I read a recent article in the New York Times that disturbed me.
A Crash. A Call for Help. Then, a Bill tells the story of a 70-year old man in Chicago who was in a minor motor vehicle accident, not his fault, who was nevertheless forced to pay the local fire department $200 for their response. The article goes on to tell the larger story of the trend of first responder agencies billing victims for their services to help solve their departments' budget woes.
I can understand rescue agencies billing people who do foolish or unlawful things such as hiking in dangerous restricted areas leading to massive search and rescue efforts, but sending a bill to a 71-year-old victim – a bill his insurance does not cover -- is wrong.
What I initially loved about being in EMS (particularly coming from a recent background in government/politics) is that in EMS, we are the clear cut good guys, or at least we are supposed to be. People are in need, they call us for help, and we do the best we can for them. But as the years have past, I am coming to fear that we are not always doing the best for the public, and that in many cases, we are showing them our less munificent side.
I am not just talking about inappropriate billing. I see this with inappropriate use of helicopters (and sometimes ground transport for that matter), unnecessary RSI and other procedures because we can and not because we should, and in unrealistically portraying our abilities to try to increase our budgets.
Sure we are lifesavers and we sometimes actually do save lives. But to go in front of federal, state, city and town councils and swear upon the the every second counts, lights and sirens to the rescue, how dare anyone hold us accountable attitude is embarrassing.
We need to tell the truth about what we do and about why we are important.
The beauty and simplicity of EMS is that – whether we save lives or not -- above all we about being there in the time of need. We are about community. No, the outcomes for cardiac arrests are dismal, but you can’t put a price on helping a family whose father’s heart has stopped. You also can’t really put a price on someone being there to give an elderly woman some narcotic analgesia instead of just picking her up on a board and jostling her all the way to the hospital. We are about doing right for the people.
What I am afraid of is in our desire to expand or justify our existing budgets we may be losing our way and becoming something that we were not.
We spend unjustified sums on the latest unproven medical technology. We respond to calls that we never went to before because it makes our numbers look better at budget time. (I've been on minor calls that have had five agencies responding). We change our staffing patterns to fit reimbursement rates. We shine artificial lights on our lifesaving myth and too few of us talk openly about our darker side. (For a truth-teller, read Rogue Medic’s Experts Debate Paramedic Intubation – JEMS.Com commentary in which he, without hyperbole, uses the term “serial killer” to describe a not unfamiliar type of paramedic.)
While these actions may seem to benefit us, the effect on the community is not always the same. Instead of being truth-tellers and true community advocates, we, in EMS, have become politicians, salesmen and marketers.
I don’t mean to be naïve. And I do not hold myself out as innocent in these issues (I acknowledge guilt of my own). I do understand that in these difficult economic times, to compete for diminishing dollars, we feel pressure to act more and more like every other interest group, business or political party. Perhaps it is inevitable. Hospitals went this route long ago. Why not us? Still it makes me uneasy.
Things aren't so black and white in EMS land anymore.
And here is clear evidence of it:
A 71-year old man who didn’t need us in the first place and who did nothing wrong gets a bill for $200, and he ends up writing out a check because he is a stand-up citizen who has always paid his bills (and is perhaps afraid of what will happen to him if he doesn’t pay even though he knows he's getting scammed).
Have we not gone astray?
