Disaster Care Standards - Changing the bar?

This is an oldie but goodie, as it is still very relevant to our national conversation, especially in light of the now certain implementation of Patient Protection and Affordable Care Act (i.e. Obamacare).

In disaster scenarios, when demand far outstrips resource, should we have a different standard of care? Does the bar change for medical treatment when the environment in which that treatment is to be provided is so radically altered from the normal?

This topic has been at the forefront of our national consciousness for over a decade now, and although general consensus seems to slightly lean to one side, no clear cut answer has yet to dominate the discussion.

To start your thinking on this subject, a wonderful article by my friend Dr. Sheri Fink should begin to raise a questions in your mind regarding what is right, moral and ethical during these very real situations which will most certainly occur again in the future.

Have you thought about how you would respond during and event like this? Are you prepared? 

Is Your EMS System Doing Its Best??

Every now and then, we hear news-worthy stories of EMT’s, firefighters, and policemen who have saved a life by being in the right place at the right time. Virtually no other condition is as time sensitive and EMS dependant as cardiac arrest. The quicker CPR is performed, the more likely the patient is to survive.

But why is this so rare? What gets these heroes to be in the ‘right place at the right time’?  Answer: The Pre-hospital System.  The correct orchestration of bystander CPR and the application of an automated external defibrillator (AED) shortly after a cardiac arrest event are by far the two most effective and simple interventions needed to save a life, yet most urban centers across the United States have pitifully few people performing timely bystander CPR, and have disparate and abysmal cardiac arrest survival rates.

These cardiac arrest ‘saves’ are celebrated not only for the effort of skill and caring our heroes in EMS put in every day when they go to work, but because as it currently stands, a cardiac arrest survival in the field is an extreme rarity.

THIS DOES NOT HAVE TO BE THE CASE.

            The ‘system’ and ‘survival statistics’ are not immutable. Over and over again, it has been shown that EMS systems can be changed to meaningfully improve pre-hospital cardiac arrest survival (see: Seattle, Las Vegas, Phoenix) – and these are not just small improvements, but improvements on the order of 10-40%!  I challenge you to find another medical intervention with such a large, favorable, and impactful improvement rate.

            So, why is this not already the case you ask??  Like everything else, it takes knowledge, awareness of the situation, effort, and money.  However, as approximately 70% of cardiac arrests occur in the home, and are suffered family members or friends, it seems like a fairly good investment, no?

So…..do you know how your EMS System is doing?  What are you or your family member’s chance of survival if they have a sudden cardiac arrest in your community? 0%? 5%? 10%?

This is not the time to sit back and assume the ambulance will be there when you need it, and it is not the time to go to your job an EMT, paramedic, or physician and accept the status quo – THIS IS TOO IMPORTANT. THESE ARE THE LIVES OF YOUR FAMILY AND FRIENDS. THIS IS YOUR LIFE. Get active. Learn the data. Push for improvement. What are you going to do about this?

EMS Recognized (Finally!)

Today, 9/27/10, the American Board of Medical Specialties officially recognized EMS as a separate sub-specialty of Emergency Medicine.  This accomplishment is not to be understated as it has been in process for over 20 years, and is an incredibly important step toward decreasing unnecessary variation within physician EMS training and practice. The board certification will undoubtedly improve and expand research, quality, and efficacy in all aspects of the pre-hospital environment. Congratulations to the National Association of EMS Physicians, the American Board of Emergency Medicine, the American College of Emergency  Physicians, and the Society of Academic Emergency Medicine! Way to go!

Link to the official press release