April 2005 Letters

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Heart Is a Lonely Hunter

While I share Thom Dick’s sympathy for those who truly have no one in their lives [EMS Reruns, Frequent Flyer: Loneliness Is an Emergency, When It’s Yours, December 2004], I must disagree with his claim that this constitutes an emergency. Webster’s defines emergency as “an unforeseen combination of circumstances or the resulting state that calls for immediate action.” The loneliness he describes is neither unforeseen, nor does it truly require immediate action.

These patients are a drain on the entire medical system. Just in the hospital, a complaint of chest pain will require a series of expensive blood tests, a cardiology consult and several hours (at least) of a monitored bed. These costs can easily run into the thousands of dollars. Multiply that by the “30 or more” times a year that the article’s “Priscilla” had called and it’s amazing the resources that only one frequent flyer can divert from patients who actually require medical care.

The costs to a prehospital service can be devastating. These patients cause deterioration in employee morale in paid systems and accelerate burnout. In a volunteer system, they discourage volunteers. Three weeks ago, my squad had three frequent flyer calls in a five-hour period, overnight. My EMT went to her second day at a new job on less than 90 minutes of sleep—all for three patients who did not require our help. She’s not running tonight.

Then there’s the danger to the patients, themselves. These people are the medical equivalent of the boy who cried wolf. Eventually, they will have a real medical emergency that could go unnoticed for some time. A professional will recognize the problem, but human nature makes it less likely.

That all being said, I believe these patients do require help, just not ours. We’re fortunate in my area to have a county agency that can assist with elderly patients like Priscilla. I certainly do not claim to have the answer to the frequent flyer problem, but answers need to be found. In this day of dwindling resources, we don’t have a choice.

Christopher J. Graham, BS, FF/EMT
Media Fire Company
Media, PA

Thom Dick responds: I feel your pain. We live in a world that has always valued the possessions of the wealthy more than the lives of the poor. Considering that, maybe it’s not surprising that our government persists in ignoring EMS. (Just ask anybody who depends on Medicare.)

Like it or not, we don’t get to decide when people’s lives become intolerable for them. And folks who write dictionaries don’t do wake-ups—so, maybe we shouldn’t place too much faith in the relevance of their definitions. This is not just medicine we’re doing here. It’s a lot more: social work, crisis intervention, injury prevention, public education—they’re all part of the package.

The hardships you describe are simply normal features of an EMSer’s life. They’re what we do, and not just anybody can do them. In fact, coping with them as a volunteer, you’re a better person than I will ever be. But if you do volunteer, don’t just volunteer for the good calls. And if you must complain, don’t just leave the solutions for somebody else.

There is a solution, although it would certainly stimulate controversy. It’s for volunteers to stop volunteering. Carpenters don’t frame houses for free. Pilots don’t fly for free, and senators certainly don’t lollygag for free. Physicians and nurses don’t practice medicine for free, either. Why should we?

The reason our government fails to accept responsibility for EMS is that, year after year, we allow it to happen. Why is that?

The Beat Goes On...

When I first read Mike Smith’s Beyond the Books column What’s Up at the Airport? (July 2004), I confess I was quite shocked—as much as I find Smith’s writings insightful. As he described the incident, the patient, despite having a return of pulse, was still in serious condition and, in my opinion, warranted the tube (GCS less than 8?). I agree that with the first pass of the laryngoscope blade causing a gag, I would have stopped, but I would have made the first attempt.

However, what surprised me even more was Smith’s response to readers’ feedback as it appeared in the October issue, expressing surprise to readers with positive experiences in opposition to his three episodes to the contrary. As much as I respect him, I can’t help but question that perhaps the concern for these separate incidents and airports were not the fault of airport staff. Perhaps the concern lies elsewhere.

G. FitzGerald

Mike Smith responds: I felt I was honest and accurate in describing what I did and saw; and I truly have a concern about airport EMS. In addition, I asked a question in a professional journal in hopes of getting clarification.

I have a few things to say, but I’ll try to keep it short. First, based on Smith’s account of what happened, there is nobody who can argue that this was good medicine. As he did not describe the other two instances, we are not able to analyze them, but let’s face it, this lady did not need a tube.

Second, yes, if you read this article one way, it does seem that its author is speaking poorly of airport medics in general, and, if taken in that context, that every one of them is substandard. But step back for a minute and read the whole article. Read it in its entirety; realize that he is pointing out specific flaws in the instances that he’s witnessed. Then, he’s asked for our feedback.

This is not the writing of a para-god who felt like bashing an entire group of people. This is an experienced medic who wanted to open our eyes to problems that we may not have seen. For those of you who wrote extremely defensive responses to Smith’s article, stop it. It’s blown out of proportion. Responses like these give paramedics the bad reputation of being conceited or whiny whenever we are criticized at all. Before you respond as if someone has insulted your grandmother, take a moment and look at what’s actually being said. It might make things a little easier for all of us.

Jason Cabral, EMT-P
Lake County Fire Protection District, CA

Correction

• In the March issue of EMS Magazine, the EMS Magazine editorial staff included specific product information in the article by Lawrence Brown and James Campagna discussing EMS medication storage. Mr. Brown and Mr. Campagna were not aware of and did not approve of this insertion. The authors are not familiar with any of these specific devices and cannot comment on their effectiveness. Mr. Brown and Mr. Campagna do not endorse any of these devices.

• The e-mail address listed in advertisements for Cindy Elbert Insurance Services in previous issues of EMS Magazine is incorrect. The correct address is cindyelber@aol.com. We apologize for any inconvenience.