Nowadays, the emergency medicine industry is a wise, tough lot. We are a health care network for every socioeconomic class. When the usual entry points to the health care system cannot become infected with a painful process or when the unthinkable happens, calling 911 for an ambulance is the best option for most people. In fact, those who really need us and cannot access us mostly die. Those who have access to us are among the most immediate and highly qualified emergency services currently available. We will catch an uninsured who cannot manage his chronic conditions through primary care. We immediately catch the injured injured patients from falling and car accidents. We catch tired, poor and bewildered people with whom no one will turn. We will catch the rich, who think that 911 is the most direct way to care in a hospital. We treat the homeless in their boxes on the sidelines. We treat athletes who injure themselves on the field. We turn to uninsured small business owners who were so afraid to go to the doctor for fear of a bill that they had been waiting for too long and their lives were in danger. We treat a naked drunkard soaking tequila right out of the bottle, peeing on our shoes. We treat a frightened elderly woman who may have taken too much medicine. We treat everyone, regardless of their ability to pay, in due time of a conscious need.
And we stretch to our limit, and something can give.
“Emergency medical care systems” or “EMS” are complex organizations consisting of several players from different disciplines. Everyone knows the name "Paramedic", some know the term "emergency medical technician" or "EMT", and some of them sometimes expressed the disgusting term "ambulance driver", canceling today highly skilled and equipped paramedics to the level of yesterday, Pioneers who just drive very quickly in rumors borrowed from a local funeral home. In almost every community in the United States, ambulances are just a phone call. Almost everyone has access to the 911 system, and almost everyone knows which of the first people they want to see on their side when the unthinkable happens. Nobody still thinks about it, and this can be fatal, because the economic suffering of our country is dragging on. Ambulance with their “duty to act” and take care of those who call them at any time when they call for any reason, please, on the model “Service Fee” to pay their bills. In general, as a rule, the community provides for the provision of ambulance services within their jurisdiction, and this creates a problem. The service fee model applies only to billing income for those who can pay only when the ambulance transfers them to their destination. This leaves a lot of time when the ambulance is in operation, but is not busy calling for at least two crew members on duty when the ambulance service cannot refund any fees for its time. Some communities supplement their services with tax dollars; however, this model imposes a disproportionate burden on property tax payers who are not demographically the ones who call for ambulance services. The homeless, temporary, and those who simply move around the city do not pay these property taxes, but are entitled to the same level of service as taxpayers, or they can pay a service charge or not. The ambulance services went to this income from property tax and insurance payments from policyholders. While government organizations such as Medicare and Medicaid pay a very preferential rate, they usually pay several hundred dollars less than what is billed to this service, and usually pay months after transport has occurred, they do not cover true cost of treating your patients.
Industry experts predict that the current US economy will hit the EMS industry very hard in the coming months. As factories and commercial organizations close their doors, people who have lost their jobs lose their health insurance provided by their employer. This is a double-edged sword, because in addition to the fact that former employees become uninsured, closed facilities that fill in tax areas do not transfer industrial and commercial tax rates to the treasury, which is a trickle of life in ambulance services. This reduction in tax revenue is a small life cycle that keeps them in working condition while they are idle, ready for the next call, or transporting those who simply cannot pay. Combine these facts with the fact that now uninsured people will start postponing primary and prophylactic medical care until their chronic or undiagnosed conditions become so serious that they should call an ambulance by placing another patient on a stretcher without being able to pay the bill. .
We have problems. Paramedics and EMT have always done exciting things with very few resources. Unfortunately, it seems that even the most dedicated and talented innovators in emergency medical care will not be able to solve this problem. Paramedics, the highest level of prehospital (or field) medical provider, are already paid very low, and in small communities, most acutely in rural areas, they work almost 100 hours a week in most cases. Paramedics and EMTs have carried the burden of overloaded and underfunded EMS systems over the past few decades. Working for low wages and taking forced overtime work as a way of life to feed their families, they held doors, and trucks coming out of ambulances are based throughout the country. Their dedication and, in my case, their propensity for their work left us all safe. Unfortunately, this tenth system, which depends on the altruistic tendencies of emergency medical workers, also falls into economic collapse. For more than a decade, there has been an acute shortage of paramedics, which has received far less pressure than a shortage of nurses. This is largely due to the lengthy training required to enter the profession, combined with low pay and long hours, which makes young, idealistic new medical assistants look for other people who pay more substantially as they age and acquire things like families, mortgage loans and responsibilities. Those who stayed got the pseudo-advantageous benefit from this lack of upward pressure on wages, provided for by the law of supply and demand, as well as ample opportunities for them to take up the second and third jobs (I have three).
