ATTENTION: Politicians and Others trying to “Fix” healthcare. Read this. Countless message boards, blogs, magazine articles, and ambulance bay conversations have all been hitting on the same topic for as long as I’ve been in the game: EMS needs to change. HappyMedic has been hitting the issue hard lately, and I want to jump on the bandwagon. While we may not always share exactly the same opinions, we both see a future destination that looks different than where we are today. This blog has always been about me trying to find a way to change EMS from the inside. I want EMS people to determine the destiny of the profession. We need to take ownership of our own industry and our own careers. Our job is to improve ourselves to improve our service to our communities. No outside influence will do it for us in a way that we will be happy with. So here I declare: I own my profession. I am a paramedic and am proud of what I am, what I do, and who we are. You should do the same. Right now. Say it out loud and freak out your coworkers and/or spouse (ok, and/or your cat) ———————————————- Why did I separate out the post? Because I think that enough people have talked about changing things for the better without offering up plans for actual ACTION. This post is about action. Here’s my dream: Here’s the idea: An Ambulance to the ER is THE MOST EXPENSIVE FORM of primary health care. Unfortunately, a good percentage of the population uses EMS and the Emergency Healthcare System as their primary healthcare system. We are the safety net for those that have no insurance and/or no other form of primary health care. People from all walks of life are forced to use us. In addition to the people who we would first identify as the “system abusers”, the homeless and the poor who cannot possibly afford to pay for a doctor visit or afford insurance, people such as small business owners and the self employed who cannot find affordable insurance are grouped in there as well. These “working poor” are apt to keep working until their condition grows to be too much for them to handle. Ever seen a farmer die of a sinus infection? I have. This guy had well over one million dollars invested in his business… and he died because primary care wasn’t affordable or accessible to him. He even was an EMT for the local ambulance service for goodness’ sake! Picture the following scenario: Your unit is dispatched to a 25yo female patient with the common complaint of “difficulty breathing”. Upon your arrival on scene you find an otherwise healthy appearing female patient complaining of chest pain and respiratory congestion. She states that she has been having a severe, productive cough producing yellowish/green mucous that is severely painful in her chest when she coughs. She states that it “Feels like she cannot catch her breath” and that every time she takes a deep breath she goes into a coughing fit and “almost passes out”. Auscultation (listening) to her lung sounds reveals diffuse wheezing and coarse rhonchi. Listening to the lungs is made more difficult by the fact that every time she tries to take a deep breath for you, she coughs and cries out in pain from the “burning” in her chest. She has a temperature of 101deg and has been blowing her nose with sinus drainage as well. In the house, there are two young children running around and she states that her husband is at work. The above presentation is pretty common, and while a more detailed assessment is needed to make a thorough diagnosis, the presentation should point you in the direction of bronchitis. As I see it, there are two possible treatment paths here. One is what would happen today, and the other is what could happen in my dreams. Treatment path #1: The paramedics load her up in the ambulance on the stretcher after spending an hour with the patient on the phone trying to find her mother to watch the kids. They place her on an EKG per protocol due to her “chest pain” even though they know that it most probably isn’t cardiac in nature. It’s fine. They recheck her vital signs, which are fine, and give her a proventil/atrovent nebulizer to clear her lungs a bit and make her feel better. They transport her uneventfully to the ER, where she is placed in triage and waits 4 hours. When she is finally admitted to the ER the nurse rechecks everything and doesn’t read the report from the paramedics who were on scene. The physician (or, most probably the physicians’ assistant in the “Fast Track” section of the ER) diagnoses the patient with bronchitis, prescribes an albuterol inhaler and an antibiotic, and sends her home with an order to find a primary care physician and be seen for follow up care. The patient doesn’t have insurance and doesn’t follow up. Total Cost? Unknown… but probably upwards of $7000.00 billed to Medicaid/Private Insurance or to the patient, who can’t pay. Treatment path #2: All of the above assessment findings. However, this time, the paramedics do all of the same treatment. This time they record a 12-lead EKG and complete a detailed physical assessment ruling out things like a mass in the lung, bacterial pneumonia, and other conditions. They prescribe an albuterol inhaler and an antibiotic after giving the patient a proventi/atrovent nebulizer treatment to make her feel better. They give her a “front of the line” pass to the local immediate care clinic or to the waiting line of the primary care physician of her choice. The patient is treated and released with firm instructions to call 911 or seek additional treatment if her symptoms worsen or do not improve with the prescriptions. A follow up phone call is scheduled to the patient in the computer system. Total Cost? Unknown for sure… but probably around $200 bucks. Here’s where this plan will work. We need to improve EMS educational standards and raise the level of care that we can give. If the insurance companies or the big healthcare payers learn about the astronomical cost savings available to them by utilizing Paramedics who are true Emergency Healthcare Providers instead of Acute Care Specialists, they will jump on the bandwagon. Here lies a plan to decrease healthcare costs by billions of dollars while expanding primary care to millions of people who cannot afford it or have access to it. What do you think? Comments are very much welcome. —————————————– Thank you all for reading my ramblings. Let’s build the momentum. For additional reading: The Current US Economy and EMS: An Unexplored potential The Current US Economy and EMS: An In-Depth look at how this mess will affect 911 in your community That does it! I’m changing this thing (from Yourhappymedic.blogspot.com)
