911:: Mo' Money vs Low Bid (was 'EMD')

[Guest guest]

On Sun, 2 Sep 2001 at 22:57:34 " Danny s Jr "

wrote, in part:

>

>... If EMD has saved only one life in the past 20 years, then

>EMD is worth it. ...<remainder & quote of previos post gone>

I've heard this statement thousands of times from EMS gadget

salesmen and EMS providers who want rigs to carry something

new and usually expensive. Lots of things that save lives

just aren't affordable. Those in power in every jurisdiction

constantly make hard choices about what they can and cannot

do, usually based on funding levels.

All of us have to work within budgets over which we have

little control. Tax payers demand services, then complain

about the tax rate. City councils and county boards fight

to provide the most with the least, then pass that battle on

to the rest of us. Out of the money pool called 'the general

fund,' portions are allocated to schools, roads, public safety,

overhead (buildings, personnel department, etc) and a host of

other things. Politicians set the priorities.

The City of Falls Church has, count 'em, TWO arborists. The

tiny city of Falls Church brags about being 'A Tree City.' I

know that other jurisdictions in this area with 100 times the

population don't have even one arborist. I also know that if

the city got rid of their arborists, they could afford some

life-saving programs and services that can't be funded. But

the politicians and citizens are proud to be 'A Tree City'

and choose to pay for arborists rather than upgrading very

old radio systems that badly need replacement. So no money

went into the 'capital improvements' pool for new radios.

After the schools and arborists are paid, the remainder is

divided up for 'essential services' like the water department

and public safety. Out of the public safety dollars, they

have to pay for police, fire, EMS. Will the police get new

cars this year of have to drive the old clunkers for another

year? Will the fire station get the new ambulance? Will

anyone get a raise? Oh, and out of the same pot, they pay

dispatchers... and buy chairs for the dispatch center, a CAD

system or big supply of printed cards, ribbons for printers,

pens, paper, and everything else that's needed in dispatch.

" If ____ saved only one life in the last 20 years, ____ is

worth it. " Fill in the blanks with your choice. One more

police officer, 10 mg vials of atropine for antidotal dosing

of organophosphate poisioning, a heavy squad truck in each

station, ... or EMD ... or any of a host of other things that

the citizens, politicians, and managers of cities, counties,

boroughs, and other political divisions must choose to fund

or not to fund.

I was an EMT for 24 years, a rural medic for 11. One time in

that time, I encountered a patient, a child, who probably

would have been saved if only we had enough atropine to

counteract ingested bug spray. We didn't. To my knowledge,

not one ambulance in Virginia carries enough atropine. Out

in the sticks, with very long transport times, lives are

saved on the scene or in the ambulance. If breathing and

circulation weren't restored before arrival at the hospital,

almost none lived. Actually, I don't recall even one who

left the hospital alive if I didn't get 'em there alive.

The decision is based on money. Thousands of dollars worth

of atropine, or other lifesaving drugs, would expire and be

thrown away for the chance of saving one person every ten

or twenty or thirty years. Worth it? The community of

citizens, politicians, and managers said, " No. "

EMD is valuable. So are ambulances, police cars, computer

aided dispatch systems, dispatchers, and defibrillators.

Each jurisdiction has to decide how they choose to use

their limited rosources. More of any of the above may

save a life; even many lives. Can you document that EMD

will save more or fewer lives than an automated external

defibrillator (AEDs)? Initial costs are similar.

Before I get down off my soap box, I'll stick my neck out

once more. EMD is NOT, at least in Virginia, an 'all-or-

nothing' program. Emergency Medical Dispatching includes

prioritizing resources. Collecting information needed by

responders that is often very different from information

needed for police or fire dispatching; that's part of EMD

courses. Lots of big city folk have paramedics on every

piece of fire or rescue equipment. Great... if they can

afford it. In rural areas, ALS resources are limited.

EMD allows sending limited ALS resources only to calls

likely to need advanced life support. EMD is NOT just

giving prearrival instructions.

NOT 'all-or-nothing' even applies to prearrival instructions

in the places where I've worked either EMS or dispatch. A

jurisdiction, at least in Virginia, can decide on their own

protocols, specifying exactly what prearrival procedures are

appropriate for their center and which are not. Attempting

to instruct an untrained person on full CPR may be justifi-

able in a city with average EMS response times of 4 minutes.

In a rural area, where the average time from dispatch to on-

scene is typically 20 minutes or more, such CPR won't save

anyone. Buy more AEDs and spread 'em around the county. A

city may decide that emergency child birth instruction isn't

necessary because of short response time; an ambulance will

be at the door before getting far enough along to make a

difference. Out in the sticks, emergency child birth

instruction can potentially save lots of little lives or at

least prevent a well-meaning but ignorant father or other

relative from doing something that would harm the new baby.

I think that we all agree that emergency medical dispatch

programs are valuable. But EMD programs are NOT all the

same and not all jurisdictions are the same. Each must

decide how they will allocate their limited resources, often

based on what they can afford in personnel and training.

It may be a shame that decisions have to be based on what

we can afford, but that is reality. So is buying from the

lowest bidder.

I'll get down off my soap box now.

Always take good care of yourself and yours,

R J 'Tree' Greenwood

Falls Church & Catlett VA

QUESTION: What percentage of patients over the age of 65

who suffer sudden cardiac arrest outside a hospital survive

to leave the hospital after receiving effective CPR?

ANSWER: Zero percent (1994 AHA ECC/CPR Conference)

QUESTION: Why, then, do we continue to do CPR on patients

who are over 65 and suffer sudden cardiac arrest outside of

hospitals.

ANSWER: The cost is minimal and there's always that one-in-

a-million chance that the patient can be saved (among some

other reasons, many having to do with psychological effects

on surviving family and EMS providers who need to know that

they did everything possible).

[Guest guest]

Well said Tree,

>>... If EMD has saved only one life in the past 20 years, then

>EMD is worth it. ...<remainder & quote of previos post gone>

I've heard this from many.. And it's simply ridiculous....

Some say it out of passion for their work, and I respect them for that

however, it's simply not based in reality.....

>EMD is valuable. So are ambulances, police cars, computer

aided dispatch systems, dispatchers, and defibrillators.

Each jurisdiction has to decide how they choose to use

their limited rosources.

In my initial post, my argument simply was that in most cases

EMD can not be done properly with one dispatcher on duty.

And that many small " one dispatcher " centers can not afford the

training, the money to keep up certification, the money to pay overtime

while others train... and certainly not the money to have two

dispatcher per shift.... which, in my opinion, is really necessary.

It's all about resource allotment.

>Thousands of dollars worth

of atropine, or other lifesaving drugs, would expire and be

thrown away for the chance of saving one person every ten

or twenty or thirty years. Worth it? The community of

citizens, politicians, and managers said, " No. "

People all over the world, die every day, because of some decision

someone made over " resource allotment " ....

It's been that way forever.

It will continue to be that way.

Weintraut