Guest guest Posted June 26, 2002 Report Share Posted June 26, 2002 Bob you ignorant _ _ _ _ I know you aren't " dis'in " AED's. One of the only two things that we have unequivocal evidence about improving cardiac arrest outcomes? And correct me if I am wrong don't you guys use the results of the Turtle Creek proceedings in building your CPR Termination protocol like many of the rest of us? Not that it is the Gospel but, its not a bad starting point. Oops almost forgot... many new initiatives such as The Texas AED Placement Program (AHA) and the ORCA AED Project seem to be focused on helping those rural systems 'eh? AND these are funds not previously available to ANY EMS much less rural EMS as a priority, right Bob? Cheers and look forward to hearing from ya' :-) Myths , I hope your presentation on " Myths of Modern EMS " will include out-of-hospital cardiac arrest, and our apparent determination to expend an more and more scarce EMS resources on the population of EMS patients that are least likely to survive, while rural and under-served counties can't even afford basic EMS coverage. Why are we driven [like lemmings] by the public policy initiatives and marketing campaigns of EMS technology manufacturers, rather than directing our greatest concentration of EMS resources toward the greatest concentrations of need? Bob Kellow Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 . Suffice to say that the first sentence of your post precludes me from discussing this matter further with you. Bob Curry wrote: > Bob you ignorant _ _ _ _ > I know you aren't " dis'in " AED's. > One of the only two things that we have unequivocal evidence about > improving > cardiac arrest outcomes? > And correct me if I am wrong don't you guys use the results of the > Turtle > Creek proceedings in building your CPR Termination protocol like many > of the > rest of us? Not that it is the Gospel but, its not a bad starting > point. > > Oops almost forgot... many new initiatives such as The Texas AED > Placement > Program (AHA) and the ORCA AED Project seem to be focused on helping > those > rural systems 'eh? AND these are funds not previously available to ANY > EMS > much less rural EMS as a priority, right Bob? > > Cheers and look forward to hearing from ya' > :-) > > > > > > > > > > > Myths > > , > > I hope your presentation on " Myths of Modern EMS " will include > out-of-hospital cardiac arrest, and our apparent determination to > expend > an more and more scarce EMS resources on the population of EMS > patients > that are least likely to survive, while rural and under-served > counties > can't even afford basic EMS coverage. Why are we driven [like > lemmings] > by the public policy initiatives and marketing campaigns of EMS > technology manufacturers, rather than directing our greatest > concentration of EMS resources toward the greatest concentrations of > need? > > Bob Kellow > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 Maxine, You captured the essence of my point. What I was referring to is not AED specific. In fact, I never mentioned AED's in my post. And for the record, I served on the Medical Advisory Committee (along with Mike Copass, Rich Cummins and others) of the original EMT-D research project conducted by the National Council of State EMS Training Coordinators and DOT-NHTSA in the mid-1980's. Bob lpate@... wrote: > Bob, > > You make an excellent point. AEDs are a good example of this--before > I go > any further, I want to make it clear that I know that there are times > when an > AED can make a lot of difference and I would not presume to tell any > department, agency, business, etc. not to get one. My comments have > more to > do with funding/spending priorities, particularly in rural areas--the > AED > just happens to be the example I chose to use because your comments > referred > to cardiac arrest. > > Regarding the placement of AEDs in law enforcement or fire department > vehicles: > Police departments in small towns (if the town even has a police > department) > often have only one officer on patrol, trying to handle all calls and > traffic > enforcement. This officer may not be immediately available to respond > to an > EMS call. > The Sheriff's Department often has only a couple of deputies covering > the > entire county. If one of them is available, it can easily take 10-15 > minutes > for them to get to the scene. > DPS officers can be even more scarce than deputies--in our area, if > you need > the DPS officer after a certain time of night, he is called out from > home. > Most of the rural fire departments are volunteer (bless 'em) and by > the time > they get to the station, get the trucks out, and get to the scene > enough time > has passed that the AED will be useless. > I can see where AEDs in public buildings might be more beneficial--the > AED > would likely be in close proximity to the patient and there would > always be > staff/employees nearby to initiate it's use quickly. However, in my > 20+ > years in EMS the cardiac arrest calls I have had in public buildings > have > been few and far between and the last one was several years ago. > I just have to wonder about the balance of priorities when we see so > much > about AED funding and AED placement projects when we have many, many > rural > EMS agencies that have a hard time coming up with a crew for the > ambulance > (or even maintaining an ambulance). The AED will be beneficial in > only a > very, very small percentage of EMS calls, but the crew and the > ambulance are > absolutely essential on every call. > > Just some rambling thoughts. > > Maxine Pate > > > > I hope your presentation on " Myths of Modern EMS " will include > > out-of-hospital cardiac arrest, and our apparent determination to > expend > > an more and more scarce EMS resources on the population of EMS > patients > > that are least likely to survive, while rural and under-served > counties > > can't even afford basic EMS coverage. Why are we driven [like > lemmings] > > by the public policy initiatives and marketing campaigns of EMS > > technology manufacturers, rather than directing our greatest > > concentration of EMS resources toward the greatest concentrations of > > > need? > > > > Bob Kellow > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 Bob and Maxine: Here are the facts as I see them perhaps you will agree: We truly work in an underfunded business. Rural services carry the brunt of this problem with few solutions available to them today. One of the expenses that they wrestle with today is the purchase and deployment of AED's. The money would not have otherwise been available to them or ANY EMS unless AED's were a BIG issue to the AHA and others. All of the grant recipients were very appreciative and now have the opportunity to redirect their previously earmarked funds to other components of their operations. External funding for AED's yields a net benefit to EMS and specifically to rural EMS as a priority. Well over $1M this year! And as Martha (future jailbird) would say " That is a good thing " Now what I do have trouble with, is the AED (and all healthcare) vendors profit margins. Most are in the double digits this year. Most hospitals are at 3%. And EMS specifically? Well, I think we all know that nobody is making a killing if they are even functioning in the black at all. As to my overt insult of your character Bob, surely you realized it was in game. But if you did not, I am sorry. Re: Myths > Maxine, > > You captured the essence of my point. What I was referring to is not AED > specific. In fact, I never mentioned AED's in my post. And for the > record, I served on the Medical Advisory Committee (along with Mike > Copass, Rich Cummins and others) of the original EMT-D research project > conducted by the National Council of State EMS Training Coordinators and > DOT-NHTSA in the mid-1980's. > > Bob > > lpate@... wrote: > > > Bob, > > > > You make an excellent point. AEDs are a good example of this--before > > I go > > any further, I want to make it clear that I know that there are times > > when an > > AED can make a lot of difference and I would not presume to tell any > > department, agency, business, etc. not to get one. My comments have > > more to > > do with funding/spending priorities, particularly in rural areas--the > > AED > > just happens to be the example I chose to use because your comments > > referred > > to cardiac arrest. > > > > Regarding the placement of AEDs in law enforcement or fire department > > vehicles: > > Police departments in small towns (if the town even has a police > > department) > > often have only one officer on patrol, trying to handle all calls and > > traffic > > enforcement. This officer may not be immediately available to respond > > to an > > EMS call. > > The Sheriff's Department often has only a couple of deputies covering > > the > > entire county. If one of them is available, it can easily take 10-15 > > minutes > > for them to get to the scene. > > DPS officers can be even more scarce than deputies--in our area, if > > you need > > the DPS officer after a certain time of night, he is called out from > > home. > > Most of the rural fire departments are volunteer (bless 'em) and by > > the time > > they get to the station, get the trucks out, and get to the scene > > enough time > > has passed that the AED will be useless. > > I can see where AEDs in public buildings might be more beneficial--the > > AED > > would likely be in close proximity to the patient and there would > > always be > > staff/employees nearby to initiate it's use quickly. However, in my > > 20+ > > years in EMS the cardiac arrest calls I have had in public buildings > > have > > been few and far between and the last one was several years ago. > > I just have to wonder about the balance of priorities when we see so > > much > > about AED funding and AED placement projects when we have many, many > > rural > > EMS agencies that have a hard time coming up with a crew for the > > ambulance > > (or even maintaining an ambulance). The AED will be beneficial in > > only a > > very, very small percentage of EMS calls, but the crew and the > > ambulance are > > absolutely essential on every call. > > > > Just some rambling thoughts. > > > > Maxine Pate > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > out-of-hospital cardiac arrest, and our apparent determination to > > expend > > > an more and more scarce EMS resources on the population of EMS > > patients > > > that are least likely to survive, while rural and under-served > > counties > > > can't even afford basic EMS coverage. Why are we driven [like > > lemmings] > > > by the public policy initiatives and marketing campaigns of EMS > > > technology manufacturers, rather than directing our greatest > > > concentration of EMS resources toward the greatest concentrations of > > > > > need? > > > > > > Bob Kellow > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 , I don't question the validity of your points, nor would I fault any department for taking advantage of AED funding sources. I know that AEDs are required on BLS units and the funding sources have made it possible for many departments to meet that requirement. I simply chose the AED as an example of what it actually a much larger problem--lack of funding for essentials. Some comments about the situation in general, NOT specifically about AEDs: How many departments don't even think about applying for grants or funding because they know they couldn't even begin to come up with the required matching funds? How many departments scrape the bottom of the barrel to come up with funds for something that will benefit only a small percentage of their population when they would have a hard time even replacing a broken oxygen regulator? How many departments are so shorthanded and overworked that no one even has time to sit down and work on a grant or funding application? How many departments feel pressured to do something just because there is funding available, instead of because it is something they really need to do? How many departments feel pressured to keep up with other departments that can afford the " bells and whistles " items, and purchase items based on appearances rather than needs and results? What kind of unrealistic expectations are being forced on departments that simply do not have the resources to meet those expectations? Now, about " myths " in general: Recently, on e-mail groups as well as in EMS publications, there has been much discussion of several things that we have previously simply accepted and taken for granted. The Golden Hour, CISD/CISM, spinal precautions, and appropriate use of lights and sirens are just a few examples. I, for one, am glad to see that we (EMS) have grown to the point where we are confident and willing to question things that we have previously simply accepted because they were taught to us by someone we looked up to or who had more experience than we had. WE are questioning WHAT WE DO and WHY WE DO IT. We are coming of age and see ourselves as being able and willing to establish our own standards based on facts, knowledge, and results instead of simply accepting standards that others have imposed on us by others. In my opinion, this questioning and critiquing of ourselves is essential if we want EMS to be recognized and accepted as a profession, and if we want to be recognized as professionals. " And as Martha (future jailbird) would say That is a good thing'. " Maxine Re: Myths > Bob and Maxine: > > Here are the facts as I see them perhaps you will agree: > We truly work in an underfunded business. > Rural services carry the brunt of this problem with few solutions available > to them today. > One of the expenses that they wrestle with today is the purchase and > deployment of AED's. > The money would not have otherwise been available to them or ANY EMS unless > AED's were a BIG issue to the AHA and others. > All of the grant recipients were very appreciative and now have the > opportunity to redirect their previously earmarked funds to other components > of their operations. > External funding for AED's yields a net benefit to EMS and specifically to > rural EMS as a priority. Well over $1M this year! > And as Martha (future jailbird) would say " That is a good thing " > > Now what I do have trouble with, is the AED (and all healthcare) vendors > profit margins. Most are in the double digits this year. Most hospitals are > at 3%. And EMS specifically? Well, I think we all know that nobody is making > a killing if they are even functioning in the black at all. > > As to my overt insult of your character Bob, surely you realized it was in > game. But if you did not, I am sorry. