psych cases. News reports thus far don't give a motivation. It seems the fire was started to draw emergency personnel to the scene. The suspect later burned his house to the ground and didn't negotiate with police.

New Jersey EMTs try to save their jobs. This report from the Star Ledger's nj.com.

I understand the budget crises that affect municipalities and taxpayers today. I also believe that there is a place for community-based EMS. One of the EMTs that would lose his job is from a family with a long history of public service.

The article makes an interesting point that the financial savings the municipalities see will ultimately be shifted to the taxpayer in the form of co-pays and denied claims when health insurance (if you are lucky enough to have it) won't cover the ambulance bills.

We need a solution that combines community-based EMS and helps the budget woes of municipalities. If I had an immediate answer this blog readership would soar!

Finally, in the category of bad news, Bryan Bledsoe addressed the helicopter issue (again) even before two medical helicopters collided in Arizona. As always, Bryan's columns are good reading.

Now more than ever, stay safe.