Mark Glencourse (Medic999) wrote a very interesting blog today. It made me and his other readers think and laugh a bit (I think MsParamedic piddled her pants). I realized that the comment I made was a bit lengthy and full of Jake, so here it is:
MedicJake:
Great post, Mark. I've never worked outside of California, but I'm guessing that every medic in an urban/metro system eventually encounters that call. I've seen partners handle the same circumstance very differently, sometimes based on knowledge and experience, and sometimes tragically based on burnout and fatigue.
I always try to over-triage if there is any question. If I'm not sure, I give the pt the benefit of the doubt, and at least don't chastise them during their performance. With the strange atypical seizures that you mentioned, that are at least common enough for us to occasionally encounter, there's only one way to be sure; portable EEG. A patient can be the best actor in the world, but brainwaves don't lie. The technology exists, and is used in other areas of healthcare, just not EMS.
The day will come when our cardiac monitor, EEG, portable ultrasound, blood analyzer, other diagnostic tools and the charting computer will all be integrated into something nearly pocket-size, like a Star Trek tricorder (Geek? Yes.), and we'll all be educated and trained to use them. People scoffed over the idea of a telephone, a TV, a VTR ( a what?), a stereo, and a personal computer all being the same posket-size device, that wouldn't need any wires to hook it up, and could store every song and movie you've ever heard or watched or even wanted to, and guess what - I'm bloggin on one right now. I can't wait to see how the technology changes over the next few decades.
Where I work we have a frequency of "acute mood disorders" that tend to have higher prevalence among certain ethnicities, which of course lends them the same kind of inappropriate and derogaatory acronyms and nicknames that medics tend to assign things. Anyhow, it seems that the most effective treatment for these emotional emergencies also tends to work on many pseudo-seizures; remove the audience, and the performance stops. If not, then like a crying baby they'll stop eventually, or you'll find out that they have tourette's syndrome or a brain tumor and look like a...gosh darn fool...
You hit the nail on the head I think though with your mentioning things like patterns of movement, incontinence, facial muscle activity, and other the little hints that without being able to analyze a brain's electrical activity in the field are our best diagnostic tools. Our minds and bodies are very reliable tools, and I hope that even once we get new technology in the field that medics will maintain their ability to assess patients excellently without technology at their aid.
Medic999:
Thanks for the comment Jake!
I like the idea of a portable EEG!!
I have a consultant at my local hospital who wants us to start using Ultra Sound Fast Scans in the prehospital environment. Im sure it would be here already if they werent so damn expensive!
MedicJake:
I recall seeing an article in JEMS about a small EMS system in the US using portable ultrasound fast scans in the field. I think it was somewhere in the midwest, possibly Ohio. I'll look for the article. The medics all got special training from physicians in how to interpret the images to look for findings in trauma patients that would justify trauma pre-alerts. I think it was supposed to be a trial study to see if it had an effect on over-triage and under-traige of trauma activations. Of course the cost is the biggest issue. It will be a long time before most of us will ever see them.
MedicJake:
Temple Terrace, Florida.
http://northeast2.tbo.com/content/2009/nov/04/ne-local-paramedics-get-new-diagnosis-tool/
READ MARK'S BLOG NOW! CLICK ME!
Sunday, March 28, 2010
Tuesday, March 23, 2010
Wasn't it socialism already?
Many are mad about the healthcare reform bill. I keep hearing it called "socialist". I choose not to agree, or disagree, because like most American policies it is a compromise between socialism and capitalism, and other -isms. Consider the following:
Before the reform bill, noone was required to carry health insurance. When the uninsured got sick though, hospitals and ambulance providers were required to provide them care, whether they could or would pay for it or not. All people were granted the right to free healthcare (socialism).
Healthcare providers (hospitals, ambulance companies, etc.) have to pay for their costs somehow, and many of their patients are uninsured and can't afford to pay (about half where I live). To cover these costs the providers bill those who can pay at higher rates. Government insurances refuse to pay more than a given amount, so healthcare providers increase billing rates even more to get more money out of private insurances, resulting in higher insurance premiums for the working class. The working class has been forced to pay higher premiums to cover the cost of the uninsured and taxed to provide government healthcare those who qualify. Those who can afford it have been forced to pay for the healthcare of those who can't so that we all get the same benefits (communism).