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 , I have never questioned the efficacy of early defibrillation, nor for that matter do I care how much money the technology manufacturer's make. Competition almost always drives down prices and margins. As I see it, the rub stems from from over heightening the importance of an occurrence, which for the vast majority is an end of life event. Consider the frequency of cardiac arrests in comparison to overall EMS demand. Then, compare the the patient outcomes to costs expended to save them in terms of capital equipment, supplies, training, regulatory oversight, etc. Add up all the costs and divide by the number of neurologically intact survivors. Compare that per capita cost to similarly derived results from the spectrum of (EMS) treatable disorders. Do you see anything unusual? The fact is that we are expending a disproportionate amount of EMS resources on the population of EMS patients who are least likely to survive. Why? For example, you can place an AED at the foot of every yucca plant in west Texas, but if you don't have EMS transport capabilities, what has been accomplished (other than product sales)? Continuing with AED's as the example, the manufacturer's and AHA have mounted a very effective marketing. public health policy and legislative campaign, which would have us and the American public believe that citizens are dropping like flies in our streets, public buildings, golf courses and airports. Note: that ghetto's and low income housing - where the sickest people in America live - are never mentioned. The campaign has been so successful that the deployment of AED's is perceived as a standard of care, the absence of which might pose a liability threat to businesses and governments. It was brilliant. Follow the money. Who do you think has paid for the planning and implementation of this nationwide campaign? Who stands to benefit financially? The very people who have fermented the belief that EMS services that do not purchase 12 lead's are substandard and guilty of underserving their respective communities. In fact, when 12 lead's were first introduced as the next generation product, almost no one purchased them - until these companies trotted out some noted physicians to extoll their virtues. By the way, they cost thousands more than the preceding generation. I have noticed for years how seemingly everyone on this list has complained about compensation. Yet, by means of strategic marketing, advertising and peer arm twisting, we have unwittingly served to further the commercial interests of these companies - at the expense of allocating or redirecting EMS resources toward professional salaries. That is why I used the term, " lemmings " . It is also why I'm such a proponent of evidence based research. The next time you check out your unit make a list of all the things that you have helped subsidize by way of inadequate and substandard pay. The myth of cardiac arrest is just one illustration. Bob Kellow P.S. Apology accepted. Curry wrote: > Bob and Maxine: > > Here are the facts as I see them perhaps you will agree: > We truly work in an underfunded business. > Rural services carry the brunt of this problem with few solutions > available > to them today. > One of the expenses that they wrestle with today is the purchase and > deployment of AED's. > The money would not have otherwise been available to them or ANY EMS > unless > AED's were a BIG issue to the AHA and others. > All of the grant recipients were very appreciative and now have the > opportunity to redirect their previously earmarked funds to other > components > of their operations. > External funding for AED's yields a net benefit to EMS and > specifically to > rural EMS as a priority. Well over $1M this year! > And as Martha (future jailbird) would say " That is a good > thing " > > Now what I do have trouble with, is the AED (and all healthcare) > vendors > profit margins. Most are in the double digits this year. Most > hospitals are > at 3%. And EMS specifically? Well, I think we all know that nobody is > making > a killing if they are even functioning in the black at all. > > As to my overt insult of your character Bob, surely you realized it > was in > game. But if you did not, I am sorry. > > > > > > Re: Myths > > > > Maxine, > > > > You captured the essence of my point. What I was referring to is not > AED > > specific. In fact, I never mentioned AED's in my post. And for the > > record, I served on the Medical Advisory Committee (along with Mike > > Copass, Rich Cummins and others) of the original EMT-D research > project > > conducted by the National Council of State EMS Training Coordinators > and > > DOT-NHTSA in the mid-1980's. > > > > Bob > > > > lpate@... wrote: > > > > > Bob, > > > > > > You make an excellent point. AEDs are a good example of > this--before > > > I go > > > any further, I want to make it clear that I know that there are > times > > > when an > > > AED can make a lot of difference and I would not presume to tell > any > > > department, agency, business, etc. not to get one. My comments > have > > > more to > > > do with funding/spending priorities, particularly in rural > areas--the > > > AED > > > just happens to be the example I chose to use because your > comments > > > referred > > > to cardiac arrest. > > > > > > Regarding the placement of AEDs in law enforcement or fire > department > > > vehicles: > > > Police departments in small towns (if the town even has a police > > > department) > > > often have only one officer on patrol, trying to handle all calls > and > > > traffic > > > enforcement. This officer may not be immediately available to > respond > > > to an > > > EMS call. > > > The Sheriff's Department often has only a couple of deputies > covering > > > the > > > entire county. If one of them is available, it can easily take > 10-15 > > > minutes > > > for them to get to the scene. > > > DPS officers can be even more scarce than deputies--in our area, > if > > > you need > > > the DPS officer after a certain time of night, he is called out > from > > > home. > > > Most of the rural fire departments are volunteer (bless 'em) and > by > > > the time > > > they get to the station, get the trucks out, and get to the scene > > > enough time > > > has passed that the AED will be useless. > > > I can see where AEDs in public buildings might be more > beneficial--the > > > AED > > > would likely be in close proximity to the patient and there would > > > always be > > > staff/employees nearby to initiate it's use quickly. However, in > my > > > 20+ > > > years in EMS the cardiac arrest calls I have had in public > buildings > > > have > > > been few and far between and the last one was several years ago. > > > I just have to wonder about the balance of priorities when we see > so > > > much > > > about AED funding and AED placement projects when we have many, > many > > > rural > > > EMS agencies that have a hard time coming up with a crew for the > > > ambulance > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > only a > > > very, very small percentage of EMS calls, but the crew and the > > > ambulance are > > > absolutely essential on every call. > > > > > > Just some rambling thoughts. > > > > > > Maxine Pate > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > out-of-hospital cardiac arrest, and our apparent determination > to > > > expend > > > > an more and more scarce EMS resources on the population of EMS > > > patients > > > > that are least likely to survive, while rural and under-served > > > counties > > > > can't even afford basic EMS coverage. Why are we driven [like > > > lemmings] > > > > by the public policy initiatives and marketing campaigns of EMS > > > > technology manufacturers, rather than directing our greatest > > > > concentration of EMS resources toward the greatest > concentrations of > > > > > > > need? > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 In the essay I wrote about rural EMS in American Heart Associations Current's Spring 2002 issue, I brought up the diparities of the AED's in all public places PAC push by the AHA and the crisis in rural EMS system. I also told the editor (who is behind us BTW) that if AHA put as much effort into helping EMS as they did in lobbying for the AED bill, that we could get somewhere here. The Current's link wasn't working this morning, but the address is: cpr-ecc.org The article was edited a lot; feel free to write them to give your own points of view on this very critical issue! Raina Dodson LP, M.S. > > > > > > > > > Bob, > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > this--before > > > > > I go > > > > > any further, I want to make it clear that I know that there are > > > times > > > > > when an > > > > > AED can make a lot of difference and I would not presume to tell > > > any > > > > > department, agency, business, etc. not to get one. My comments > > > have > > > > > more to > > > > > do with funding/spending priorities, particularly in rural > > > areas--the > > > > > AED > > > > > just happens to be the example I chose to use because your > > > comments > > > > > referred > > > > > to cardiac arrest. > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > department > > > > > vehicles: > > > > > Police departments in small towns (if the town even has a police > > > > > department) > > > > > often have only one officer on patrol, trying to handle all calls > > > and > > > > > traffic > > > > > enforcement. This officer may not be immediately available to > > > respond > > > > > to an > > > > > EMS call. > > > > > The Sheriff's Department often has only a couple of deputies > > > covering > > > > > the > > > > > entire county. If one of them is available, it can easily take > > > 10-15 > > > > > minutes > > > > > for them to get to the scene. > > > > > DPS officers can be even more scarce than deputies--in our area, > > > if > > > > > you need > > > > > the DPS officer after a certain time of night, he is called out > > > from > > > > > home. > > > > > Most of the rural fire departments are volunteer (bless 'em) and > > > by > > > > > the time > > > > > they get to the station, get the trucks out, and get to the scene > > > > > enough time > > > > > has passed that the AED will be useless. > > > > > I can see where AEDs in public buildings might be more > > > beneficial--the > > > > > AED > > > > > would likely be in close proximity to the patient and there would > > > > > always be > > > > > staff/employees nearby to initiate it's use quickly. However, in > > > my > > > > > 20+ > > > > > years in EMS the cardiac arrest calls I have had in public > > > buildings > > > > > have > > > > > been few and far between and the last one was several years ago. > > > > > I just have to wonder about the balance of priorities when we see > > > so > > > > > much > > > > > about AED funding and AED placement projects when we have many, > > > many > > > > > rural > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > ambulance > > > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > > > > > only a > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > ambulance are > > > > > absolutely essential on every call. > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > out-of-hospital cardiac arrest, and our apparent determination > > > to > > > > > expend > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > patients > > > > > > that are least likely to survive, while rural and under-served > > > > > counties > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > lemmings] > > > > > > by the public policy initiatives and marketing campaigns of EMS > > > > > > technology manufacturers, rather than directing our greatest > > > > > > concentration of EMS resources toward the greatest > > > concentrations of > > > > > > > > > > > need? > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 I am very excited to see that the Mall of Abilene will have an AED in place effective tomorrow. I think it is great. So many cardiac patients go to the mall to walk. It is their " Cardiac Rehab " every day. I think we have a big problem with AEDs in public places. These places do not know that an AED is available for them. They know what it is, but they do not know that they can get one. I would like to see more education and " advertising " for the AED in public places. Just a thought, Neil White, LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2002 Report Share Posted July 1, 2002 I can place an AED total for $2500 or so. Where would you use that $2500 that would have better benefit? We're not talking about gobs of ongoing funding here. The fact is, in a lot of rural areas, it is not feasible to staff for ALS. So for volunteer departments, EMS or FR, AEDs represent a level of advanced care unavailable to them in any other form. They are NOT going to staff ambulances with medics, drugs, manual defibrillators, etc. They are doing good to have EMT level training if that, and a first aid kit (or in better cases a minimal BLS ambulance). AEDs will address the #1 killer, heart disease. So with an AED you have addressed the largest primary survey issue. Seems cost effective to me. Again, if you only have $2500, where are you going to spend it better? lpate@... wrote: > Bob, > > You make an excellent point. AEDs are a good example of this--before > I go > any further, I want to make it clear that I know that there are times > when an > AED can make a lot of difference and I would not presume to tell any > department, agency, business, etc. not to get one. My comments have > more to > do with funding/spending priorities, particularly in rural areas--the > AED > just happens to be the example I chose to use because your comments > referred > to cardiac arrest. > > Regarding the placement of AEDs in law enforcement or fire department > vehicles: > Police departments in small towns (if the town even has a police > department) > often have only one officer on patrol, trying to handle all calls and > traffic > enforcement. This officer may not be immediately available to respond > to an > EMS call. > The Sheriff's Department often has only a couple of deputies covering > the > entire county. If one of them is available, it can easily take 10-15 > minutes > for them to get to the scene. > DPS officers can be even more scarce than deputies--in our area, if > you need > the DPS officer after a certain time of night, he is called out from > home. > Most of the rural fire departments are volunteer (bless 'em) and by > the time > they get to the station, get the trucks out, and get to the scene > enough time > has passed that the AED will be useless. > I can see where AEDs in public buildings might be more beneficial--the > AED > would likely be in close proximity to the patient and there would > always be > staff/employees nearby to initiate it's use quickly. However, in my > 20+ > years in EMS the cardiac arrest calls I have had in public buildings > have > been few and far between and the last one was several years ago. > I just have to wonder about the balance of priorities when we see so > much > about AED funding and AED placement projects when we have many, many > rural > EMS agencies that have a hard time coming up with a crew for the > ambulance > (or even maintaining an ambulance). The AED will be beneficial in > only a > very, very small percentage of EMS calls, but the crew and the > ambulance are > absolutely essential on every call. > > Just some rambling thoughts. > > Maxine Pate > > > > I hope your presentation on " Myths of Modern EMS " will include > > out-of-hospital cardiac arrest, and our apparent determination to > expend > > an more and more scarce EMS resources on the population of EMS > patients > > that are least likely to survive, while rural and under-served > counties > > can't even afford basic EMS coverage. Why are we driven [like > lemmings] > > by the public policy initiatives and marketing campaigns of EMS > > technology manufacturers, rather than directing our greatest > > concentration of EMS resources toward the greatest concentrations of > > > need? > > > > Bob Kellow > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2002 Report Share Posted July 1, 2002 Steve, I would argue that an AED is not " advanced care " . An AED is a non-operator dependent, battery operated machine that functions on a predetermined, software driven algorithm. I would assign the term " care " to human beings. Some questions: (1) Is $2,500 all the money your service will ever have? (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? (3) If there's only one AED (depending on where it's " placed " ), who in the community served will have access to it, and who will not? (4) What is the frequency of demand for an AED in your community compared to other types of calls (%)? I believe that the needs of the many (aggregate demand) outweigh the needs of the few (marginal demand) - especially given such abysmal outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how beneficial do you believe one AED will be? I'd invest the money in the people who are expected to deliver the " care " . As an aside, I remember giving a speech on this issue 20 years ago in Houston. As a (tongue in cheek) joke, I told the audience of about 100 that NASA was about to launch into geosynchronous earth orbit a satellite that could detect cardiac arrests, locate the victim via GPS and deliver with great precision a shock using a particle beam generator. The service would be licensed to EMS organizations and re-sold as subscriptions in their respective communities. Deaths from cardiac arrest would cease to exist within five years! To my complete amazement following the speech, I was approached by no less than seven people who wanted to know how much NASA was planning to charge for the licensing fee (rim shot). Bob Kellow Steve wrote: > I can place an AED total for $2500 or so. Where would you use that > $2500 that would have better benefit? We're not talking about gobs of > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > AEDs represent a level of advanced care unavailable to them in any > other > form. They are NOT going to staff ambulances with medics, drugs, > manual > defibrillators, etc. They are doing good to have EMT level training > if > that, and a first aid kit (or in better cases a minimal BLS > ambulance). > AEDs will address the #1 killer, heart disease. So with an AED you > have > addressed the largest primary survey issue. Seems cost effective to > me. > > Again, if you only have $2500, where are you going to spend it better? > > > > > lpate@... wrote: > > > Bob, > > > > You make an excellent point. AEDs are a good example of > this--before > > I go > > any further, I want to make it clear that I know that there are > times > > when an > > AED can make a lot of difference and I would not presume to tell any > > > department, agency, business, etc. not to get one. My comments have > > > more to > > do with funding/spending