firetender
Community Leader Emeritus
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In literally studying the thread, “Holding Someone’s Hands” I was really struck by the juiciness of the responses. There were strong points of view, a clear willingness to challenge each other on the subject and, at the same time, lots of soul-searching.
There was a strong as steel parallel issue there, too: “I thought I’d be running emergencies. What the hell is this?” Me and my partners asked ourselves the same 30 years ago. I recall our projecting we could see it getting worse. It clearly has!
Now, I offer an opportunity for all the private ambulance company owners, my Supervisors, and all the County officials I’ve gone head to head with in my career to roll over in their graves. (…and forgive me, if any are still alive, we’re talkin’ decades ago!) I will now state the opposite of what my life stood for as a medic:
SAVING LIVES IS ALL ABOUT BUSINESS!
That’s the way things work here in the US. Radio-transmitted telemetry, for example, was developed for the space program so the astronaut’s hearts could be monitored during the trip. Someone recognized its applicability to on-ground emergencies, but we’d still be exclusively taking pulses were it not for someone else figuring he could make money.
Taking a broad generalization for illustrative purposes only, can you see that every point from that moment on was about creating a market for those goods? And even if that’s not quite accurate, can you at least see that the altruistic innovators had to enlist the support of the business world to get things done? To do THAT, someone had to translate saving lives into an equation that included money. My only observation is, if you look where it started – especially since we are an incredibly high-tech industry – you’ll find someone seeking profit. (If I can be refuted here, I’m happy to be.)
The character of modern day medicine is driven by market forces. Believe you me, the day after paramedic level of services can no longer be taken as a tax write-off, you’re going to be back to load and go!
I proposed my overview of the relationship between the people and modern-day healthcare in the thread mentioned above. I’d like to expand the perspective.
As medicine became more specialized and the people’s ACCESS to personally-delivered medical care diminished, there were fewer and fewer places to go for people seeking help and/or reassurance on medical situations they faced. The experiences you shared with me illuminated that – especially since the societal structure has bred the people to depend more on the professional than their peers, neighbors and relatives.
The character of what you do today, with the rare exception of those few services that exclusively respond to emergencies, is that your job is to pick up the slack of what the medical system does not want to deal with: human beings with their everyday, routine medical (and psychological because most people cannot afford a shrink!) maladies.
We’re at the bottom of the food chain because we’re the only guys who will actually GO TO THEM. Everyone else is doing a splendid job, but let’s face it, if you can’t get to them under your own power (spelled U-S, too!) then you don’t get the help you need.
What you are is an expression of a system designed to carry the burden of first response (and remember, I said NOTHING about emergency response) so the professionals above you don’t have to. We’re first responders to more than we were told!
More and more people are using emergency services as primary care evaluation services – a kind of Mobile Medical Intervention Services. In fact, I like that term so much, I’m gonna make it an acronym (MMIS) and keep referring to it in my writings!
I feel like the guy who comes to the party late and tells everyone they gotta turn the music down, but folks, get a clue, in the majority, EMS are really MMIS. And, with my generation, the Baby Boomers, and me coming around the bend into sunset, the numbers of routine non-emergency transports or interventions are going to increase considerably. (At heart, we’re wimps, and even more disoriented because we remember how it once was, and we ARE confused over the way things are now and need your help! Please, I beg you - especially when I wet the gurney, have pity!)
The forces that define our relationships with our patients are economic as well. As medical care gets further and further away from the people taking care of each other, it’s got to go to the only professionals to whom they have access. Rich folks get doctors to their houses, did you know that?
Also, the way it’s set up – because we keep telling ourselves and others that we’re basically a humanitarian service – if we’re called to an emergency, we don’t wait for the cash before we render treatment. Do the poor have access to anything better?
Your job, in a larger part than you're willing to admit, is to intervene for the poor.
(I want you to know that it is only since spending time on this site that these things began to string together for me. You’ve been huge teachers and I thank you!)
So, the economic forces, contributed to by the professionalization of routine health care has put every EMS provider between a rock and a hard place.
How do you possibly fill all these ambulances with personnel (to take care of that huge population in need) if you tell the applicants that what they really are enrolled in is an MMIS that, out of necessity, must take care of the occasional true emergency?
Is this a conspiracy? No, as much as I grew up on those kinda theories I have to say it is not. EMS advertises itself as something you enter to save lives, but IT CANNOT EXIST UNLESS IT’S TAKING CARE OF THE MEDICAL RUNOFF THAT THE SYSTEM GENERATES WHILE CONFORMING TO ECONOMIC FORCES.
Every hack I know who went into management did so with the knowledge that you had to attend to economic realities first or you’d never get to do the important stuff. Still, he or she would cling to the idea, and promote and even Sell it, that EMS is about emergencies.
Just like the advertisement that gets you into the Appliance Store to see the nifty-thrifty $200 refrigerator where you encounter the salesman that makes sure you walk out with the $1,050.00 model with the bells and whistles, you’ve been asked to invest your lives in emergencies and have been given the keys to an Ambu-van.
But it is not your stupidity that got you there, nor is it a plot by the multi-national corporations to make you their pawns. It is the basic struggle where altruism must conform to economic forces in order to get things done.