However, this short-term benefit probably ended. EMS specialists work in many areas, some work only part-time or “as needed”, and some work in strictly volunteer bars. Former full-time specialists who have left the profession for more green pastures seem to be constantly updating their certificates, completing the necessary continuing education. These people view their EMS licensing as part of their resumes, and since their current non-EMS employers face layoffs and / or direct closures, these people return to return their jobs to EMS. For the first time in many carers, EMS employers see something they have never seen before: more employers than there are jobs. This is a sea change in most EMS organizations. Services responded by hiring paramedics and EMT to fill shifts, which are usually covered by their current employees working overtime. Consequently, the extra hours that the current feldsher physicians depended on to inflate their salaries instead of higher wages have disappeared. Personally, my annual salary has been halved, and I'm not alone. Without increasing pressure on wages caused by the former lack of medical assistants, our salary will collapse. This puts already vulnerable feldshers who have highly skilled jobs and who sacrifice themselves for their communities for many years, with a real risk of poverty.
The public is largely unaware of what is happening in the back of the ambulance. "Ambulance" or "ALS" ambulance is staffed with at least one medical assistant and combines the care of emergency medical care with an intensive care unit. Paramedics have the ability to manage about sixty emergency medicines, perform limited emergency surgery skills, receive training and perform the same skills of extended cardiac life as doctors, and bring the first hour of emergency care closer to the place where their patient is faced with. Paramedics education is college-level education, which requires nearly four years of intensive class work to obtain a license, and then more than one hundred hours of continuing education to maintain the licensing cycle. The basic life support system or the BLS ambulance staffed with EMT provides vital stabilization skills and emergency medicines for a wide variety of medical emergencies. Both are your best friend when you need them. Most communities realized cost savings for minor shortcomings by combining ALS resources with BLS resources, for example, completing emergency services with one Paramedic and one EMT, or sending Paramedic first aid with the first BLS response block. There are other models. Large cities, as a rule, use all the resources of the ALS, and Paramedics - on a fire apparatus that responds with a double paramedical ambulance. Although this is the most preferred model for firefighters. combining, current research shows that this most expensive method can actually be detrimental to patients. Communities need to be familiar with how their ambulance service will be delivered, the companies or organizations that deliver it, and the capabilities that their ambulances have. A solution that works for one jurisdiction may not need work for another. The public should participate, because at the moment everything is at stake.
It is important to note that ambulances are not limited to 911 emergency answers. Paramedics are emergency specialists and are masters or mobile healthcare. An ambulance, by definition, moves patients from point “A” to point “B”. These items need not always be from the emergency scene to the emergency room. Many ambulance services provide non-emergency services to patients who are too weak to travel by any other means. It may be in nursing homes for routine appointments, discharge from the hospital or even before a doctor's appointment, as well as for many other reasons. In urban areas, entire private ambulance companies use this as their sole mission. In small areas, ambulance services in the communities use these non-excitable transports as generators of income in addition to their emergency 911 coverage. For the most part, these services are paid for by Medicare and Medicaid, because patients who are sick enough need an ambulance because their only the way of transportation is too sick to work and too sick to receive any income or have insurance. For their part, Medicare and Medicaid are doing everything they can to deny, and with any payment they can finally decide to pay, and create mazes of documents and forms that must be done perfectly so that they agree to invoice. There are also laws that prohibit ambulance operators from ever billing patients directly if Medicare or Medicaid decides not to take the tab, leaving ambulance service to eat the cost of transportation. In my ambulance, I have to get four separate signatures from each patient each time so that my employer can either bill the patient, or their insurance, or apply for Medicare / Medicaid. Always trying to convince an unconscious patient to sign your name? What about their panicked spouse? The government has established the same rules for ambulances as in hospitals and clinics. However, it does not work in the pre-hospital environment. In cases where there is an opportunity in the emergency department of the hospital to provide clerical staff, I must bow to my dying patient, urging them to sign the form.