priorities, particularly in rural > areas--the > > AED > > just happens to be the example I chose to use because your comments > > referred > > to cardiac arrest. > > > > Regarding the placement of AEDs in law enforcement or fire > department > > vehicles: > > Police departments in small towns (if the town even has a police > > department) > > often have only one officer on patrol, trying to handle all calls > and > > traffic > > enforcement. This officer may not be immediately available to > respond > > to an > > EMS call. > > The Sheriff's Department often has only a couple of deputies > covering > > the > > entire county. If one of them is available, it can easily take > 10-15 > > minutes > > for them to get to the scene. > > DPS officers can be even more scarce than deputies--in our area, if > > you need > > the DPS officer after a certain time of night, he is called out from > > > home. > > Most of the rural fire departments are volunteer (bless 'em) and by > > the time > > they get to the station, get the trucks out, and get to the scene > > enough time > > has passed that the AED will be useless. > > I can see where AEDs in public buildings might be more > beneficial--the > > AED > > would likely be in close proximity to the patient and there would > > always be > > staff/employees nearby to initiate it's use quickly. However, in my > > > 20+ > > years in EMS the cardiac arrest calls I have had in public buildings > > > have > > been few and far between and the last one was several years ago. > > I just have to wonder about the balance of priorities when we see so > > > much > > about AED funding and AED placement projects when we have many, many > > > rural > > EMS agencies that have a hard time coming up with a crew for the > > ambulance > > (or even maintaining an ambulance). The AED will be beneficial in > > only a > > very, very small percentage of EMS calls, but the crew and the > > ambulance are > > absolutely essential on every call. > > > > Just some rambling thoughts. > > > > Maxine Pate > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > out-of-hospital cardiac arrest, and our apparent determination to > > expend > > > an more and more scarce EMS resources on the population of EMS > > patients > > > that are least likely to survive, while rural and under-served > > counties > > > can't even afford basic EMS coverage. Why are we driven [like > > lemmings] > > > by the public policy initiatives and marketing campaigns of EMS > > > technology manufacturers, rather than directing our greatest > > > concentration of EMS resources toward the greatest concentrations > of > > > > > need? > > > > > > Bob Kellow > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2002 Report Share Posted July 1, 2002 What do you value? Human life is not a marginal thing. So, I can place an AED for $2500, cost of a unit and training. What else can you do, at $2500 per delivered unit, that is as beneficial? Where else would you spend this amount of money and get this impact? We're talking about the #1 killer of mankind here. We're talking about definitive initial care for that #1 killer. Just what else can you do, dollar for dollar, and have this kind of impact?? Do you need two units? Great, now it's $5000. What can you do two of for $5000 that can have as much impact on quality of life for so many folks (CDC says 450,000 die of heart disease. If half are SCAs, then 225,000 SCAs. If 40% can be saved by defib, then 90,000 potential saves PER YEAR. And just how more advanced do you want to get than cardiac defibrillation? The CARE is advanced, it's just packaged in a basic, easy to use delivery system. Yes, it's targeted at the population at risk of DEATH, which is a small portion of the sick and injured. But look at the outcomes. Death or Life. Very worth doing. Bob Kellow wrote: > Steve, > > I would argue that an AED is not " advanced care " . An AED is a > non-operator dependent, battery operated machine that functions on a > predetermined, software driven algorithm. I would assign the term " care " > to human beings. > > Some questions: (1) Is $2,500 all the money your service will ever have? > (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? > (3) If there's only one AED (depending on where it's " placed " ), who in > the community served will have access to it, and who will not? (4) What > is the frequency of demand for an AED in your community compared to > other types of calls (%)? > > I believe that the needs of the many (aggregate demand) outweigh the > needs of the few (marginal demand) - especially given such abysmal > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > beneficial do you believe one AED will be? I'd invest the money in the > people who are expected to deliver the " care " . > > As an aside, I remember giving a speech on this issue 20 years ago in > Houston. As a (tongue in cheek) joke, I told the audience of about 100 > that NASA was about to launch into geosynchronous earth orbit a > satellite that could detect cardiac arrests, locate the victim via GPS > and deliver with great precision a shock using a particle beam > generator. The service would be licensed to EMS organizations and > re-sold as subscriptions in their respective communities. Deaths from > cardiac arrest would cease to exist within five years! > > To my complete amazement following the speech, I was approached by no > less than seven people who wanted to know how much NASA was planning to > charge for the licensing fee (rim shot). > > Bob Kellow > > Steve wrote: > > > I can place an AED total for $2500 or so. Where would you use that > > $2500 that would have better benefit? We're not talking about gobs of > > > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > > AEDs represent a level of advanced care unavailable to them in any > > other > > form. They are NOT going to staff ambulances with medics, drugs, > > manual > > defibrillators, etc. They are doing good to have EMT level training > > if > > that, and a first aid kit (or in better cases a minimal BLS > > ambulance). > > AEDs will address the #1 killer, heart disease. So with an AED you > > have > > addressed the largest primary survey issue. Seems cost effective to > > me. > > > > Again, if you only have $2500, where are you going to spend it better? > > > > > > > > > > lpate@... wrote: > > > > > Bob, > > > > > > You make an excellent point. AEDs are a good example of > > this--before > > > I go > > > any further, I want to make it clear that I know that there are > > times > > > when an > > > AED can make a lot of difference and I would not presume to tell any > > > > > department, agency, business, etc. not to get one. My comments have > > > > > more to > > > do with funding/spending priorities, particularly in rural > > areas--the > > > AED > > > just happens to be the example I chose to use because your comments > > > referred > > > to cardiac arrest. > > > > > > Regarding the placement of AEDs in law enforcement or fire > > department > > > vehicles: > > > Police departments in small towns (if the town even has a police > > > department) > > > often have only one officer on patrol, trying to handle all calls > > and > > > traffic > > > enforcement. This officer may not be immediately available to > > respond > > > to an > > > EMS call. > > > The Sheriff's Department often has only a couple of deputies > > covering > > > the > > > entire county. If one of them is available, it can easily take > > 10-15 > > > minutes > > > for them to get to the scene. > > > DPS officers can be even more scarce than deputies--in our area, if > > > you need > > > the DPS officer after a certain time of night, he is called out from > > > > > home. > > > Most of the rural fire departments are volunteer (bless 'em) and by > > > the time > > > they get to the station, get the trucks out, and get to the scene > > > enough time > > > has passed that the AED will be useless. > > > I can see where AEDs in public buildings might be more > > beneficial--the > > > AED > > > would likely be in close proximity to the patient and there would > > > always be > > > staff/employees nearby to initiate it's use quickly. However, in my > > > > > 20+ > > > years in EMS the cardiac arrest calls I have had in public buildings > > > > > have > > > been few and far between and the last one was several years ago. > > > I just have to wonder about the balance of priorities when we see so > > > > > much > > > about AED funding and AED placement projects when we have many, many > > > > > rural > > > EMS agencies that have a hard time coming up with a crew for the > > > ambulance > > > (or even maintaining an ambulance). The AED will be beneficial in > > > only a > > > very, very small percentage of EMS calls, but the crew and the > > > ambulance are > > > absolutely essential on every call. > > > > > > Just some rambling thoughts. > > > > > > Maxine Pate > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > out-of-hospital cardiac arrest, and our apparent determination to > > > expend > > > > an more and more scarce EMS resources on the population of EMS > > > patients > > > > that are least likely to survive, while rural and under-served > > > counties > > > > can't even afford basic EMS coverage. Why are we driven [like > > > lemmings] > > > > by the public policy initiatives and marketing campaigns of EMS > > > > technology manufacturers, rather than directing our greatest > > > > concentration of EMS resources toward the greatest concentrations > > of > > > > > > > need? > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2002 Report Share Posted July 1, 2002 Wait a minute. Ventricular fibrillation is not the number one killer of humankind. Worldwide it is infectious disease. In the US it is cardiovascular disease. Ventricular fibrillation is only a small part of the cardiovascular disease picture. AEDs are a good way to spend the money--but they are not the holy grail of EMS. EBB Re: Myths > What do you value? Human life is not a marginal thing. So, I can place an > AED for $2500, cost of a unit and training. What else can you do, at $2500 > per delivered unit, that is as beneficial? Where else would you spend this > amount of money and get this impact? We're talking about the #1 killer of > mankind here. We're talking about definitive initial care for that #1 > killer. Just what else can you do, dollar for dollar, and have this kind of > impact?? Do you need two units? Great, now it's $5000. What can you do two > of for $5000 that can have as much impact on quality of life for so many > folks (CDC says 450,000 die of heart disease. If half are SCAs, then 225,000 > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER YEAR. > > And just how more advanced do you want to get than cardiac defibrillation? > The CARE is advanced, it's just packaged in a basic, easy to use delivery > system. > > Yes, it's targeted at the population at risk of DEATH, which is a small > portion of the sick and injured. But look at the outcomes. Death or Life. > > Very worth doing. > > > > > Bob Kellow wrote: > > > Steve, > > > > I would argue that an AED is not " advanced care " . An AED is a > > non-operator dependent, battery operated machine that functions on a > > predetermined, software driven algorithm. I would assign the term " care " > > to human beings. > > > > Some questions: (1) Is $2,500 all the money your service will ever have? > > (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? > > (3) If there's only one AED (depending on where it's " placed " ), who in > > the community served will have access to it, and who will not? (4) What > > is the frequency of demand for an AED in your community compared to > > other types of calls (%)? > > > > I believe that the needs of the many (aggregate demand) outweigh the > > needs of the few (marginal demand) - especially given such abysmal > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > beneficial do you believe one AED will be? I'd invest the money in the > > people who are expected to deliver the " care " . > > > > As an aside, I remember giving a speech on this issue 20 years ago in > > Houston. As a (tongue in cheek) joke, I told the audience of about 100 > > that NASA was about to launch into geosynchronous earth orbit a > > satellite that could detect cardiac arrests, locate the victim via GPS > > and deliver with great precision a shock using a particle beam > > generator. The service would be licensed to EMS organizations and > > re-sold as subscriptions in their respective communities. Deaths from > > cardiac arrest would cease to exist within five years! > > > > To my complete amazement following the speech, I was approached by no > > less than seven people who wanted to know how much NASA was planning to > > charge for the licensing fee (rim shot). > > > > Bob Kellow > > > > Steve wrote: > > > > > I can place an AED total for $2500 or so. Where would you use that > > > $2500 that would have better benefit? We're not talking about gobs of > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > > > AEDs represent a level of advanced care unavailable to them in any > > > other > > > form. They are NOT going to staff ambulances with medics, drugs, > > > manual > > > defibrillators, etc. They are doing good to have EMT level training > > > if > > > that, and a first aid kit (or in better cases a minimal BLS > > > ambulance). > > > AEDs will address the #1 killer, heart disease. So with an AED you > > > have > > > addressed the largest primary survey issue. Seems cost effective to > > > me. > > > > > > Again, if you only have $2500, where are you going to spend it better? > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > Bob, > > > > > > > > You make an excellent point. AEDs are a good example of > > > this--before > > > > I go > > > > any further, I want to make it clear that I know that there are > > > times > > > > when an > > > > AED can make a lot of difference and I would not presume to tell any > > > > > > > department, agency, business, etc. not to get one. My comments have > > > > > > > more to > > > > do with funding/spending priorities, particularly in rural > > > areas--the > > > > AED > > > > just happens to be the example I chose to use because your comments > > > > referred > > > > to cardiac arrest. > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > department > > > > vehicles: > > > > Police departments in small towns (if the town even has a police > > > > department) > > > > often have only one officer on patrol, trying to handle all calls > > > and > > > > traffic > > > > enforcement. This officer may not be immediately available to > > > respond > > > > to an > > > > EMS call. > > > > The Sheriff's Department often has only a couple of deputies > > > covering > > > > the > > > > entire county. If one of them is available, it can easily take > > > 10-15 > > > > minutes > > > > for them to get to the scene. > > > > DPS officers can be even more scarce than deputies--in our area, if > > > > you need > > > > the DPS officer after a certain time of night, he is called out from > > > > > > > home. > > > > Most of the rural fire departments are volunteer (bless 'em) and by > > > > the time > > > > they get to the station, get the trucks out, and get to the scene > > > > enough time > > > > has passed that the AED will be useless. > > > > I can see where AEDs in public buildings might be more > > > beneficial--the > > > > AED > > > > would likely be in close proximity to the patient and there would > > > > always be > > > > staff/employees nearby to initiate it's use quickly. However, in my > > > > > > > 20+ > > > > years in EMS the cardiac arrest calls I have had in public buildings > > > > > > > have > > > > been few and far between and the last one was several years ago. > > > > I just have to wonder about the balance of priorities when we see so > > > > > > > much > > > > about AED funding and AED placement projects when we have many, many > > > > > > > rural > > > > EMS agencies that have a hard time coming up with a crew for the > > > > ambulance > > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > only a > > > > very, very small percentage of EMS calls, but the crew and the > > > > ambulance are > > > > absolutely essential on every call. > > > > > > > > Just some rambling thoughts. > > > > > > > > Maxine Pate > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > out-of-hospital cardiac arrest, and our apparent determination to > > > > expend > > > > > an more and more scarce EMS resources on the population of EMS > > > > patients > > > > > that are least likely to survive, while rural and under-served > > > > counties > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > lemmings] > > > > > by the public policy initiatives and marketing campaigns of EMS > > > > > technology manufacturers, rather than directing our