And EVERYBODY, because they want to think of themselves and each other as responsive, altruistic human beings, employs denial of what is to keep the system alive so it can do the good it is asked to do.
There was a strong as steel parallel issue there, too: “I thought I’d be running emergencies. What the hell is this?” Me and my partners asked ourselves the same 30 years ago. I recall our projecting we could see it getting worse. It clearly has!
Now, I offer an opportunity for all the private ambulance company owners, my Supervisors, and all the County officials I’ve gone head to head with in my career to roll over in their graves. (…and forgive me, if any are still alive, we’re talkin’ decades ago!) I will now state the opposite of what my life stood for as a medic:
SAVING LIVES IS ALL ABOUT BUSINESS!
That’s the way things work here in the US. Radio-transmitted telemetry, for example, was developed for the space program so the astronaut’s hearts could be monitored during the trip. Someone recognized its applicability to on-ground emergencies, but we’d still be exclusively taking pulses were it not for someone else figuring he could make money.
Taking a broad generalization for illustrative purposes only, can you see that every point from that moment on was about creating a market for those goods? And even if that’s not quite accurate, can you at least see that the altruistic innovators had to enlist the support of the business world to get things done? To do THAT, someone had to translate saving lives into an equation that included money. My only observation is, if you look where it started – especially since we are an incredibly high-tech industry – you’ll find someone seeking profit. (If I can be refuted here, I’m happy to be.)
The character of modern day medicine is driven by market forces. Believe you me, the day after paramedic level of services can no longer be taken as a tax write-off, you’re going to be back to load and go!
I proposed my overview of the relationship between the people and modern-day healthcare in the thread mentioned above. I’d like to expand the perspective.
As medicine became more specialized and the people’s ACCESS to personally-delivered medical care diminished, there were fewer and fewer places to go for people seeking help and/or reassurance on medical situations they faced. The experiences you shared with me illuminated that – especially since the societal structure has bred the people to depend more on the professional than their peers, neighbors and relatives.
The character of what you do today, with the rare exception of those few services that exclusively respond to emergencies, is that your job is to pick up the slack of what the medical system does not want to deal with: human beings with their everyday, routine medical (and psychological because most people cannot afford a shrink!) maladies.
We’re at the bottom of the food chain because we’re the only guys who will actually GO TO THEM. Everyone else is doing a splendid job, but let’s face it, if you can’t get to them under your own power (spelled U-S, too!) then you don’t get the help you need.
What you are is an expression of a system designed to carry the burden of first response (and remember, I said NOTHING about emergency response) so the professionals above you don’t have to. We’re first responders to more than we were told!
More and more people are using emergency services as primary care evaluation services – a kind of Mobile Medical Intervention Services. In fact, I like that term so much, I’m gonna make it an acronym (MMIS) and keep referring to it in my writings!
I feel like the guy who comes to the party late and tells everyone they gotta turn the music down, but folks, get a clue, in the majority, EMS are really MMIS. And, with my generation, the Baby Boomers, and me coming around the bend into sunset, the numbers of routine non-emergency transports or interventions are going to increase considerably. (At heart, we’re wimps, and even more disoriented because we remember how it once was, and we ARE confused over the way things are now and need your help! Please, I beg you - especially when I wet the gurney, have pity!)
The forces that define our relationships with our patients are economic as well. As medical care gets further and further away from the people taking care of each other, it’s got to go to the only professionals to whom they have access. Rich folks get doctors to their houses, did you know that?
Also, the way it’s set up – because we keep telling ourselves and others that we’re basically a humanitarian service – if we’re called to an emergency, we don’t wait for the cash before we render treatment. Do the poor have access to anything better?
Your job, in a larger part than you're willing to admit, is to intervene for the poor.
(I want you to know that it is only since spending time on this site that these things began to string together for me. You’ve been huge teachers and I thank you!)
So, the economic forces, contributed to by the professionalization of routine health care has put every EMS provider between a rock and a hard place.
How do you possibly fill all these ambulances with personnel (to take care of that huge population in need) if you tell the applicants that what they really are enrolled in is an MMIS that, out of necessity, must take care of the occasional true emergency?
Is this a conspiracy? No, as much as I grew up on those kinda theories I have to say it is not. EMS advertises itself as something you enter to save lives, but IT CANNOT EXIST UNLESS IT’S TAKING CARE OF THE MEDICAL RUNOFF THAT THE SYSTEM GENERATES WHILE CONFORMING TO ECONOMIC FORCES.
Every hack I know who went into management did so with the knowledge that you had to attend to economic realities first or you’d never get to do the important stuff. Still, he or she would cling to the idea, and promote and even Sell it, that EMS is about emergencies.
Just like the advertisement that gets you into the Appliance Store to see the nifty-thrifty $200 refrigerator where you encounter the salesman that makes sure you walk out with the $1,050.00 model with the bells and whistles, you’ve been asked to invest your lives in emergencies and have been given the keys to an Ambu-van.
But it is not your stupidity that got you there, nor is it a plot by the multi-national corporations to make you their pawns. It is the basic struggle where altruism must conform to economic forces in order to get things done.
And EVERYBODY, because they want to think of themselves and each other as responsive, altruistic human beings, employs denial of what is to keep the system alive so it can do the good it is asked to do.
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