Now after the bill is enacted, everyone will be required to have health insurance. This will mean more business for insurance companies, more competition, and lower premiums eventually, and probably very quickly. This will mean that every person is required to pay for their own services, on a fees-for-service basis, and no longer able to rely on society to pay their bills for them (capitalism).
It is true that if you only view it from the standpoint that we are being told what to do, then yes it seems very...whatever you want to call it. The fact is that the only other "capitalistic" option is to remove laws that require hospitals and ambulance providers to provide care to everyone regardless of ability to pay. We can let paramedics and triage nurses require insurance cards or cash-in-hand before giving assessments and treatments just like they do at the doctor's office. If you think that would be unjust because "all people are entitled to healthcare", well that is a socialist ideal, and you really want socialism so just think about that.
From my point of view as a paramedic I think that the new healthcare reform bill will be good for people's well being in the long run. People will be healthier because not only will they have healthcare, but they will be able to go to the doctor anytime, and the sooner they go, the cheaper it will be. I have seen all too many times a patient wait through being ill because they couldn't afford to go in, until they were so critically ill that they had no choice, in turn changing what could have been a $100 doctor visit into a $20,000+ visit to the ICU.
The fact is that illnesses, like accidents, just happen. We are required to have car insurnace because of this, and so it only makes sense to have health insurance too. My fiancée had an emergency appendectomy last year. Without warning she was ill, in the ER, in surgery, and then admitted for a total cost after just a couple days of over $50,000. Without insurance...well you can imagine.
Think about what really is socialist, communist, capitalist, or whatever -ist label you want to put on our society before you rant too much. If you really want a truly and fully capitalist healthcare system, be willing to be the one to swipe credit cards and turn away the uninsured at the emergency room doors.
Before the reform bill, noone was required to carry health insurance. When the uninsured got sick though, hospitals and ambulance providers were required to provide them care, whether they could or would pay for it or not. All people were granted the right to free healthcare (socialism).
Healthcare providers (hospitals, ambulance companies, etc.) have to pay for their costs somehow, and many of their patients are uninsured and can't afford to pay (about half where I live). To cover these costs the providers bill those who can pay at higher rates. Government insurances refuse to pay more than a given amount, so healthcare providers increase billing rates even more to get more money out of private insurances, resulting in higher insurance premiums for the working class. The working class has been forced to pay higher premiums to cover the cost of the uninsured and taxed to provide government healthcare those who qualify. Those who can afford it have been forced to pay for the healthcare of those who can't so that we all get the same benefits (communism).
Now after the bill is enacted, everyone will be required to have health insurance. This will mean more business for insurance companies, more competition, and lower premiums eventually, and probably very quickly. This will mean that every person is required to pay for their own services, on a fees-for-service basis, and no longer able to rely on society to pay their bills for them (capitalism).
It is true that if you only view it from the standpoint that we are being told what to do, then yes it seems very...whatever you want to call it. The fact is that the only other "capitalistic" option is to remove laws that require hospitals and ambulance providers to provide care to everyone regardless of ability to pay. We can let paramedics and triage nurses require insurance cards or cash-in-hand before giving assessments and treatments just like they do at the doctor's office. If you think that would be unjust because "all people are entitled to healthcare", well that is a socialist ideal, and you really want socialism so just think about that.
From my point of view as a paramedic I think that the new healthcare reform bill will be good for people's well being in the long run. People will be healthier because not only will they have healthcare, but they will be able to go to the doctor anytime, and the sooner they go, the cheaper it will be. I have seen all too many times a patient wait through being ill because they couldn't afford to go in, until they were so critically ill that they had no choice, in turn changing what could have been a $100 doctor visit into a $20,000+ visit to the ICU.
The fact is that illnesses, like accidents, just happen. We are required to have car insurnace because of this, and so it only makes sense to have health insurance too. My fiancée had an emergency appendectomy last year. Without warning she was ill, in the ER, in surgery, and then admitted for a total cost after just a couple days of over $50,000. Without insurance...well you can imagine.
Think about what really is socialist, communist, capitalist, or whatever -ist label you want to put on our society before you rant too much. If you really want a truly and fully capitalist healthcare system, be willing to be the one to swipe credit cards and turn away the uninsured at the emergency room doors.
Subscribe to:
Posts (Atom)
