I see that irony just doesn't seem to work on this forum.
People are people, injuries are injuries, doesn't matter where they are, how it happened or why.
Obviously there are differences between living in a big city and way out yonder in the country.
None of which matters when it comes to things like standardizing health care. Standardising doesn't have to mean that everyone gets the same brand of bandage or that the person that's out in the woods get treated the same as the guy who's collapsed on a street corner.
Have statewide, national would be better but you have to start somewhere, where was I, oh yeah, have standards of care with things like transport time and access to trauma centers and geography taken into account, standardise the training of the responders to actually be health care providers able to make informed decisions about patient treatment instead of absolute minimally trained ambulance drivers,charge the citizens at large for what is, after all, a public service and have at it.
The idea that because one lives in a rural area that they don't deserve the same access to emergency health care is simply ludicrous. The idea that an EMT working in say Los Angeles county can only treat up to a certain point while an EMT working in Riverside county can do more or less is simply ludicrous. If I live in one county or one state and happen to be traveling thru another, has my need for health care magically changed?
As is the idea that county/local/state governments need to mandate health care to the degree that they do is simply outdated. As someone wrote earlier, people bleed the same everywhere.
We need to look at the bigger picture and quit focusing on the same old, same old.
Feel free to disagree.
John E.
P.S. there was nothing uninformed about my earlier expressed opinion.
I happen to agree with you, almost entirely. It is the right way to think, it's the right end goal. I disagree with the execution.
Again, without starting the rural v urban or the ALS v BLS debate, it's hard to have the same standards of care everywhere. In the city, its great to say that we will get any patient on whom we appreciate a STEMI to a hospital with PCI within X minutes for the optimum door-to-balloon time (or onset of symptoms-to-balloon time), and we may be able to achieve that goal 90% of the time. That same patient, presenting in a more rural environment may not get to the hospital for X+ 40 minutes, and that may not be a PCI hospital. They both deserve the same standard of care, not disagreement, it just isn’t possible without bringing alternative technology (HEMS is a different discussion).
Another issue inherent in this (again, I’m not trying to revive the vollie debate) is differences in training, experience and monitoring. BostonEMS boasts that because they have a very busy system, and fairly few medics, statistically, each medic averages one tube/month. Because of this, they maintain a very high level of proficiency, and although I don’t have the numbers in front of me, a very high accuracy rate compared to national rates. Can more urban departments maintain that level of proficiency where they MIGHT get one tube every year...? Probably not! Do those more rural patients deserve the same standard of care, of course! There is only so much these departments that only get 200 calls/year can do to keep up their stills. Fred the Head only does so much, and it’s often impractical for these medics to keep up their skills on cadavers. Hey, there was even a town (in of all places, MA) this week that was found to have falsified training records—for several years.
It's hard enough maintaining the staff required to stay in service, let alone maintaining the required training/certifications, then trying to add on additional in-service trainings, it becomes impossible. I saw a study (again, I don’t have it in front of me) that said that skill retention for compressions (CPR) is 8-9 months. Everybody complains that ARC is only a 1-year certification, and the standard for professional rescuer is AHA (I know, there are other reasons).
I happen to live and work in the great state of Taxachusetts. We were just rated as having the best emergency health care system in the country (that isn’t saying much), yet we were rated 33 (D) for Medical Liability Environment. The average malpractice award payment is among the highest in the nation: $437,000 compared to the $285,218 average across the states. This causes a policy environment, where doctors need to over-test, suspecting the zebra (not the horse) when they hear footsteps, just in case. That leads our OEMS to be uber-conservative, and among the least progressive states in the country re: new protocols and procedures.
The idea that we should have universal national protocols scares me. I agree with national treatment guidelines, an aspiration, but I just don’t see it to be practical everywhere.
Do you have an idea of where I am coming from? Am I making sense?