greatest > > > > > concentration of EMS resources toward the greatest concentrations > > > of > > > > > > > > > need? > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2002 Report Share Posted July 1, 2002 Steve, You didn't answer any of my questions. And, where did you get these data? Bob Steve wrote: > What do you value? Human life is not a marginal thing. So, I can > place an > AED for $2500, cost of a unit and training. What else can you do, at > $2500 > per delivered unit, that is as beneficial? Where else would you spend > this > amount of money and get this impact? We're talking about the #1 killer > of > mankind here. We're talking about definitive initial care for that #1 > > killer. Just what else can you do, dollar for dollar, and have this > kind of > impact?? Do you need two units? Great, now it's $5000. What can you > do two > of for $5000 that can have as much impact on quality of life for so > many > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > 225,000 > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER > YEAR. > > And just how more advanced do you want to get than cardiac > defibrillation? > The CARE is advanced, it's just packaged in a basic, easy to use > delivery > system. > > Yes, it's targeted at the population at risk of DEATH, which is a > small > portion of the sick and injured. But look at the outcomes. Death or > Life. > > Very worth doing. > > > > > Bob Kellow wrote: > > > Steve, > > > > I would argue that an AED is not " advanced care " . An AED is a > > non-operator dependent, battery operated machine that functions on a > > > predetermined, software driven algorithm. I would assign the term > " care " > > to human beings. > > > > Some questions: (1) Is $2,500 all the money your service will ever > have? > > (2) What do you mean by " place an AED " ? In a vehicle? A building? > Where? > > (3) If there's only one AED (depending on where it's " placed " ), who > in > > the community served will have access to it, and who will not? (4) > What > > is the frequency of demand for an AED in your community compared to > > other types of calls (%)? > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > needs of the few (marginal demand) - especially given such abysmal > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > beneficial do you believe one AED will be? I'd invest the money in > the > > people who are expected to deliver the " care " . > > > > As an aside, I remember giving a speech on this issue 20 years ago > in > > Houston. As a (tongue in cheek) joke, I told the audience of about > 100 > > that NASA was about to launch into geosynchronous earth orbit a > > satellite that could detect cardiac arrests, locate the victim via > GPS > > and deliver with great precision a shock using a particle beam > > generator. The service would be licensed to EMS organizations and > > re-sold as subscriptions in their respective communities. Deaths > from > > cardiac arrest would cease to exist within five years! > > > > To my complete amazement following the speech, I was approached by > no > > less than seven people who wanted to know how much NASA was planning > to > > charge for the licensing fee (rim shot). > > > > Bob Kellow > > > > Steve wrote: > > > > > I can place an AED total for $2500 or so. Where would you use > that > > > $2500 that would have better benefit? We're not talking about > gobs of > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is > not > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or > FR, > > > AEDs represent a level of advanced care unavailable to them in any > > > > other > > > form. They are NOT going to staff ambulances with medics, drugs, > > > manual > > > defibrillators, etc. They are doing good to have EMT level > training > > > if > > > that, and a first aid kit (or in better cases a minimal BLS > > > ambulance). > > > AEDs will address the #1 killer, heart disease. So with an AED > you > > > have > > > addressed the largest primary survey issue. Seems cost effective > to > > > me. > > > > > > Again, if you only have $2500, where are you going to spend it > better? > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > Bob, > > > > > > > > You make an excellent point. AEDs are a good example of > > > this--before > > > > I go > > > > any further, I want to make it clear that I know that there are > > > times > > > > when an > > > > AED can make a lot of difference and I would not presume to tell > any > > > > > > > department, agency, business, etc. not to get one. My comments > have > > > > > > > more to > > > > do with funding/spending priorities, particularly in rural > > > areas--the > > > > AED > > > > just happens to be the example I chose to use because your > comments > > > > referred > > > > to cardiac arrest. > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > department > > > > vehicles: > > > > Police departments in small towns (if the town even has a police > > > > > department) > > > > often have only one officer on patrol, trying to handle all > calls > > > and > > > > traffic > > > > enforcement. This officer may not be immediately available to > > > respond > > > > to an > > > > EMS call. > > > > The Sheriff's Department often has only a couple of deputies > > > covering > > > > the > > > > entire county. If one of them is available, it can easily take > > > 10-15 > > > > minutes > > > > for them to get to the scene. > > > > DPS officers can be even more scarce than deputies--in our area, > if > > > > you need > > > > the DPS officer after a certain time of night, he is called out > from > > > > > > > home. > > > > Most of the rural fire departments are volunteer (bless 'em) and > by > > > > the time > > > > they get to the station, get the trucks out, and get to the > scene > > > > enough time > > > > has passed that the AED will be useless. > > > > I can see where AEDs in public buildings might be more > > > beneficial--the > > > > AED > > > > would likely be in close proximity to the patient and there > would > > > > always be > > > > staff/employees nearby to initiate it's use quickly. However, > in my > > > > > > > 20+ > > > > years in EMS the cardiac arrest calls I have had in public > buildings > > > > > > > have > > > > been few and far between and the last one was several years ago. > > > > > I just have to wonder about the balance of priorities when we > see so > > > > > > > much > > > > about AED funding and AED placement projects when we have many, > many > > > > > > > rural > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > ambulance > > > > (or even maintaining an ambulance). The AED will be beneficial > in > > > > only a > > > > very, very small percentage of EMS calls, but the crew and the > > > > ambulance are > > > > absolutely essential on every call. > > > > > > > > Just some rambling thoughts. > > > > > > > > Maxine Pate > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > out-of-hospital cardiac arrest, and our apparent determination > to > > > > expend > > > > > an more and more scarce EMS resources on the population of EMS > > > > > patients > > > > > that are least likely to survive, while rural and under-served > > > > > counties > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > lemmings] > > > > > by the public policy initiatives and marketing campaigns of > EMS > > > > > technology manufacturers, rather than directing our greatest > > > > > concentration of EMS resources toward the greatest > concentrations > > > of > > > > > > > > > need? > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 Dr. Bledsoe, If you look at the work of J. McGinnis (Sr. VP of the Health Group at Woods , former Scholar-in-Residence National Academy of Sciences, former Assistant Surgeon General, former Deputy Assistant Secretary for Health/director U.S. Office of Disease Prevention & Healht Promtion), the number one preventable cause of death in the U.S. and Texas is tobacco use. (440,000+ Americans annually according to CDC. The Texas numbers work out to be one Texas every 25 minutes.) I'm not sure tobacco ranks globally, but the World Health Orgianization thinks enough to make smoking prevention in underdeveloped nations a top priority. CVD, Cancer and Stroke at the top causes of death listed on death certificates which is what gets reported into the mortality databases. If we're going to really address the causes, then we need to look proactively at what we can do to prevent them from happening, or help support prevention efforts (smoking cessation, healthy eating, physical activity, doing preventive medicine, etc.), rather than just how to better treat medical problems once they occur. (The old health care versus sick care paradigm.) Re: Myths Wait a minute. Ventricular fibrillation is not the number one killer of humankind. Worldwide it is infectious disease. In the US it is cardiovascular disease. Ventricular fibrillation is only a small part of the cardiovascular disease picture. AEDs are a good way to spend the money--but they are not the holy grail of EMS. EBB Re: Myths > What do you value? Human life is not a marginal thing. So, I can place an > AED for $2500, cost of a unit and training. What else can you do, at $2500 > per delivered unit, that is as beneficial? Where else would you spend this > amount of money and get this impact? We're talking about the #1 killer of > mankind here. We're talking about definitive initial care for that #1 > killer. Just what else can you do, dollar for dollar, and have this kind of > impact?? Do you need two units? Great, now it's $5000. What can you do two > of for $5000 that can have as much impact on quality of life for so many > folks (CDC says 450,000 die of heart disease. If half are SCAs, then 225,000 > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER YEAR. > > And just how more advanced do you want to get than cardiac defibrillation? > The CARE is advanced, it's just packaged in a basic, easy to use delivery > system. > > Yes, it's targeted at the population at risk of DEATH, which is a small > portion of the sick and injured. But look at the outcomes. Death or Life. > > Very worth doing. > > > > > Bob Kellow wrote: > > > Steve, > > > > I would argue that an AED is not " advanced care " . An AED is a > > non-operator dependent, battery operated machine that functions on a > > predetermined, software driven algorithm. I would assign the term " care " > > to human beings. > > > > Some questions: (1) Is $2,500 all the money your service will ever have? > > (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? > > (3) If there's only one AED (depending on where it's " placed " ), who in > > the community served will have access to it, and who will not? (4) What > > is the frequency of demand for an AED in your community compared to > > other types of calls (%)? > > > > I believe that the needs of the many (aggregate demand) outweigh the > > needs of the few (marginal demand) - especially given such abysmal > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > beneficial do you believe one AED will be? I'd invest the money in the > > people who are expected to deliver the " care " . > > > > As an aside, I remember giving a speech on this issue 20 years ago in > > Houston. As a (tongue in cheek) joke, I told the audience of about 100 > > that NASA was about to launch into geosynchronous earth orbit a > > satellite that could detect cardiac arrests, locate the victim via GPS > > and deliver with great precision a shock using a particle beam > > generator. The service would be licensed to EMS organizations and > > re-sold as subscriptions in their respective communities. Deaths from > > cardiac arrest would cease to exist within five years! > > > > To my complete amazement following the speech, I was approached by no > > less than seven people who wanted to know how much NASA was planning to > > charge for the licensing fee (rim shot). > > > > Bob Kellow > > > > Steve wrote: > > > > > I can place an AED total for $2500 or so. Where would you use that > > > $2500 that would have better benefit? We're not talking about gobs of > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > > > AEDs represent a level of advanced care unavailable to them in any > > > other > > > form. They are NOT going to staff ambulances with medics, drugs, > > > manual > > > defibrillators, etc. They are doing good to have EMT level training > > > if > > > that, and a first aid kit (or in better cases a minimal BLS > > > ambulance). > > > AEDs will address the #1 killer, heart disease. So with an AED you > > > have > > > addressed the largest primary survey issue. Seems cost effective to > > > me. > > > > > > Again, if you only have $2500, where are you going to spend it better? > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > Bob, > > > > > > > > You make an excellent point. AEDs are a good example of > > > this--before > > > > I go > > > > any further, I want to make it clear that I know that there are > > > times > > > > when an > > > > AED can make a lot of difference and I would not presume to tell any > > > > > > > department, agency, business, etc. not to get one. My comments have > > > > > > > more to > > > > do with funding/spending priorities, particularly in rural > > > areas--the > > > > AED > > > > just happens to be the example I chose to use because your comments > > > > referred > > > > to cardiac arrest. > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > department > > > > vehicles: > > > > Police departments in small towns (if the town even has a police > > > > department) > > > > often have only one officer on patrol, trying to handle all calls > > > and > > > > traffic > > > > enforcement. This officer may not be immediately available to > > > respond > > > > to an > > > > EMS call. > > > > The Sheriff's Department often has only a couple of deputies > > > covering > > > > the > > > > entire county. If one of them is available, it can easily take > > > 10-15 > > > > minutes > > > > for them to get to the scene. > > > > DPS officers can be even more scarce than deputies--in our area, if > > > > you need > > > > the DPS officer after a certain time of night, he is called out from > > > > > > > home. > > > > Most of the rural fire departments are volunteer (bless 'em) and by > > > > the time > > > > they get to the station, get the trucks out, and get to the scene > > > > enough time > > > > has passed that the AED will be useless. > > > > I can see where AEDs in public buildings might be more > > > beneficial--the > > > > AED > > > > would likely be in close proximity to the patient and there would > > > > always be > > > > staff/employees nearby to initiate it's use quickly. However, in my > > > > > > > 20+ > > > > years in EMS the cardiac arrest calls I have had in public buildings > > > > > > > have > > > > been few and far between and the last one was several years ago. > > > > I just have to wonder about the balance of priorities when we see so > > > > > > > much > > > > about AED funding and AED placement projects when we have many, many > > > > > > > rural > > > > EMS agencies that have a hard time coming up with a crew for the > > > > ambulance > > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > only a > > > > very, very small percentage of EMS calls, but the crew and the > > > > ambulance are > > > > absolutely essential on every call. > > > > > > > > Just some rambling thoughts. > > > > > > > > Maxine Pate > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > out-of-hospital cardiac arrest, and our apparent determination to > > > > expend > > > > > an more and more scarce EMS resources on the population of EMS > > > > patients > > > > > that are least likely to survive, while rural and under-served > > > > counties > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > lemmings] > > > > > by the public policy initiatives and marketing campaigns of EMS > > > > > technology manufacturers, rather than directing our greatest > > > > > concentration of EMS resources toward the greatest concentrations > > > of > > > > > > > > > need? > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 I agree. Obesity, a problem I fight all the time, is so widespread that it has become more of a problem than virtually anything else. Many of us in EMS, nursing, and medicine set poor examples. My wife and I were at a weekend trip at Richland-Chambers lake. She wanted to stop by the -Stover outlet store in Corsicana (she weighs 100 pounds on a good day). I had to sit in the car as we had the dog with us. Virtually everybody who walked into or out of that place was at least 30-40% overweight. I noticed the same thing at a Wal-Mart recently. Man, we are all getting too fat. Too much MTV, too many buffets, too little physical exercise, too many video games and computers, etc. Maybe we should develop automated external muzzles for those of us prone to