Healthcare in America

Healthcare in America

June 26, 2017

Alan E. Perry

Life, Liberty and the pursuit of happiness, as well as several other “civil rights” are afforded by our constitution. Nowhere does it say we will all have healthcare, or for that matter pick-up trucks, big bank accounts, or a reasonable IQ.

Our lives are shaped by our circumstances and how we react and adapt to move ourselves where we want to be. Each person selects their own priorities and accepts the risk and rewards of those decisions. Some plan, make good decisions, accept responsibility and do better. Some are short sighted, irrational and blame others for their misfortune. Granted some get handed circumstances that are inherently more difficult to manage than others purely because of chance, but this is the exception.

Individual health is affected largely by personal choice. There are exceptions to this, but again this is the exception not the norm and not the subject of this discussion. That being said; there are actions individuals can take to manage certain known risk such as hypertension and diabetes. But back to the issue; individuals must accept the responsibility for their health buy treating their bodies with respect, exercising, staying physically active, eating properly, managing their known conditions and avoiding risk that are not necessary.

The assertion of the “universal healthcare” concept is that everyone has a right to exactly the same healthcare, and that those who cannot afford it will receive it at the expense of those who can. This is the definition of socialism; will it stop here? I think not. This “universal healthcare” idea provides no incentive for (in fact punishes) those who take care of themselves and make wise decisions about their body and provides reward for those who squander their own resources and health. As an example, take a 50-year-old male who has taken care of himself and has no medical problems; he used to be able to get health insurance (if he chose to get it at all) at a very reasonable rate based on his age and absence of risk factors. Another 50-year-old male, who has been reckless, excessive and generally abusive to his body and sedentary has multiple medical problems and disabled as a result. Do they both get treated fairly? The healthy one sees his insurance rates and deductibles go up and he is no longer able to save for his retirement. The unhealthy one gets free healthcare and a disability check.

In 1935 President Roosevelt and the Congress legislated the Social security act which created a financial safety net. In 1965 Medicare and Medicaid where added, Medicare provides financial assistance for healthcare to those 65 and over, Medicaid provides financial assistance for healthcare for low income families and individuals. These programs addressed the need for the elderly and the economically disadvantaged to have access to basic healthcare as a safety net, it never intended to put them on par with those who opted for more extravagant treatments and could afford them. Our government has programs to assist those who have trouble obtaining food, housing, medical care and education. It does not guarantee these. NGO’s have typically also assisted with these basic human needs, but again no guarantee.

By guaranteeing universal healthcare we are opening a very large can of parasitic worms and diminishing the value of personal accountability and self-determination. It will not take long before the authors of this malignancy begin demanding that everyone is entitled to a three-bedroom house with a garage, a new pick-up truck, free cable TV and an all-expense paid vacation semi-annually. Look closely, it’s already happening.

We live in a nation founded on the principals of personal responsibility, self-determination and respect and tolerance for those with differing views. It worked then, as it should now, because each person knew with certainty that if they worked and took responsibility for their actions they would have a much better chance of succeeding than those who choose to sit in the bars or street corners and refuse to contribute or better themselves. We raised our children to understand that if you did not become vested in your future and provide for your family there would be undesirable consequences.

As voters and taxpayers what are we to do when the numbers those receiving this ever-growing list of entitlements exceed the numbers of those paying for them. This Nation will collapse if this occurs, and it will be violent. We must find a way to get healthcare out of the corporation’s hands, out of the government’s hands, and back into the hands of the providers and the patient. We must also look at the broader problem that got us here in the first place and acknowledge that while we are all created equal, our decisions, actions and efforts will determine the amount of resources we will have as individuals and a Nation. as Thomas Jefferson put it " Free men are not equal".

The Three-man Medic Company

Three-man Medic Company

By Alan Perry, June 21, 2016

Congratulations on your promotion! Your new assignment is lieutenant on a Medic Company!? It should come as no surprise that the busiest piece of equipment, with the most at stake in the daily performance of it's duties, has finally been elevated to the company level. You and the other personnel assigned to your Medic Company are taking a huge step forward for Emergency Services. Thanks to this new concept your organization will be able to more efficiently and responsibly provide necessary emergency medical services to the public you serve.

“How did this happen?” you ask. Your City Council and the City Manager have been systematically looking at all city department functions looking for ways improve efficiency, reduce costs and improve retention of ALS personnel. The traditional Fire Department staffing model and even its name could be re-aligned to reflect what it actually does. After conducting an “operational effectiveness and efficiency” study and looking at evolving practices in staffing and deployment, the city manager and the interim Fire Chief determined that a major re-alignment of physical and human resources needed to occur. This included adding Company Officers on medics, Field Medical Officer Captains for each battalion and shift, a EMS Duty Chief for each shift, and a Division Chief of EMS.

