Friday, January 23

How did we get here?

What are we doing anymore?

Not an entirely rhetorical question, but looking back over the last few dispatches I've been on, it's a fair question.

What is the role of Emergency Medical Services in the 21st Century?

We were born of the traumatic injuries of the 50s and 60s, adapted from the battlefield surgeons of old. We were given basic skills, then basic tools.
Then the emergence of advanced cardiac care. We became the first link in the Chain of Survival and evolved from ventilators and thumpers to vasopressors and antiarrythmics. We can create artificial, clinical life and, in some cases, perfuse tissue until advanced care can take over.
We started as funeral home drivers, then ambulance attendants, then technicians and are now on the verge of being recognized as a legitimate profession, not just a trade school certificate.
We have evolved by setting training standards, publishing journals and lobbying politically for this new profession, the one we chose to advance by doing it to the best of our ability.

And then something happened. Something slowly, so as not to alarm us or give us a chance to object.

EMS became the catch all for everything lacking in the Health Care system. We're the hospice nurse after hours, the 2 AM taxi driver. We're the solution when the question defies reason. It used to be "I don't know what to do, call 911" now it's "I want to goto the hospital, call an ambulance."

Ambulances and by extension, those resources that respond with them, are being called to extend aid to the homeless, the elderly, the disadvantaged, not the sick or injured. When I took this job I knew that people of all races, creeds and economic status would need our services and I treat each one with the respect I would want to receive.

The car accident, the allergic reaction, the choking, these are our patients.
The hungry, the tired, the alone, they are our fellow citizens, but not our patients.

But what about those who don't need us? Those who simply have no other recourse or way to receive assistance, whatever their issue may be? The woman who can't stand up when she sits down too far from her walker? The man out of breath at the top of the flight of stairs not because of his asthma, but because of his obesity and poor exercise habits?

They call us knowing full well it is against the law for us to deny them care. I have been told to my face by persons who requested our services (not patients by definition) that my job is simply to drive them to a doctor. I take a deep breath smile and do it, knowing they'll never listen to reason or wait in line like everyone else to get an appointment.

Many may wish to blame immigrants. People not paying into the system who are perceived in the news as clogging the system. I happen to work in a municipality that is very lenient when it comes to enforcing immigration and I see few of them.

It is those who believe they are entitled to a level of care they do not need that are clogging the system and it is, I fear, too late to change the mindset they have adopted.
I see their children watching, learning that no matter how you mismanage your affairs or ignore your health, no one will tell you otherwise.

I'm really happy to be where I am. I worked very hard to get this job and chose it specifically because it is still a Fire based transporting agency. I love my carreer and am proud to work with other professionals on a daily basis, bad apples aside.

At the rate our responses are growing and the impending retirement of the baby boomers, when will Emergency Medical Services be reclassified as such? If there was a Routine Medical Technician position, I would not put in for it.

If we don't get a handle on what the public expects from their emergency responders, I fear in 10 years time we will be giving psych evals and family counciling in the back of the ambulance instead on focusing on the reason we exist in the first place.

We are the insurance policy. We are the only ones who can do what we do and are asked more each day to pick up the slack of other agencies while seeing our own budget cut.

I don't have the answer. We may never have an answer, but when will we begin to speak up against the blanket policies that require us to act when our action is not needed or being blatantly abused?

Call this a rant, a complaint, call it the random ramblings of a misguided almost burnt out medic, but I'll still be at work next shift, an hour early with a smile on my face because I know as bad as it gets, it can always get worse.

I could be back making tortillas for $4.35 an hour.

Your still Happy Medic

1 comment:

Big Show said...

how about dispatchers referring people to a local taxi service? How about the hospitals providing a transport van that you could call if you need to go to the hospital, someone calls 911, the dispatcher understands that it does not qualify for EMS, he then places a call to the local hospital to send out one of their vans, would make alot of sense to do it that way...