overeat. BEB Re: Myths > > > > What do you value? Human life is not a marginal thing. So, I can place > an > > AED for $2500, cost of a unit and training. What else can you do, at > $2500 > > per delivered unit, that is as beneficial? Where else would you spend > this > > amount of money and get this impact? We're talking about the #1 killer of > > mankind here. We're talking about definitive initial care for that #1 > > killer. Just what else can you do, dollar for dollar, and have this kind > of > > impact?? Do you need two units? Great, now it's $5000. What can you do > two > > of for $5000 that can have as much impact on quality of life for so many > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > 225,000 > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER YEAR. > > > > And just how more advanced do you want to get than cardiac defibrillation? > > The CARE is advanced, it's just packaged in a basic, easy to use delivery > > system. > > > > Yes, it's targeted at the population at risk of DEATH, which is a small > > portion of the sick and injured. But look at the outcomes. Death or > Life. > > > > Very worth doing. > > > > > > > > > > Bob Kellow wrote: > > > > > Steve, > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > non-operator dependent, battery operated machine that functions on a > > > predetermined, software driven algorithm. I would assign the term " care " > > > to human beings. > > > > > > Some questions: (1) Is $2,500 all the money your service will ever have? > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? > > > (3) If there's only one AED (depending on where it's " placed " ), who in > > > the community served will have access to it, and who will not? (4) What > > > is the frequency of demand for an AED in your community compared to > > > other types of calls (%)? > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > needs of the few (marginal demand) - especially given such abysmal > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > beneficial do you believe one AED will be? I'd invest the money in the > > > people who are expected to deliver the " care " . > > > > > > As an aside, I remember giving a speech on this issue 20 years ago in > > > Houston. As a (tongue in cheek) joke, I told the audience of about 100 > > > that NASA was about to launch into geosynchronous earth orbit a > > > satellite that could detect cardiac arrests, locate the victim via GPS > > > and deliver with great precision a shock using a particle beam > > > generator. The service would be licensed to EMS organizations and > > > re-sold as subscriptions in their respective communities. Deaths from > > > cardiac arrest would cease to exist within five years! > > > > > > To my complete amazement following the speech, I was approached by no > > > less than seven people who wanted to know how much NASA was planning to > > > charge for the licensing fee (rim shot). > > > > > > Bob Kellow > > > > > > Steve wrote: > > > > > > > I can place an AED total for $2500 or so. Where would you use that > > > > $2500 that would have better benefit? We're not talking about gobs of > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > > > > AEDs represent a level of advanced care unavailable to them in any > > > > other > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > manual > > > > defibrillators, etc. They are doing good to have EMT level training > > > > if > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > ambulance). > > > > AEDs will address the #1 killer, heart disease. So with an AED you > > > > have > > > > addressed the largest primary survey issue. Seems cost effective to > > > > me. > > > > > > > > Again, if you only have $2500, where are you going to spend it better? > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > Bob, > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > this--before > > > > > I go > > > > > any further, I want to make it clear that I know that there are > > > > times > > > > > when an > > > > > AED can make a lot of difference and I would not presume to tell any > > > > > > > > > department, agency, business, etc. not to get one. My comments have > > > > > > > > > more to > > > > > do with funding/spending priorities, particularly in rural > > > > areas--the > > > > > AED > > > > > just happens to be the example I chose to use because your comments > > > > > referred > > > > > to cardiac arrest. > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > department > > > > > vehicles: > > > > > Police departments in small towns (if the town even has a police > > > > > department) > > > > > often have only one officer on patrol, trying to handle all calls > > > > and > > > > > traffic > > > > > enforcement. This officer may not be immediately available to > > > > respond > > > > > to an > > > > > EMS call. > > > > > The Sheriff's Department often has only a couple of deputies > > > > covering > > > > > the > > > > > entire county. If one of them is available, it can easily take > > > > 10-15 > > > > > minutes > > > > > for them to get to the scene. > > > > > DPS officers can be even more scarce than deputies--in our area, if > > > > > you need > > > > > the DPS officer after a certain time of night, he is called out from > > > > > > > > > home. > > > > > Most of the rural fire departments are volunteer (bless 'em) and by > > > > > the time > > > > > they get to the station, get the trucks out, and get to the scene > > > > > enough time > > > > > has passed that the AED will be useless. > > > > > I can see where AEDs in public buildings might be more > > > > beneficial--the > > > > > AED > > > > > would likely be in close proximity to the patient and there would > > > > > always be > > > > > staff/employees nearby to initiate it's use quickly. However, in my > > > > > > > > > 20+ > > > > > years in EMS the cardiac arrest calls I have had in public buildings > > > > > > > > > have > > > > > been few and far between and the last one was several years ago. > > > > > I just have to wonder about the balance of priorities when we see so > > > > > > > > > much > > > > > about AED funding and AED placement projects when we have many, many > > > > > > > > > rural > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > ambulance > > > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > > only a > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > ambulance are > > > > > absolutely essential on every call. > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > out-of-hospital cardiac arrest, and our apparent determination to > > > > > expend > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > patients > > > > > > that are least likely to survive, while rural and under-served > > > > > counties > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > lemmings] > > > > > > by the public policy initiatives and marketing campaigns of EMS > > > > > > technology manufacturers, rather than directing our greatest > > > > > > concentration of EMS resources toward the greatest concentrations > > > > of > > > > > > > > > > > need? > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 In the US, where would you spend that $2500 more effectively? " Dr. Bledsoe " wrote: > Wait a minute. Ventricular fibrillation is not the number one killer of > humankind. Worldwide it is infectious disease. In the US it is > cardiovascular disease. Ventricular fibrillation is only a small part of > the cardiovascular disease picture. AEDs are a good way to spend the > money--but they are not the holy grail of EMS. > > EBB > Re: Myths > > > What do you value? Human life is not a marginal thing. So, I can place > an > > AED for $2500, cost of a unit and training. What else can you do, at > $2500 > > per delivered unit, that is as beneficial? Where else would you spend > this > > amount of money and get this impact? We're talking about the #1 killer of > > mankind here. We're talking about definitive initial care for that #1 > > killer. Just what else can you do, dollar for dollar, and have this kind > of > > impact?? Do you need two units? Great, now it's $5000. What can you do > two > > of for $5000 that can have as much impact on quality of life for so many > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > 225,000 > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER YEAR. > > > > And just how more advanced do you want to get than cardiac defibrillation? > > The CARE is advanced, it's just packaged in a basic, easy to use delivery > > system. > > > > Yes, it's targeted at the population at risk of DEATH, which is a small > > portion of the sick and injured. But look at the outcomes. Death or > Life. > > > > Very worth doing. > > > > > > > > > > Bob Kellow wrote: > > > > > Steve, > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > non-operator dependent, battery operated machine that functions on a > > > predetermined, software driven algorithm. I would assign the term " care " > > > to human beings. > > > > > > Some questions: (1) Is $2,500 all the money your service will ever have? > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? > > > (3) If there's only one AED (depending on where it's " placed " ), who in > > > the community served will have access to it, and who will not? (4) What > > > is the frequency of demand for an AED in your community compared to > > > other types of calls (%)? > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > needs of the few (marginal demand) - especially given such abysmal > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > beneficial do you believe one AED will be? I'd invest the money in the > > > people who are expected to deliver the " care " . > > > > > > As an aside, I remember giving a speech on this issue 20 years ago in > > > Houston. As a (tongue in cheek) joke, I told the audience of about 100 > > > that NASA was about to launch into geosynchronous earth orbit a > > > satellite that could detect cardiac arrests, locate the victim via GPS > > > and deliver with great precision a shock using a particle beam > > > generator. The service would be licensed to EMS organizations and > > > re-sold as subscriptions in their respective communities. Deaths from > > > cardiac arrest would cease to exist within five years! > > > > > > To my complete amazement following the speech, I was approached by no > > > less than seven people who wanted to know how much NASA was planning to > > > charge for the licensing fee (rim shot). > > > > > > Bob Kellow > > > > > > Steve wrote: > > > > > > > I can place an AED total for $2500 or so. Where would you use that > > > > $2500 that would have better benefit? We're not talking about gobs of > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > > > > AEDs represent a level of advanced care unavailable to them in any > > > > other > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > manual > > > > defibrillators, etc. They are doing good to have EMT level training > > > > if > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > ambulance). > > > > AEDs will address the #1 killer, heart disease. So with an AED you > > > > have > > > > addressed the largest primary survey issue. Seems cost effective to > > > > me. > > > > > > > > Again, if you only have $2500, where are you going to spend it better? > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > Bob, > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > this--before > > > > > I go > > > > > any further, I want to make it clear that I know that there are > > > > times > > > > > when an > > > > > AED can make a lot of difference and I would not presume to tell any > > > > > > > > > department, agency, business, etc. not to get one. My comments have > > > > > > > > > more to > > > > > do with funding/spending priorities, particularly in rural > > > > areas--the > > > > > AED > > > > > just happens to be the example I chose to use because your comments > > > > > referred > > > > > to cardiac arrest. > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > department > > > > > vehicles: > > > > > Police departments in small towns (if the town even has a police > > > > > department) > > > > > often have only one officer on patrol, trying to handle all calls > > > > and > > > > > traffic > > > > > enforcement. This officer may not be immediately available to > > > > respond > > > > > to an > > > > > EMS call. > > > > > The Sheriff's Department often has only a couple of deputies > > > > covering > > > > > the > > > > > entire county. If one of them is available, it can easily take > > > > 10-15 > > > > > minutes > > > > > for them to get to the scene. > > > > > DPS officers can be even more scarce than deputies--in our area, if > > > > > you need > > > > > the DPS officer after a certain time of night, he is called out from > > > > > > > > > home. > > > > > Most of the rural fire departments are volunteer (bless 'em) and by > > > > > the time > > > > > they get to the station, get the trucks out, and get to the scene > > > > > enough time > > > > > has passed that the AED will be useless. > > > > > I can see where AEDs in public buildings might be more > > > > beneficial--the > > > > > AED > > > > > would likely be in close proximity to the patient and there would > > > > > always be > > > > > staff/employees nearby to initiate it's use quickly. However, in my > > > > > > > > > 20+ > > > > > years in EMS the cardiac arrest calls I have had in public buildings > > > > > > > > > have > > > > > been few and far between and the last one was several years ago. > > > > > I just have to wonder about the balance of priorities when we see so > > > > > > > > > much > > > > > about AED funding and AED placement projects when we have many, many > > > > > > > > > rural > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > ambulance > > > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > > only a > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > ambulance are > > > > > absolutely essential on every call. > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > out-of-hospital cardiac arrest, and our apparent determination to > > > > > expend > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > patients > > > > > > that are least likely to survive, while rural and under-served > > > > > counties > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > lemmings] > > > > > > by the public policy initiatives and marketing campaigns of EMS > > > > > > technology manufacturers, rather than directing our greatest > > > > > > concentration of EMS resources toward the greatest concentrations > > > > of > > > > > > > > > > > need? > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 Which data? Zoll AEDPlus - $2025 list. Training class - $200 Maintenance over 5 years - trivial, maybe $250. Bob Kellow wrote: > Steve, > > You didn't answer any of my questions. And, where did you get these > data? > > Bob > > Steve wrote: > > > What do you value? Human life is not a marginal thing. So, I can > > place an > > AED for $2500, cost of a unit and training. What else can you do, at > > $2500 > > per delivered unit, that is as beneficial? Where else would you spend > > this > > amount of money and get this impact? We're talking about the #1 killer > > of > > mankind here. We're talking about definitive initial care for that #1 > > > > killer. Just what else can you do, dollar for dollar, and have this > > kind of > > impact?? Do you need two units? Great, now it's $5000. What can you > > do two > > of for $5000 that can have as much impact on quality of life for so > > many > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > > 225,000 > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER > > YEAR. > > > > And just how more advanced do you want to get than cardiac > > defibrillation? > > The CARE is advanced, it's just packaged in a basic, easy to use > > delivery > > system. > > > > Yes, it's targeted at the population at risk of DEATH, which is a > > small > > portion of the sick and injured. But look at the outcomes. Death or > > Life. > > > > Very worth doing. > > > > > > > > > > Bob Kellow wrote: > > > > > Steve, > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > non-operator dependent, battery operated machine that functions on a > > > > > predetermined, software driven algorithm. I would assign the term > > " care " > > > to human beings. > > > > > > Some questions: (1) Is $2,500 all the money your service will ever > > have? > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? > > Where? > > > (3) If there's only one AED (depending on where it's " placed " ), who > > in > > > the community served will have access to it, and who will not? (4) > > What > > > is the frequency of demand for an AED in your community compared to > > > other types of calls (%)? > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > > > needs of the few (marginal