To respond to this crisis, some communities have closed their services and have teamed up with neighboring communities. Some of them have privatized public services. Some of them, like Columbus, OH even consider it a mistake to lower their rights from ALS to BLS. Although I do not agree with the proposal of Columbus, I agree that communities should look for the most efficient way to provide EMS services for their community, and some of these solutions are privately owned. I would strongly caution against simply lowering the dismal wages paid to medical assistants and EMT, but I would say that the answer may well be to ask Paramedics to take on more tasks and perform different roles. There is a lot to learn in the British Rapide Response Paramedic and Emergency Practices. These are specialized and highly educated medical assistants who respond to medical accidents with a higher level of knowledge and responsibility than their first aid. They might consider the equivalent of our American "Medical Assistant" (PA-C) or "Nurse Practitioner" (ARNP). These paramedics respond to the patient's request, evaluate and diagnose, and can refer patients to the most appropriate level of care for their condition. Sometimes care is an emergency first aid for the ER (or an accident and emergency) in the UK, sometimes it is a referral to the line for their normal family doctor, and sometimes it is on-site diagnosis and treatment for their condition. Currently, American medical assistants do not can legally diagnose a disease. Even obvious fractures are given by “Field Diagnoses” of “probable” fractures, although they are treated the same. Studies have shown that paramedics can reliably diagnose the presence of a spinal fracture and an acute heart attack with almost 100% accuracy of documentation. General medical conditions are regularly “diagnosed on the spot” with the help of medical assistants, and these patients are given some help, either a patient prescribing “against medical advice”, or quickly sent to the ER to be “blessed” by the ER and quickly unloaded to their homeland. I cannot even calculate how many times I have a “sweetened” diabetic patient with low blood sugar levels, starting IV, introducing sugar through IV soby, fixing their immediate problem, and then allowing the patient to sign a waiver of an ambulance transport form. It was in the thousands. In most cases, since I cannot legally “diagnose” a patient’s condition, my service cannot bill a patient for care. Current laws allow us to pay only for patient delivery to the ER. These procedures are free for the patient and very expensive for our care.
If medical assistants were allowed to treat medical diagnoses, develop and follow treatment plans, and “treat and release” patients or classify them as more appropriate medical care than ER, when medically acceptable, they can significantly affect the overall cost of healthcare. countrywide. ER is the most expensive form of healthcare. When it is medically acceptable, it saves lives. However, when more and more people turn to the ER for primary health care, the system is overloaded to the limit. If you have ever tried to seek medical help even in medium-sized cities for a serious but not life-threatening state of health, you experienced hourly waiting times for care. Позволяя Парамедикам диагностировать, лечить и определять наиболее приемлемый с медицинской точки зрения путь лечения пациентов, мы могли бы облегчить перегрузку, отложить незначительные медицинские проблемы до менее дорогостоящего, но все же соответствующего медицинского обслуживания, и устранить небольшие проблемы прямо на улице. Представьте себе, что скорая помощь ALS реагирует на 30 человек-мужчин с общей жалобой на «затрудненное дыхание». Парамедики будут слушать звуки легких пациента, принимать его жизненно важные признаки, проверять уровень его кислорода в крови и, вероятно, даже приложить пациента к монитору сердца, чтобы исключить сердечную проблему. В настоящее время парамедики будут определять соответствующие процедуры для пациента и выполнять их. Представьте себе, что у пациента был простой случай бронхита. Парамедики могут дать лечение дыханием и транспортировать пациента в ER, где он, скорее всего, будет выписан с помощью предписанного ингалятора и соответствующего антибиотика. Однако, если бы парамедики могли сделать то же самое в резиденции пациента, они бы сэкономили все, что платит за медицинскую помощь пациента тысячам долларов.
Это потребует некоторых изменений в системе, которые некоторым в отрасли не понравится. Во-первых, парамедическое образование должно быть коренным образом изменено, чтобы потребовать степень (которой в настоящее время нет), и еще нужно добавить классы. Во-вторых, юридический статус профессии должен быть изменен. Страховым компаниям и другим плательщикам придется работать с этой отраслью, чтобы разрабатывать тарифы на фельдшерскую помощь. Законы должны быть изменены, чтобы изменить фельдшеров. сфера практики. Я считаю, что стоит осознать огромную экономию средств, а также то, что страховые компании смогут воспользоваться этой общей экономией, даже если это означает увеличение денежных средств, выплачиваемых службам скорой помощи. Медработники и # 39; обязанностей и вознаграждения, будет заметно расти.
Я уже говорил об этом, и я снова это повторю. У экономики есть проблемы, связанные с оказанием неотложной медицинской помощи. Однако на горизонте есть яркое пятно. В течение последнего десятилетия СЭМ томится под контролем тех, кто имеет политические планы. Люди, возвращающиеся в EMS или приезжающие на полный рабочий день EMS, которые работали в других отраслях частного сектора, обязаны привнести свой опыт и опыт в EMS. Я не верю, что они согласятся на статус-кво и прорвутся через существующие барьеры, удерживающие нашу профессию.
Затем мы можем двигаться по поводу настоящей работы нашей профессии, которая заботится о каждом, когда и где они нужны нам.
