Street Saint: Emergency at the Emergency Services

A veteran paramedic declares an emergency in our nation s trauma care system, decries the declining standards within the commercial ambulance corps and hospital emergency rooms, and offers a first-hand account of the emergency care system. In a dramatic semi-autobiographical volume he points out several factors driving the decline: the abuse of the system by the non-emergency patients, the distortions produced by fiscal requirements, the decline in personnel training. Television programs featuring emergency medicine created a hype that brought would-be heroes to the profession. Many of them would have preferred careers with the police or fire departments, but lacked the necessary physical or mental attributes, and opted for EMS instead. The onslaught of patients has forced the system to confer licenses on people with the barest of training and forces those who are already overworked to train them. The profession had two options to stay in business and remain profitable: cut the number of practitioners, or increase the number of patients. Seeing those who don t need to be seen generates income and positive statistics, while it perpetuates a reportable loss to substantiate the need for more money. Our lives are in danger. People depend on the finest trained medical profession in the world, but that profession no longer exists. Field treatment for a heart attack was once done with lights and sirens and breakneck speed, and the patients were told to take it easy for as long as they lived. The ride to the hospital increased the patient s anxiety and blood pressure and raced them closer to death; those were some of the 40% who died. After the advent of paramedicine, patients were kept calm, were stabilized, and were pain free and stable at ER arrival. Paramedics could utilize telemetry, including twelve lead assessments, and send it to hospitals or even a cardiologist hundreds of miles away. That meant that thrombolitic therapy, once given in intensive care units after emergency room diagnosis, could be started immediately. The patient often returned to a life more active than he had lived before the incident. Now, there is no time. Other calls are left hanging as a 911-abuser demands immediate gratification by adding shortness of breath to a complaint. Lawyers have been allowed to advertise and create the impression that every fender-bender might lead to a life of leisure. The heart attack patient is again being treated with lights and sirens, and often spends the maximum number of Medicare days in intensive care before being sent for cardiac cath lab; three days after infliction, instead of 30 minutes, as would have been done in a hospital not dependent on government money. "