demand) - especially given such abysmal > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > > > beneficial do you believe one AED will be? I'd invest the money in > > the > > > people who are expected to deliver the " care " . > > > > > > As an aside, I remember giving a speech on this issue 20 years ago > > in > > > Houston. As a (tongue in cheek) joke, I told the audience of about > > 100 > > > that NASA was about to launch into geosynchronous earth orbit a > > > satellite that could detect cardiac arrests, locate the victim via > > GPS > > > and deliver with great precision a shock using a particle beam > > > generator. The service would be licensed to EMS organizations and > > > re-sold as subscriptions in their respective communities. Deaths > > from > > > cardiac arrest would cease to exist within five years! > > > > > > To my complete amazement following the speech, I was approached by > > no > > > less than seven people who wanted to know how much NASA was planning > > to > > > charge for the licensing fee (rim shot). > > > > > > Bob Kellow > > > > > > Steve wrote: > > > > > > > I can place an AED total for $2500 or so. Where would you use > > that > > > > $2500 that would have better benefit? We're not talking about > > gobs of > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is > > not > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or > > FR, > > > > AEDs represent a level of advanced care unavailable to them in any > > > > > > other > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > manual > > > > defibrillators, etc. They are doing good to have EMT level > > training > > > > if > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > ambulance). > > > > AEDs will address the #1 killer, heart disease. So with an AED > > you > > > > have > > > > addressed the largest primary survey issue. Seems cost effective > > to > > > > me. > > > > > > > > Again, if you only have $2500, where are you going to spend it > > better? > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > Bob, > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > this--before > > > > > I go > > > > > any further, I want to make it clear that I know that there are > > > > times > > > > > when an > > > > > AED can make a lot of difference and I would not presume to tell > > any > > > > > > > > > department, agency, business, etc. not to get one. My comments > > have > > > > > > > > > more to > > > > > do with funding/spending priorities, particularly in rural > > > > areas--the > > > > > AED > > > > > just happens to be the example I chose to use because your > > comments > > > > > referred > > > > > to cardiac arrest. > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > department > > > > > vehicles: > > > > > Police departments in small towns (if the town even has a police > > > > > > > department) > > > > > often have only one officer on patrol, trying to handle all > > calls > > > > and > > > > > traffic > > > > > enforcement. This officer may not be immediately available to > > > > respond > > > > > to an > > > > > EMS call. > > > > > The Sheriff's Department often has only a couple of deputies > > > > covering > > > > > the > > > > > entire county. If one of them is available, it can easily take > > > > 10-15 > > > > > minutes > > > > > for them to get to the scene. > > > > > DPS officers can be even more scarce than deputies--in our area, > > if > > > > > you need > > > > > the DPS officer after a certain time of night, he is called out > > from > > > > > > > > > home. > > > > > Most of the rural fire departments are volunteer (bless 'em) and > > by > > > > > the time > > > > > they get to the station, get the trucks out, and get to the > > scene > > > > > enough time > > > > > has passed that the AED will be useless. > > > > > I can see where AEDs in public buildings might be more > > > > beneficial--the > > > > > AED > > > > > would likely be in close proximity to the patient and there > > would > > > > > always be > > > > > staff/employees nearby to initiate it's use quickly. However, > > in my > > > > > > > > > 20+ > > > > > years in EMS the cardiac arrest calls I have had in public > > buildings > > > > > > > > > have > > > > > been few and far between and the last one was several years ago. > > > > > > > I just have to wonder about the balance of priorities when we > > see so > > > > > > > > > much > > > > > about AED funding and AED placement projects when we have many, > > many > > > > > > > > > rural > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > > > ambulance > > > > > (or even maintaining an ambulance). The AED will be beneficial > > in > > > > > only a > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > ambulance are > > > > > absolutely essential on every call. > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > > > out-of-hospital cardiac arrest, and our apparent determination > > to > > > > > expend > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > > > patients > > > > > > that are least likely to survive, while rural and under-served > > > > > > > counties > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > lemmings] > > > > > > by the public policy initiatives and marketing campaigns of > > EMS > > > > > > technology manufacturers, rather than directing our greatest > > > > > > concentration of EMS resources toward the greatest > > concentrations > > > > of > > > > > > > > > > > need? > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 My smart-aleck response would be " Wal-Mart. " But, I can't think of a better way to spend the money than on AEDs (except maybe concomittant BLS education). AEDs work and save lives and the research shows it. I just felt that you overstated the magnitude of ventricular fibrillation in the whole CV disease spectrum. We should want the following in the overall scheme of things: 1. Widespread AEDs and bystander CPR education 2. Quality, well-educated and equipped First Responders 3. ALS Units that truly bring the emergency department to the patient (with paramedics that are paid well and who will stay in the business). 4. Transport to the appropriate hospital. 5. Definitive care and rehabilitation. We are really saying the same thing Steve. BEB BEB Re: Myths > > > > > What do you value? Human life is not a marginal thing. So, I can place > > an > > > AED for $2500, cost of a unit and training. What else can you do, at > > $2500 > > > per delivered unit, that is as beneficial? Where else would you spend > > this > > > amount of money and get this impact? We're talking about the #1 killer of > > > mankind here. We're talking about definitive initial care for that #1 > > > killer. Just what else can you do, dollar for dollar, and have this kind > > of > > > impact?? Do you need two units? Great, now it's $5000. What can you do > > two > > > of for $5000 that can have as much impact on quality of life for so many > > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > > 225,000 > > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER YEAR. > > > > > > And just how more advanced do you want to get than cardiac defibrillation? > > > The CARE is advanced, it's just packaged in a basic, easy to use delivery > > > system. > > > > > > Yes, it's targeted at the population at risk of DEATH, which is a small > > > portion of the sick and injured. But look at the outcomes. Death or > > Life. > > > > > > Very worth doing. > > > > > > > > > > > > > > > Bob Kellow wrote: > > > > > > > Steve, > > > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > > non-operator dependent, battery operated machine that functions on a > > > > predetermined, software driven algorithm. I would assign the term " care " > > > > to human beings. > > > > > > > > Some questions: (1) Is $2,500 all the money your service will ever have? > > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? > > > > (3) If there's only one AED (depending on where it's " placed " ), who in > > > > the community served will have access to it, and who will not? (4) What > > > > is the frequency of demand for an AED in your community compared to > > > > other types of calls (%)? > > > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > > needs of the few (marginal demand) - especially given such abysmal > > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > > beneficial do you believe one AED will be? I'd invest the money in the > > > > people who are expected to deliver the " care " . > > > > > > > > As an aside, I remember giving a speech on this issue 20 years ago in > > > > Houston. As a (tongue in cheek) joke, I told the audience of about 100 > > > > that NASA was about to launch into geosynchronous earth orbit a > > > > satellite that could detect cardiac arrests, locate the victim via GPS > > > > and deliver with great precision a shock using a particle beam > > > > generator. The service would be licensed to EMS organizations and > > > > re-sold as subscriptions in their respective communities. Deaths from > > > > cardiac arrest would cease to exist within five years! > > > > > > > > To my complete amazement following the speech, I was approached by no > > > > less than seven people who wanted to know how much NASA was planning to > > > > charge for the licensing fee (rim shot). > > > > > > > > Bob Kellow > > > > > > > > Steve wrote: > > > > > > > > > I can place an AED total for $2500 or so. Where would you use that > > > > > $2500 that would have better benefit? We're not talking about gobs of > > > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > > > > > AEDs represent a level of advanced care unavailable to them in any > > > > > other > > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > > manual > > > > > defibrillators, etc. They are doing good to have EMT level training > > > > > if > > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > > ambulance). > > > > > AEDs will address the #1 killer, heart disease. So with an AED you > > > > > have > > > > > addressed the largest primary survey issue. Seems cost effective to > > > > > me. > > > > > > > > > > Again, if you only have $2500, where are you going to spend it better? > > > > > > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > > > Bob, > > > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > > this--before > > > > > > I go > > > > > > any further, I want to make it clear that I know that there are > > > > > times > > > > > > when an > > > > > > AED can make a lot of difference and I would not presume to tell any > > > > > > > > > > > department, agency, business, etc. not to get one. My comments have > > > > > > > > > > > more to > > > > > > do with funding/spending priorities, particularly in rural > > > > > areas--the > > > > > > AED > > > > > > just happens to be the example I chose to use because your comments > > > > > > referred > > > > > > to cardiac arrest. > > > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > > department > > > > > > vehicles: > > > > > > Police departments in small towns (if the town even has a police > > > > > > department) > > > > > > often have only one officer on patrol, trying to handle all calls > > > > > and > > > > > > traffic > > > > > > enforcement. This officer may not be immediately available to > > > > > respond > > > > > > to an > > > > > > EMS call. > > > > > > The Sheriff's Department often has only a couple of deputies > > > > > covering > > > > > > the > > > > > > entire county. If one of them is available, it can easily take > > > > > 10-15 > > > > > > minutes > > > > > > for them to get to the scene. > > > > > > DPS officers can be even more scarce than deputies--in our area, if > > > > > > you need > > > > > > the DPS officer after a certain time of night, he is called out from > > > > > > > > > > > home. > > > > > > Most of the rural fire departments are volunteer (bless 'em) and by > > > > > > the time > > > > > > they get to the station, get the trucks out, and get to the scene > > > > > > enough time > > > > > > has passed that the AED will be useless. > > > > > > I can see where AEDs in public buildings might be more > > > > > beneficial--the > > > > > > AED > > > > > > would likely be in close proximity to the patient and there would > > > > > > always be > > > > > > staff/employees nearby to initiate it's use quickly. However, in my > > > > > > > > > > > 20+ > > > > > > years in EMS the cardiac arrest calls I have had in public buildings > > > > > > > > > > > have > > > > > > been few and far between and the last one was several years ago. > > > > > > I just have to wonder about the balance of priorities when we see so > > > > > > > > > > > much > > > > > > about AED funding and AED placement projects when we have many, many > > > > > > > > > > > rural > > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > > ambulance > > > > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > > > only a > > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > > ambulance are > > > > > > absolutely essential on every call. > > > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > > out-of-hospital cardiac arrest, and our apparent determination to > > > > > > expend > > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > > patients > > > > > > > that are least likely to survive, while rural and under-served > > > > > > counties > > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > > lemmings] > > > > > > > by the public policy initiatives and marketing campaigns of EMS > > > > > > > technology manufacturers, rather than directing our greatest > > > > > > > concentration of EMS resources toward the greatest concentrations > > > > > of > > > > > > > > > > > > > need? > > > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 I think you're right. and I didn't realize how overgeneralized what I said was till you reminded me. And as long as you don't say K-Mart.... =Steve= " Dr. Bledsoe " wrote: > My smart-aleck response would be " Wal-Mart. " But, I can't think of a better > way to spend the money than on AEDs (except maybe concomittant BLS > education). AEDs work and save lives and the research shows it. I just > felt that you overstated the magnitude of ventricular fibrillation in the > whole CV disease spectrum. We should want the following in the overall > scheme of things: > > 1. Widespread AEDs and bystander CPR education > 2. Quality, well-educated and equipped First Responders > 3. ALS Units that truly bring the emergency department to the patient (with > paramedics that are paid well and who will stay in the business). > 4. Transport to the appropriate hospital. > 5. Definitive care and rehabilitation. > > We are really saying the same thing Steve. > > BEB > BEB > Re: Myths > > > > > > > What do you value? Human life is not a marginal thing. So, I can > place > > > an > > > > AED for $2500, cost of a unit and training. What else can you do, at > > > $2500 > > > > per delivered unit, that is as beneficial? Where else would you spend > > > this > > > > amount of money and get this impact? We're talking about the #1 killer > of > > > > mankind here. We're talking about definitive initial care for that #1 > > > > killer. Just what else can you do, dollar for dollar, and have this > kind > > > of > > > > impact?? Do you need two units? Great, now it's $5000. What can you > do > > > two > > > > of for $5000 that can have as much impact on quality of life for so > many > > > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > > > 225,000 > > > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER > YEAR. > > > > > > > > And just how more advanced do you want to get than cardiac > defibrillation? > > > > The CARE is advanced, it's just packaged in a basic, easy to use > delivery > > > > system. > > > > > > > > Yes, it's targeted at the population at risk of DEATH, which is a > small > > > > portion of the sick and injured. But look at the outcomes. Death or > > > Life. > > > > > > > > Very worth doing. > > > > > > > > > > > > > > > > > > > > Bob Kellow wrote: > > > > > > > > > Steve, > > > > > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > > > non-operator dependent, battery operated machine that functions on a > > > > > predetermined, software driven algorithm. I would assign the term > " care " > > > > > to human beings. > > > > > > > > > > Some questions: (1) Is $2,500 all the money your service will ever > have? > > > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? > Where? > > > > > (3) If there's only one AED (depending on where it's " placed " ), who > in > > > > > the community served will have access to it, and who will not? (4) > What > > > > > is the frequency of demand for an AED in your community compared to > > > > > other types of calls (%)? > > > > > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > > > needs of the few (marginal demand) - especially given such abysmal > > > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > > > beneficial do you believe one AED will be? I'd invest the money in > the > > > > > people who are expected to deliver the " care " . > > > > > > > > > > As an aside, I remember giving a speech on this issue 20 years ago > in > > > > > Houston. As a (tongue in cheek) joke, I told the audience of about > 100 > > > > > that NASA was about to launch into geosynchronous earth orbit a > > > > > satellite that could detect cardiac arrests, locate the victim via > GPS > > > > > and deliver with great precision a shock using a particle beam > > > > > generator. The service would be licensed to EMS organizations and > > > > > re-sold as subscriptions in their respective communities. Deaths > from > > > > > cardiac arrest would cease to exist within five years! > > > > > > > > > > To my complete amazement following the speech, I was approached by > no > > > > > less than seven people who wanted to know how much NASA was planning > to > > > > > charge for the licensing fee (rim shot). > > > > > > > > > > Bob Kellow > > > > > > > > > > Steve wrote: > > > > > > > > > > > I can place an AED total for $2500 or so. Where would you use > that > > > > > > $2500 that would have better benefit? We're not talking about > gobs of > > > > > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is > not > > > > > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or > FR, > > > > > > AEDs represent a level of advanced care unavailable to them in any > > > > > > other > > > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > > > manual > > > > > > defibrillators, etc. They are doing good to have EMT level > training > > > > > > if > > > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > > > ambulance). > > > > > > AEDs will address the #1 killer, heart disease. So with an AED > you > > > > > > have > > > > > > addressed the largest primary survey issue. Seems cost effective > to > > > > > > me. > > > > > > > > > > > > Again, if you only have $2500, where are you going to spend it > better? