WhiteCoat

The Importance of Emergency Medical Services

There has been a lot of “spinning” of the tragic shooting that occurred in Colorado last week.

More guns. Less guns. Democratic policy issues. Republican policy issues.

I’m going to try not to add my spin to the mix, but I do want to raise one issue for everyone to consider.

As this event unfolded, there were many stories about how there were delays in EMS response and how police were “pleading” for ambulances to get to the scene. You can read about the issues involved at the link.

The point I want everyone to think about is the importance of emergency medical services.

I regularly post about hospitals closing their emergency departments. US cities have lost 30% of their emergency departments in the past 20 years. Earlier this week I posted an article about some “expert” in England who believed care would be improved by closing emergency departments and consolidating care.

There are many issues that influence the availability of emergency medical care which I am not going to list at this point to avoid trying to “spin” the issue. You all can debate them in the comments section if you’d like.

Just consider that when a mass casualty event occurs in the future … whether it is a natural disaster, a fire, large motor vehicle accident, a shooting, or an act of war … do we really want to make emergency medical care harder to access?

Few people appreciate the importance of emergency medical services until they are the ones having an emergency.

15 Responses to “The Importance of Emergency Medical Services”

  1. GrumpyRN says:

    I’m going to take a bit of issue with you. Rose Johnson is not some “expert”, she IS an expert in emergency medicine. A consultant is the top grade in medicine in UK. The A&E department would not be closed completely, it would be downgraded and take less serious patients with the serious ones going to the level 1 hospital. You are trying to put American systems into the UK. We work differently, not better, or worse but differently.

    If ambulances were missing then surely this is an ambulance problem and trying make it an A&E(ED) problem is wrong.

    • Raf says:

      It also needs to be noted that we still have a (just about) unified health system – you call for an ambulance, the dispatch desk controls every single emergency ambulance in the area and can talk directly to the guys for neighbouring areas.

      We’re also much, much more densely populated than most of the US. When A&E departments are downsized or closed, journey times are typically increased by 3-5 minutes for patients who’d otherwise have been taken to that hospital.

      No comparison really.

    • WhiteCoat says:

      I agree that the systems work differently.
      I also agree that trying to say that one system is better than the other is like saying that an apple tastes better than an orange. Can’t compare the two.

      The intent of this post wasn’t to compare the two systems. Then intent of the posts was to make people think about some of the potential undesirable consequences of cutting emergency medical services.

      The article I cited stated that they were considering “getting rid of one of the county’s two accident and emergency departments – in Worcester and Redditch”. Those two cities are 20 miles apart according to MapQuest. Someone having a heart attack that has to drive an additional 20 miles or more just to get care is not a 3-5 minute difference in trip timing. More like 35 minutes difference in timing according to MapQuest – under ideal traffic conditions and assuming that there are rigs available.

      Whether or not the systems are different, there are many conditions that are time-critical for treatment. Consider strokes, MIs, and major trauma just to name a few. I obviously don’t know the topography, traffic, and landmarks in England, but there are aspects of medicine which are universal. The “golden hour” doesn’t change with a patient’s country, health system, or EMS system.

      • Raf says:

        Assuming that all Redditch patients would instead have to go to Worcester is something of a mistake as the nearest A&E departments to each city are be in the neighbouring county – our counties are small and densely populated. Redditch is very near to the massive Birmingham conurbation, Solihull in particular, about 10 miles closer than it is to Worcester. It’s Redditch that they want to downgrade; so you’re taking a hit of arguably 15 minutes extra travel at worst, in return for a bigger and better equipped A&E department at Worcester with more experienced staff who have more resources to hand. Paramedics are already able to give TPA at scene/on the run to a stroking patient who may not for whatever reason reach the hospital quickly enough, and acute MIs who need to go straight to a cath lab are already diverted to wherever the nearest one is, because 5 or 10 or 20 minutes extra on the road in return for going directly up to angio is saving lives.

        Trauma: the air ambulance service (helicopters in England, Scotland also have planes for some of the most remote islands) for very urgent transport of major trauma cases and select other extremely time-critical patients cuts the travel time to pretty much any hospital in the entire COUNTRY down to a matter of 20-30 minutes. Such patients will be taken directly to the nearest trauma centre/burns unit etc as appropriate, and they’ll generally get there very quickly indeed.

        I genuinely doubt that downgrading Redditch A&E to a minor injuries unit will have any catastrophic effect on people getting the care they need in good time.

      • GrumpyRN says:

        Thank you Raf, you have said it for me.

        Whitecoat, my initial concern was that you were mistaking Rose Johnson as someone with no ED experience/knowledge whereas she is in fact extremely qualified to put forward these recommendations.
        In my area we already work with a system as recommended, what we lose in the 10-15 minutes extra travel time (maximum) we make up for in centralisation of experience, knowledge and facilities.