With nearly 80% of the calls for service being related to medical emergencies, and only 5% actually involving any type of fire, the name has been changed to “Emergency Services”. Every station will have at least one three-man Medic Company in addition to a four-man Engine Company, and every Medic Company will have at least one ALS provider. These Medic Companies can handle 80% of EMS calls without the need for additional resources.

Second run engines have all been replaced by Rapid Response Companies, a three-man company in a medium duty truck equipped for firefighting and rescue operations without a pump or water. These trucks co-respond with Medic Companies on high acuity EMS calls for manpower, and function like flying squads for fire and rescue calls. They are much more cost effective to operate compared to the engines and ladders that were used before, each district has two. Engine Companies are staffed with four, safe levels of staffing are still maintained since Medics Companies co-respond to fires as well.

You noticed the changes in the promotional process you just participated in. The increased emphasis on EMS practices and operations in the process was not random. The City Manager and Fire Chief both realized that promotions within the organization need to reflect the current role of the Department as well as the need for a change in the culture of the organization.

The money your City is saving is being re-invested in a new training facility for public safety (EMS/Police/Fire), and an aggressive public education program focusing on health and safety issues through the Community Risk Reduction Division (formerly Fire Prevention). The Chief has indicated recently that the Department will be moving to correct pay compression issues due to consistent budget surpluses and possibly even provide a second set of turnout gear. As an added bonus, those who choose the EMS assignments receive a 10% salary differential.

In the Fire service these changes might seem radical, in business and politics they can't come fast enough. Many Fire Departments across the country are developing new and innovative ways to provide the public with the best return for their emergency services dollar independent of any industry guidance. At the national level there seems to be some lag in even acknowledging the need for realignment. The NFPA and IAFF are quick to protect the future of the fire Service and the employment of Firefighters but have not seriously addressed the need for any realignment of personnel or resources other than to protect the control and influence of the Fire Service on public safety. The diversity of Fire Service organizations and localities has a great deal to do with the difficulty in developing a recommendation that will work for us all. I think that if we seriously consider what the public both expects and needs in emergency services we can do what we do best, fix the problem so we can get the opportunity to be the heroes we want to be.

Sweet dreams,

https://www.ncbi.nlm.nih.gov/pubmed/10163385

EMS Anxiety

EMS (Supply) Anxiety

By Alan Perry

February 29, 2016

What causes EMS supplies to be stockpiled on your medic or in your station? Is it insecurity or anxiety about a procedure? An unreliable EMS supply system? Lack of communication? A fear of an MCI event? In the ideal EMS supply system all units carry the same equipment and supplies, stocked at pre-defined levels, to assure that units can remain functional without unreasonable delays in restocking them. Unfortunately the practice of EMS supply hoarding, whether on the medic or in the station, confounds this goal. It drives up the cost of consumable items by increasing inventory levels while taking them out of circulation where they frequently become damaged or expire. That creates some of the very problems that the hoarding strategy seems to be trying to avoid, namely unpredictable stock levels or out-of-stock items.

I believe fear can be a factor, although an irrational one, it seems some of the supplies most likely to be overstocked are related to ALS procedures (ET tubes), infection control (masks, gloves, etc.) and trauma supplies (kling, tape, bandages). Could it be that somehow having more of these items allows us to handle those situations more effectively, or are they serving as a security blanket?

Communication is also an important factor; if the apparatus get checked off every shift, supply orders are placed every shift as well. If the supply system is not responsive, and fails to fill the orders as they are received, it can easily lead to duplicate (triplicate, quadrupled…) orders unless providers communicate what orders they have placed to each other. If supplies are not kept in specific locations in specific quantities this will lead to items being kept in multiple locations in variable quantities. The system should define what, where and quantity for items stocked on each piece of equipment. In most Fire-based EMS systems and volunteer systems, there is also a high degree of staff variability on each transport unit, frequently only a single shift assignment a month or pay cycle. In that situation you have little ownership of the apparatus or continuity in its care and restocking, both of which further confound the issue.

Most EMS systems now have dedicated resources they can rely on for MCI events. While a medic may be sacrificed in some instances to manage an MCI incident the majority of units will be used for treatment and transport of single patients. There really is no need to equip each ambulance with enough nasal cannulas, ET tubes and 12x30 trauma dressings to treat a dozen victims –that’s an irrational fear.

The reliability and of an EMS supply system will affect its efficiency. If your providers know the supply system is reliable and responsive to their needs they will be far less likely to set up individual stashes of these precious commodities on the medic or in the station. Providers should be aware of the consequences of these actions, which increase the cost to the organization, have a negative impact on its reliability as well.

Be safe,

Alan