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > > > > > Bob, > > > > > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > > > this--before > > > > > > > I go > > > > > > > any further, I want to make it clear that I know that there are > > > > > > times > > > > > > > when an > > > > > > > AED can make a lot of difference and I would not presume to tell > any > > > > > > > > > > > > > department, agency, business, etc. not to get one. My comments > have > > > > > > > > > > > > > more to > > > > > > > do with funding/spending priorities, particularly in rural > > > > > > areas--the > > > > > > > AED > > > > > > > just happens to be the example I chose to use because your > comments > > > > > > > referred > > > > > > > to cardiac arrest. > > > > > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > > > department > > > > > > > vehicles: > > > > > > > Police departments in small towns (if the town even has a police > > > > > > > department) > > > > > > > often have only one officer on patrol, trying to handle all > calls > > > > > > and > > > > > > > traffic > > > > > > > enforcement. This officer may not be immediately available to > > > > > > respond > > > > > > > to an > > > > > > > EMS call. > > > > > > > The Sheriff's Department often has only a couple of deputies > > > > > > covering > > > > > > > the > > > > > > > entire county. If one of them is available, it can easily take > > > > > > 10-15 > > > > > > > minutes > > > > > > > for them to get to the scene. > > > > > > > DPS officers can be even more scarce than deputies--in our area, > if > > > > > > > you need > > > > > > > the DPS officer after a certain time of night, he is called out > from > > > > > > > > > > > > > home. > > > > > > > Most of the rural fire departments are volunteer (bless 'em) and > by > > > > > > > the time > > > > > > > they get to the station, get the trucks out, and get to the > scene > > > > > > > enough time > > > > > > > has passed that the AED will be useless. > > > > > > > I can see where AEDs in public buildings might be more > > > > > > beneficial--the > > > > > > > AED > > > > > > > would likely be in close proximity to the patient and there > would > > > > > > > always be > > > > > > > staff/employees nearby to initiate it's use quickly. However, > in my > > > > > > > > > > > > > 20+ > > > > > > > years in EMS the cardiac arrest calls I have had in public > buildings > > > > > > > > > > > > > have > > > > > > > been few and far between and the last one was several years ago. > > > > > > > I just have to wonder about the balance of priorities when we > see so > > > > > > > > > > > > > much > > > > > > > about AED funding and AED placement projects when we have many, > many > > > > > > > > > > > > > rural > > > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > > > ambulance > > > > > > > (or even maintaining an ambulance). The AED will be beneficial > in > > > > > > > only a > > > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > > > ambulance are > > > > > > > absolutely essential on every call. > > > > > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > > > out-of-hospital cardiac arrest, and our apparent determination > to > > > > > > > expend > > > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > > > patients > > > > > > > > that are least likely to survive, while rural and under-served > > > > > > > counties > > > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > > > lemmings] > > > > > > > > by the public policy initiatives and marketing campaigns of > EMS > > > > > > > > technology manufacturers, rather than directing our greatest > > > > > > > > concentration of EMS resources toward the greatest > concentrations > > > > > > of > > > > > > > > > > > > > > > need? > > > > > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 I think you're right. and I didn't realize how overgeneralized what I said was till you reminded me. And as long as you don't say K-Mart.... =Steve= " Dr. Bledsoe " wrote: > My smart-aleck response would be " Wal-Mart. " But, I can't think of a better > way to spend the money than on AEDs (except maybe concomittant BLS > education). AEDs work and save lives and the research shows it. I just > felt that you overstated the magnitude of ventricular fibrillation in the > whole CV disease spectrum. We should want the following in the overall > scheme of things: > > 1. Widespread AEDs and bystander CPR education > 2. Quality, well-educated and equipped First Responders > 3. ALS Units that truly bring the emergency department to the patient (with > paramedics that are paid well and who will stay in the business). > 4. Transport to the appropriate hospital. > 5. Definitive care and rehabilitation. > > We are really saying the same thing Steve. > > BEB > BEB > Re: Myths > > > > > > > What do you value? Human life is not a marginal thing. So, I can > place > > > an > > > > AED for $2500, cost of a unit and training. What else can you do, at > > > $2500 > > > > per delivered unit, that is as beneficial? Where else would you spend > > > this > > > > amount of money and get this impact? We're talking about the #1 killer > of > > > > mankind here. We're talking about definitive initial care for that #1 > > > > killer. Just what else can you do, dollar for dollar, and have this > kind > > > of > > > > impact?? Do you need two units? Great, now it's $5000. What can you > do > > > two > > > > of for $5000 that can have as much impact on quality of life for so > many > > > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > > > 225,000 > > > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER > YEAR. > > > > > > > > And just how more advanced do you want to get than cardiac > defibrillation? > > > > The CARE is advanced, it's just packaged in a basic, easy to use > delivery > > > > system. > > > > > > > > Yes, it's targeted at the population at risk of DEATH, which is a > small > > > > portion of the sick and injured. But look at the outcomes. Death or > > > Life. > > > > > > > > Very worth doing. > > > > > > > > > > > > > > > > > > > > Bob Kellow wrote: > > > > > > > > > Steve, > > > > > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > > > non-operator dependent, battery operated machine that functions on a > > > > > predetermined, software driven algorithm. I would assign the term > " care " > > > > > to human beings. > > > > > > > > > > Some questions: (1) Is $2,500 all the money your service will ever > have? > > > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? > Where? > > > > > (3) If there's only one AED (depending on where it's " placed " ), who > in > > > > > the community served will have access to it, and who will not? (4) > What > > > > > is the frequency of demand for an AED in your community compared to > > > > > other types of calls (%)? > > > > > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > > > needs of the few (marginal demand) - especially given such abysmal > > > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > > > beneficial do you believe one AED will be? I'd invest the money in > the > > > > > people who are expected to deliver the " care " . > > > > > > > > > > As an aside, I remember giving a speech on this issue 20 years ago > in > > > > > Houston. As a (tongue in cheek) joke, I told the audience of about > 100 > > > > > that NASA was about to launch into geosynchronous earth orbit a > > > > > satellite that could detect cardiac arrests, locate the victim via > GPS > > > > > and deliver with great precision a shock using a particle beam > > > > > generator. The service would be licensed to EMS organizations and > > > > > re-sold as subscriptions in their respective communities. Deaths > from > > > > > cardiac arrest would cease to exist within five years! > > > > > > > > > > To my complete amazement following the speech, I was approached by > no > > > > > less than seven people who wanted to know how much NASA was planning > to > > > > > charge for the licensing fee (rim shot). > > > > > > > > > > Bob Kellow > > > > > > > > > > Steve wrote: > > > > > > > > > > > I can place an AED total for $2500 or so. Where would you use > that > > > > > > $2500 that would have better benefit? We're not talking about > gobs of > > > > > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is > not > > > > > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or > FR, > > > > > > AEDs represent a level of advanced care unavailable to them in any > > > > > > other > > > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > > > manual > > > > > > defibrillators, etc. They are doing good to have EMT level > training > > > > > > if > > > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > > > ambulance). > > > > > > AEDs will address the #1 killer, heart disease. So with an AED > you > > > > > > have > > > > > > addressed the largest primary survey issue. Seems cost effective > to > > > > > > me. > > > > > > > > > > > > Again, if you only have $2500, where are you going to spend it > better? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > > > > > Bob, > > > > > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > > > this--before > > > > > > > I go > > > > > > > any further, I want to make it clear that I know that there are > > > > > > times > > > > > > > when an > > > > > > > AED can make a lot of difference and I would not presume to tell > any > > > > > > > > > > > > > department, agency, business, etc. not to get one. My comments > have > > > > > > > > > > > > > more to > > > > > > > do with funding/spending priorities, particularly in rural > > > > > > areas--the > > > > > > > AED > > > > > > > just happens to be the example I chose to use because your > comments > > > > > > > referred > > > > > > > to cardiac arrest. > > > > > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > > > department > > > > > > > vehicles: > > > > > > > Police departments in small towns (if the town even has a police > > > > > > > department) > > > > > > > often have only one officer on patrol, trying to handle all > calls > > > > > > and > > > > > > > traffic > > > > > > > enforcement. This officer may not be immediately available to > > > > > > respond > > > > > > > to an > > > > > > > EMS call. > > > > > > > The Sheriff's Department often has only a couple of deputies > > > > > > covering > > > > > > > the > > > > > > > entire county. If one of them is available, it can easily take > > > > > > 10-15 > > > > > > > minutes > > > > > > > for them to get to the scene. > > > > > > > DPS officers can be even more scarce than deputies--in our area, > if > > > > > > > you need > > > > > > > the DPS officer after a certain time of night, he is called out > from > > > > > > > > > > > > > home. > > > > > > > Most of the rural fire departments are volunteer (bless 'em) and > by > > > > > > > the time > > > > > > > they get to the station, get the trucks out, and get to the > scene > > > > > > > enough time > > > > > > > has passed that the AED will be useless. > > > > > > > I can see where AEDs in public buildings might be more > > > > > > beneficial--the > > > > > > > AED > > > > > > > would likely be in close proximity to the patient and there > would > > > > > > > always be > > > > > > > staff/employees nearby to initiate it's use quickly. However, > in my > > > > > > > > > > > > > 20+ > > > > > > > years in EMS the cardiac arrest calls I have had in public > buildings > > > > > > > > > > > > > have > > > > > > > been few and far between and the last one was several years ago. > > > > > > > I just have to wonder about the balance of priorities when we > see so > > > > > > > > > > > > > much > > > > > > > about AED funding and AED placement projects when we have many, > many > > > > > > > > > > > > > rural > > > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > > > ambulance > > > > > > > (or even maintaining an ambulance). The AED will be beneficial > in > > > > > > > only a > > > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > > > ambulance are > > > > > > > absolutely essential on every call. > > > > > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > > > out-of-hospital cardiac arrest, and our apparent determination > to > > > > > > > expend > > > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > > > patients > > > > > > > > that are least likely to survive, while rural and under-served > > > > > > > counties > > > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > > > lemmings] > > > > > > > > by the public policy initiatives and marketing campaigns of > EMS > > > > > > > > technology manufacturers, rather than directing our greatest > > > > > > > > concentration of EMS resources toward the greatest > concentrations > > > > > > of > > > > > > > > > > > > > > > need? > > > > > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 , This one line is the most important part of your reply. Add " well educated and well trained " and we have a winner. Regards, Donn -----Original Message----- From: Dr. Bledsoe 3. ALS Units that truly bring the emergency department to the patient (with paramedics that are paid well and who will stay in the business). BEB Re: Myths > > > > > What do you value? Human life is not a marginal thing. So, I can place > > an > > > AED for $2500, cost of a unit and training. What else can you do, at > > $2500 > > > per delivered unit, that is as beneficial? Where else would you spend > > this > > > amount of money and get this impact? We're talking about the #1 killer of > > > mankind here. We're talking about definitive initial care for that #1 > > > killer. Just what else can you do, dollar for dollar, and have this kind > > of > > > impact?? Do you need two units? Great, now it's $5000. What can you do > > two > > > of for $5000 that can have as much impact on quality of life for so many > > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > > 225,000 > > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER YEAR. > > > > > > And just how more advanced do you want to get than cardiac defibrillation? > > > The CARE is advanced, it's just packaged in a basic, easy to use delivery > > > system. > > > > > > Yes, it's targeted at the population at risk of DEATH, which is a small > > > portion of the sick and injured. But look at the outcomes. Death or > > Life. > > > > > > Very worth doing. > > > > > > > > > > > > > > > Bob Kellow wrote: > > > > > > > Steve, > > > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > > non-operator dependent, battery operated machine that functions on a > > > > predetermined, software driven algorithm. I would assign the term " care " > > > > to human beings. > > > > > > > > Some questions: (1) Is $2,500 all the money your service will ever have? > > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? Where? > > > > (3) If there's only one AED (depending on where it's " placed " ), who in > > > > the community served will