        Newspapers in this country, and I’m sure in yours, love sensationalising everything. A downgrade becomes a ‘closure’ which then gives the papers something to write about and makes them look like champions of the people. A few years ago we closed an old 18th century hospital in my area which was frankly dangerous, but according to the papers we were going to cause all sorts of harm. it wasn’t until the senior doctors wrote and told the people the truth that the papers stopped.

  2. Steve says:

    Regarding the EMS response to the Aurora shootings- The timeline given in the article was very confusing and needs to answer one question- how long from the time the scene was declared safe until the first ambulance arrived on scene? You can’t send unarmed EMS crews into a hot situation even if they have body armor (which they probably didn’t).

    The cops putting the wounded into their cars and taking off was a good idea. Obviously you would try to avoid doing this in someone with a spinal injury and I feel bad for the next cop that does it and gets sued even if it saves 1,000 lives in the process. One study I read in Philly showed that penetrating trauma patients taken by police to the ED actually had lower mortality- most likely due to faster transport.

    • MamaOnABudget says:

      (Just for reference, I live about 25 miles from Aurora and was following the incident live over scanners and local news)

      One point that you made, Steve, and that we’re still waiting for clarification on was the “safe” declaration. The Aurora PD says that had nothing to do with “delay” (I put that in quotes because there were SEVENTY people shot – they can’t all go at once!). But I guess just recently there was a new law or resolution passed here that disallowed fire/ambulance help anywhere near a crime scene until it was declared safe… and it took a LONG time for that declaration, especially considering the reports the next day that the shooter was apprehended very soon after the shooting right outside the theater.

      Please don’t read this as I’m trying to pass blame – I’m not. This is something that first responders train for, but no training can prep you completely for something of this caliber actually happening. Now that the immediate threat is over, the nit-picking starts over who is responsible for it not going better, happening faster, giving better care, etc. The money hungry are already suing the theater/production company/shooter’s doctor… despite not being one of those shot. God forbid we look at how well things WERE handled as quickly as they were because, thankfully, the health care was there – was open – was able to take them in. Instead of saying “Things would be better if… (ambulances came faster, doctor collected mail sooner, gun laws were stricter/concealed carry had been allowed)” – how about we (generally) put the focus on where the real fault is? The shooter.

      • Vladimir von Winkelstien says:

        The shooter is bonkers. Focusing the blame on him only helps us fail to understand how the shooting is ultimately our fault. If we simply say, “Crazy people should control themselves better”, then this type of thing is going to keep happening.

        The shooter’s own mother knew that he had gone off the deep end, well in advance of the shooting. The whole thing could have been prevented, if there were a non-punitive process in place for her to alert authorities, and for him to be monitored, picked up, and placed in a treatment program.

        But we don’t want to pay for that sort of thing, so shootings by crazy people are going to keep happening. And for that, the fault is ours.

  3. Intelligence says:

    The question that no one has answered adequately is whether any of the victims were potentially intelligence targets. The shooter’s actions and demeanor is consistent with the training received by government assassins. The USA should investigate the shooter’s intelligence contacts.

    • RSDS says:

      Back in the 1970s, there used to be a Navy Intelligence School located on Lowery Air Force Base. Lowery was situated between Denver and Aurora. Go out the Quebec Street gate, and you were in Denver; but go out the Sixth Avenue gate, and you were in Aurora.

  4. Starjack says:

    Part of the reason I want to go into EMS is because if something like the Aurora shootings happens in my hometown, I want to be there to do my part.

    Emergency care, both EMS and ER’s – I mean ED’s – need to be kept accessible to everyone. Not just people who can afford it, or people who live nearby; everyone. I know this creates problems with drug seekers and malingerers, but the alternative is a world where people with true emergencies can’t get good care. Imagine getting into a car crash and having the EMT’s check peoples’ insurance cards before treating them.

  5. Doug says:

    What was the status of mutal aid agreement between Aurora and the surrounding community EMS systems? Once the scope of this incident became apparent why wasn’t a general alert broadcast to the surrounding EMS resources to respond?

  6. Matt says:

    “Just consider that when a mass casualty event occurs in the future … whether it is a natural disaster, a fire, large motor vehicle accident, a shooting, or an act of war … do we really want to make emergency medical care harder to access?”

    Evidently we do. Sounds like the voters and taxpayers have spoken. If they don’t like the current state of affairs, there’s always another election around the corner.

    • WhiteCoat says:

      OK, who are you and what have you done with Matt?
      I’ve agreed with you like twice in the past month. Maybe even three times. What’s happening to me?
      I miss our arguments.

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