One of the educational sessions I attended this past week had to do with ethics in EMS. The instructor said something that butted right against an issue I already have.
He pointed out that attending a training conference is, in part, a decision based on ethics.
What?
He went on to ask how it had been decided who would attend the conference, whether their agency was paying for it, what was included in what was paid for (are people going out drinking on taxpayers' money?), and- most importantly- if the people who are the most motivated and most interested in continuing their education are at the conference, who is left behind to take care of the community?
And boy, did that hit one of my triggers.
One of the things that became extremely apparent early on is that working with a small volunteer agency in the middle of nowhere, whether or not I was home when we got a call could potentially made a HUGE difference to patient care.
I had an instructor tell me not to worry about it, that if I didn't go, "someone else would."
Well... not so much. There have been times when we have had only two active EMTs, and if we weren't home, then there would NOT be "someone else" to go. We are in a slightly better position now, with three. Yes, the transporting agency that takes our patients to the hospital will eventually show up, but they are coming from further away. On a good day, when they have an available ambulance that is at their base, and when the call is for an address on the "near side" of our town, they can get to the call in about ten minutes. But if they are coming from the hospital, and the call is on the "far side" of our little town, it can take them over half an hour to get there, even going hot. I'm sure I don't need to tell you that a response time of half an hour (or more) is simply not acceptable in a true emergency.
I had to learn to deal with the fact that while I have no personal legal responsibility to stay home in case there is a call, I need to consider the implications of delayed patient care if I'm not able to go to a call. For most calls, it isn't such a big deal. There's no immediate life threat, and while I'd still like to be there and provide superior patient care to someone in my community- many of whom are people I know- I can trust that they will be cared for appropriately and adequately. But sometimes, it DOES matter, and it can matter a LOT.
Consider this last academic semester.
Of the three active EMTs, all three of us worked well outside our response area at the same time on one day a week. That meant that during that time, our town had NO COVERAGE from our agency, and relied only on the transporting agency, coming from further away. There was nothing any of us could do about it. And yes, there were some calls during that time slot where I really wish at least one of us had been there.
So now, here I was at a training conference, being reminded that the simple fact of my being there, and not here, could mean that someone in my community would not have access to care in their time of need. Fortunately, that didn't happen.
But a couple of months ago, two of us went to a training conference together.
And in between, we had a period of several weeks where there were only two of us available, and I ran into the other one at the grocery store in the nearest real town, when we suddenly realized no one was minding the hen house, so to speak.
Can an agency provide effective EMS with only two responders? Or one, much of the time?
Do we need to stay in constant contact, letting each other know every move we make so when one of is at the store, or goes to a social event, or visits family elsewhere, the other can clear their schedule and stay in town? Do we need to forget about that glass of wine with dinner, because then, by company policy, we need to stay out of service for several hours, and it might leave the town without an EMT?
The answer MUST BE that no, we cannot be expected to bear that level of responsibility.
And yet...
Part of me wants to send out a mailer to the people on the far side of town, making sure they understand that if they have heart problems, they better get them taken care of because if they go down, it's likely no one will get to them quickly enough to make any difference. To suggest that older people not live alone past a certain street address. To put signs along the main roadway that say "Caution: delayed EMS zone. Please drive carefully!"
I don't see a solution.
Some people say we need to change to having paid providers out here, but there are significant barriers to that idea, only one of them being the expense.
The local town board has apparently bought into some "study" nearby students have done, that spell out "the problems in EMS," focusing on issues that aren't really the problems we have here. They want to put effort into "educating the public" so that they don't "abuse the EMS system" by calling 911 for non-emergent things. For the most part, we don't have that problem, We need to educate the public to CALL SOONER when they are in trouble. Call 911 before calling your son, your neighbor, your childhood best friend, and anyone else who isn't in a position to actually help you. Get help rolling towards you before it's too late.
I think our only reasonable path has to be better recruitment and retention, with perhaps some legislative action that provides some sort of incentives or benefits for volunteers. We can't raise taxes enough to pay for 24/7 coverage where by far, most of the time, those employees would sit there doing nothing for days at a time- but maybe we can find enough financial support to encourage more volunteers to share that load.
If we don't, the simple truth is that people will die.
Maybe even me, if the other 2 EMTs aren't home.
This is not only a national problem, it's very much a PERSONAL one.
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