One of the paramedics I work with on a regular basis regularly goes on rants about how we respond to calls. Technically he goes on rants about WHO responds to medical emergencies in Sort of Big City. In many cases (realistically too many) the fire department responds, lights a’flashing, siren blaring, riding and a’roping – Sorry, Mel Brooks moment there. But you get the point. They rush to calls with their 1/4 of a Million Dollar trucks and do… nothing. Nothing of benefit medically because much of the time the Oxygen they give is unneeded and there is little else in their medical kit that is of much use. “When the only tool you have is a hammer…”
I know all of this, so does my partner, if you are in EMS, you probably know it too. In fact everyone involved in the decision making process probably knows it. So, you ask, why do we send the fire department to medical calls when they have no useful role to play?
Politics.
That ugly word.
Speaking of ugly, here is an ugly truth about EMS that most people in EMS won’t admit to.
To the people who call 9-1-1 for an ambulance only one thing matters.
Response time. Overwhelmingly they don’t care or know who is staffing the ambulance. It could be two paramedics, two EMTs, two furniture movers. People don’t care, they just want someone to show up in their time of need.
The vast majority of complaints that EMS systems receive involve response times. Not the level or type of provider or even the type of medical care. It’s how fast the ambulance or someone pulls up to the front door. It doesn’t even matter if the call is for a cardiac problem or a toothache. If someone calls EMS HQ or City Hall, or the FD HQ and complains that the ambulance took too long, someone is going to have to explain something. In fact, if you’re working for a for profit transfer only ambulance service and Ye Olde Folkes Rest Home calls and complains that your ambulance took too long to come and pick up Mrs. McGillicuddy for her Podiatrist appointment chances are the crew is going to hear about it.
Please understand that I am not endorsing this activity. In fact, I hate it and think that it’s dangerous. And stupid. And all the curse words you’ve no doubt said when you are told to respond lights and siren to a stupid call.
Yes, I know that Medical Priority Dispatch has different response levels. That’s great in theory, but I’d be willing to bet that your dispatcher has buffed up a call or two to get a faster response. I’d be willing to bet that your management knows about that, but doesn’t do one thing to stop it. Because in the end it’s about how fast we get to the call, not what we do once we get there.
To quote Taggart, “I am depressed.”
I fight this fight a lot, even though we provide a fire-based EMS service. We chase all ambulance calls with a light squad to provide lifting help and an extra set or two of hands, since dispatch info is ALWAYS complete and accurate. When I passed a rule down three years ago that this squad will respond NON-EMERGENT on most calls, you would have thought I canceled Christmas. Everyone wants to make the woo-woo lights go. And look at me! I’m a hero! The mindset is hard to change.
It gets old after a while. That lights and siren thing, that is.
I do have to wonder what will happen to you when someone doesn’t get, or at least things they didn’t get, their response quickly enough?
We’re a volunteer outfit. When you show up 7 minutes after the tone out, you get, “WHAT TOOK YOU SOOO LONG!?!?!?!?!?!?!?!?!!!11!!eleventy!!”
Then two weeks later the same person calls the station to complain about the “Blue Light Commandos” racing up the street to the fire station.
We floated a referendum last February to pay a small stipend to the folks dumb enough to be on-call. It was close (as could be expected in this economy), but it passed. I keep waiting for the demand that we cut that seven minutes down (the station is on the edge of town). The only answer is 24/7 staffing. I’d love to do it, but there’s just no money for it. Nothing bad has happened yet; we’re lucky in that we’ve provided ALS service for the past ten years (with a handful of saves, besides). So far, nothing but the hysterical family member at the scene (who typically calls back a day or two later and apologizes). But how long can that continue?
(And that was a lot of parenthetical expressions. Sorry about that. I’ve had a couple of woe-is-me beers.)
I’ve written before about the trade offs of living in rural areas. You get beautiful scenery and often very friendly neighbors, but you are also remote from medical help if something goes wrong. You can’t have both, it seems.
We did this to ourselves. It’s the only area of healthcare where people can expect immediate treatment and get it. Hell, people go into emergency rooms and expect to wait.
Like you said, politics.