have access to it, and who will not? (4) What > > > > is the frequency of demand for an AED in your community compared to > > > > other types of calls (%)? > > > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > > needs of the few (marginal demand) - especially given such abysmal > > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > > beneficial do you believe one AED will be? I'd invest the money in the > > > > people who are expected to deliver the " care " . > > > > > > > > As an aside, I remember giving a speech on this issue 20 years ago in > > > > Houston. As a (tongue in cheek) joke, I told the audience of about 100 > > > > that NASA was about to launch into geosynchronous earth orbit a > > > > satellite that could detect cardiac arrests, locate the victim via GPS > > > > and deliver with great precision a shock using a particle beam > > > > generator. The service would be licensed to EMS organizations and > > > > re-sold as subscriptions in their respective communities. Deaths from > > > > cardiac arrest would cease to exist within five years! > > > > > > > > To my complete amazement following the speech, I was approached by no > > > > less than seven people who wanted to know how much NASA was planning to > > > > charge for the licensing fee (rim shot). > > > > > > > > Bob Kellow > > > > > > > > Steve wrote: > > > > > > > > > I can place an AED total for $2500 or so. Where would you use that > > > > > $2500 that would have better benefit? We're not talking about gobs of > > > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is not > > > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or FR, > > > > > AEDs represent a level of advanced care unavailable to them in any > > > > > other > > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > > manual > > > > > defibrillators, etc. They are doing good to have EMT level training > > > > > if > > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > > ambulance). > > > > > AEDs will address the #1 killer, heart disease. So with an AED you > > > > > have > > > > > addressed the largest primary survey issue. Seems cost effective to > > > > > me. > > > > > > > > > > Again, if you only have $2500, where are you going to spend it better? > > > > > > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > > > Bob, > > > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > > this--before > > > > > > I go > > > > > > any further, I want to make it clear that I know that there are > > > > > times > > > > > > when an > > > > > > AED can make a lot of difference and I would not presume to tell any > > > > > > > > > > > department, agency, business, etc. not to get one. My comments have > > > > > > > > > > > more to > > > > > > do with funding/spending priorities, particularly in rural > > > > > areas--the > > > > > > AED > > > > > > just happens to be the example I chose to use because your comments > > > > > > referred > > > > > > to cardiac arrest. > > > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > > department > > > > > > vehicles: > > > > > > Police departments in small towns (if the town even has a police > > > > > > department) > > > > > > often have only one officer on patrol, trying to handle all calls > > > > > and > > > > > > traffic > > > > > > enforcement. This officer may not be immediately available to > > > > > respond > > > > > > to an > > > > > > EMS call. > > > > > > The Sheriff's Department often has only a couple of deputies > > > > > covering > > > > > > the > > > > > > entire county. If one of them is available, it can easily take > > > > > 10-15 > > > > > > minutes > > > > > > for them to get to the scene. > > > > > > DPS officers can be even more scarce than deputies--in our area, if > > > > > > you need > > > > > > the DPS officer after a certain time of night, he is called out from > > > > > > > > > > > home. > > > > > > Most of the rural fire departments are volunteer (bless 'em) and by > > > > > > the time > > > > > > they get to the station, get the trucks out, and get to the scene > > > > > > enough time > > > > > > has passed that the AED will be useless. > > > > > > I can see where AEDs in public buildings might be more > > > > > beneficial--the > > > > > > AED > > > > > > would likely be in close proximity to the patient and there would > > > > > > always be > > > > > > staff/employees nearby to initiate it's use quickly. However, in my > > > > > > > > > > > 20+ > > > > > > years in EMS the cardiac arrest calls I have had in public buildings > > > > > > > > > > > have > > > > > > been few and far between and the last one was several years ago. > > > > > > I just have to wonder about the balance of priorities when we see so > > > > > > > > > > > much > > > > > > about AED funding and AED placement projects when we have many, many > > > > > > > > > > > rural > > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > > ambulance > > > > > > (or even maintaining an ambulance). The AED will be beneficial in > > > > > > only a > > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > > ambulance are > > > > > > absolutely essential on every call. > > > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > > out-of-hospital cardiac arrest, and our apparent determination to > > > > > > expend > > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > > patients > > > > > > > that are least likely to survive, while rural and under-served > > > > > > counties > > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > > lemmings] > > > > > > > by the public policy initiatives and marketing campaigns of EMS > > > > > > > technology manufacturers, rather than directing our greatest > > > > > > > concentration of EMS resources toward the greatest concentrations > > > > > of > > > > > > > > > > > > > need? > > > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 Alright so nobody's perfect. I is well-educated, but my wife says I ain't well-trained. BEB Re: Myths > > > > > > > What do you value? Human life is not a marginal thing. So, I can > place > > > an > > > > AED for $2500, cost of a unit and training. What else can you do, at > > > $2500 > > > > per delivered unit, that is as beneficial? Where else would you spend > > > this > > > > amount of money and get this impact? We're talking about the #1 killer > of > > > > mankind here. We're talking about definitive initial care for that #1 > > > > killer. Just what else can you do, dollar for dollar, and have this > kind > > > of > > > > impact?? Do you need two units? Great, now it's $5000. What can you > do > > > two > > > > of for $5000 that can have as much impact on quality of life for so > many > > > > folks (CDC says 450,000 die of heart disease. If half are SCAs, then > > > 225,000 > > > > SCAs. If 40% can be saved by defib, then 90,000 potential saves PER > YEAR. > > > > > > > > And just how more advanced do you want to get than cardiac > defibrillation? > > > > The CARE is advanced, it's just packaged in a basic, easy to use > delivery > > > > system. > > > > > > > > Yes, it's targeted at the population at risk of DEATH, which is a > small > > > > portion of the sick and injured. But look at the outcomes. Death or > > > Life. > > > > > > > > Very worth doing. > > > > > > > > > > > > > > > > > > > > Bob Kellow wrote: > > > > > > > > > Steve, > > > > > > > > > > I would argue that an AED is not " advanced care " . An AED is a > > > > > non-operator dependent, battery operated machine that functions on a > > > > > predetermined, software driven algorithm. I would assign the term > " care " > > > > > to human beings. > > > > > > > > > > Some questions: (1) Is $2,500 all the money your service will ever > have? > > > > > (2) What do you mean by " place an AED " ? In a vehicle? A building? > Where? > > > > > (3) If there's only one AED (depending on where it's " placed " ), who > in > > > > > the community served will have access to it, and who will not? (4) > What > > > > > is the frequency of demand for an AED in your community compared to > > > > > other types of calls (%)? > > > > > > > > > > I believe that the needs of the many (aggregate demand) outweigh the > > > > > needs of the few (marginal demand) - especially given such abysmal > > > > > outcomes. If you don't have even, " ...a minimal BLS ambulance. " , how > > > > > beneficial do you believe one AED will be? I'd invest the money in > the > > > > > people who are expected to deliver the " care " . > > > > > > > > > > As an aside, I remember giving a speech on this issue 20 years ago > in > > > > > Houston. As a (tongue in cheek) joke, I told the audience of about > 100 > > > > > that NASA was about to launch into geosynchronous earth orbit a > > > > > satellite that could detect cardiac arrests, locate the victim via > GPS > > > > > and deliver with great precision a shock using a particle beam > > > > > generator. The service would be licensed to EMS organizations and > > > > > re-sold as subscriptions in their respective communities. Deaths > from > > > > > cardiac arrest would cease to exist within five years! > > > > > > > > > > To my complete amazement following the speech, I was approached by > no > > > > > less than seven people who wanted to know how much NASA was planning > to > > > > > charge for the licensing fee (rim shot). > > > > > > > > > > Bob Kellow > > > > > > > > > > Steve wrote: > > > > > > > > > > > I can place an AED total for $2500 or so. Where would you use > that > > > > > > $2500 that would have better benefit? We're not talking about > gobs of > > > > > > > > > > > > ongoing funding here. The fact is, in a lot of rural areas, it is > not > > > > > > > > > > > > feasible to staff for ALS. So for volunteer departments, EMS or > FR, > > > > > > AEDs represent a level of advanced care unavailable to them in any > > > > > > other > > > > > > form. They are NOT going to staff ambulances with medics, drugs, > > > > > > manual > > > > > > defibrillators, etc. They are doing good to have EMT level > training > > > > > > if > > > > > > that, and a first aid kit (or in better cases a minimal BLS > > > > > > ambulance). > > > > > > AEDs will address the #1 killer, heart disease. So with an AED > you > > > > > > have > > > > > > addressed the largest primary survey issue. Seems cost effective > to > > > > > > me. > > > > > > > > > > > > Again, if you only have $2500, where are you going to spend it > better? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > lpate@... wrote: > > > > > > > > > > > > > Bob, > > > > > > > > > > > > > > You make an excellent point. AEDs are a good example of > > > > > > this--before > > > > > > > I go > > > > > > > any further, I want to make it clear that I know that there are > > > > > > times > > > > > > > when an > > > > > > > AED can make a lot of difference and I would not presume to tell > any > > > > > > > > > > > > > department, agency, business, etc. not to get one. My comments > have > > > > > > > > > > > > > more to > > > > > > > do with funding/spending priorities, particularly in rural > > > > > > areas--the > > > > > > > AED > > > > > > > just happens to be the example I chose to use because your > comments > > > > > > > referred > > > > > > > to cardiac arrest. > > > > > > > > > > > > > > Regarding the placement of AEDs in law enforcement or fire > > > > > > department > > > > > > > vehicles: > > > > > > > Police departments in small towns (if the town even has a police > > > > > > > department) > > > > > > > often have only one officer on patrol, trying to handle all > calls > > > > > > and > > > > > > > traffic > > > > > > > enforcement. This officer may not be immediately available to > > > > > > respond > > > > > > > to an > > > > > > > EMS call. > > > > > > > The Sheriff's Department often has only a couple of deputies > > > > > > covering > > > > > > > the > > > > > > > entire county. If one of them is available, it can easily take > > > > > > 10-15 > > > > > > > minutes > > > > > > > for them to get to the scene. > > > > > > > DPS officers can be even more scarce than deputies--in our area, > if > > > > > > > you need > > > > > > > the DPS officer after a certain time of night, he is called out > from > > > > > > > > > > > > > home. > > > > > > > Most of the rural fire departments are volunteer (bless 'em) and > by > > > > > > > the time > > > > > > > they get to the station, get the trucks out, and get to the > scene > > > > > > > enough time > > > > > > > has passed that the AED will be useless. > > > > > > > I can see where AEDs in public buildings might be more > > > > > > beneficial--the > > > > > > > AED > > > > > > > would likely be in close proximity to the patient and there > would > > > > > > > always be > > > > > > > staff/employees nearby to initiate it's use quickly. However, > in my > > > > > > > > > > > > > 20+ > > > > > > > years in EMS the cardiac arrest calls I have had in public > buildings > > > > > > > > > > > > > have > > > > > > > been few and far between and the last one was several years ago. > > > > > > > I just have to wonder about the balance of priorities when we > see so > > > > > > > > > > > > > much > > > > > > > about AED funding and AED placement projects when we have many, > many > > > > > > > > > > > > > rural > > > > > > > EMS agencies that have a hard time coming up with a crew for the > > > > > > > ambulance > > > > > > > (or even maintaining an ambulance). The AED will be beneficial > in > > > > > > > only a > > > > > > > very, very small percentage of EMS calls, but the crew and the > > > > > > > ambulance are > > > > > > > absolutely essential on every call. > > > > > > > > > > > > > > Just some rambling thoughts. > > > > > > > > > > > > > > Maxine Pate > > > > > > > > > > > > > > > > > > > > > > I hope your presentation on " Myths of Modern EMS " will include > > > > > > > > out-of-hospital cardiac arrest, and our apparent determination > to > > > > > > > expend > > > > > > > > an more and more scarce EMS resources on the population of EMS > > > > > > > patients > > > > > > > > that are least likely to survive, while rural and under-served > > > > > > > counties > > > > > > > > can't even afford basic EMS coverage. Why are we driven [like > > > > > > > lemmings] > > > > > > > > by the public policy initiatives and marketing campaigns of > EMS > > > > > > > > technology manufacturers, rather than directing our greatest > > > > > > > > concentration of EMS resources toward the greatest > concentrations > > > > > > of > > > > > > > > > > > > > > > need? > > > > > > > > > > > > > > > > Bob Kellow > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2002 Report Share Posted July 2, 2002 Perhaps this is the reason that people feel that AEDs ought to be widely available: We have repeatedly been told in EMS that rapid defibrillation is one of the very few interventions that we can prove actually has value. What can we in EMS do to fix the fact that infectious diseases are the #1 killers worldwide? Nothing. So we tend to want to do what we " think " we know we can do. This issue brings into focus the ever present conflict between evidence based EMS and pragmatic EMS. It is very valid to ask how we ought to best deploy available funds. But let's face it, what we do is influenced by what our " customers " see as important to them, and the PR job that has been done for the AED beings it into the forefront of " desired " equipment for many services, particularly those that are dependent upon public support in the form of donations as are most rural volunteer systems. There may be valid reasons for placing AEDs in, say, police cars in some communities. But there also may be valid reasons not to do so. Fact is, careful analysis ought to be done before knee jerking one way or another. One size does not fit all in EMS. Gene Gandy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2002 Report Share Posted July 3, 2002 Amen Dr. B. The problem is not the AEDs, the problem is the crisis in EMS that has yet to be addressed effectively. > My smart-aleck response would be " Wal-Mart. " But, I can't think of a better > way to spend the money than on AEDs (except maybe concomittant BLS > education). AEDs work and save lives and the research shows it. I just > felt that you overstated the magnitude of ventricular fibrillation in the > whole CV disease spectrum. We should want the following in the overall > scheme of things: > > 1. Widespread AEDs and bystander CPR education > 2. Quality, well-educated and equipped First Responders > 3. ALS Units that truly bring the emergency department to the patient (with > paramedics that are paid well and who will stay in the business). > 4. Transport to the appropriate hospital. > 5. Definitive care and rehabilitation. > > We are really saying the same thing Steve. > > BEB > BEB > > Quote Link to comment Share on other sites More sharing options...
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