Ambulance Abuse Differs from Health Care Abuse

Here is a story out of Buffalo, NY http://www.wgrz.com/news/local/story.aspx?storyid=69029&catid=37 that was sent in Russ Hogue, a paramedic student and podcast listener. It would be easy to get caught up in the health care reform buzz, but I think you have to look a little more shallow to see the real problem. Be sure to view the video, too.

At issue here is one persons use of the 9-1-1 system for access to health care. The example might seem extreme to the EMS uninitiated citizen and may even be shocking to some. But if you've been in emergency response for more than five-minutes, you'll recognize this situation as a common one. You see, there is this guy in Buffalo who has Sickle Cell Anemia. And being legitimately ill with the disease calls 9-1-1 once, sometimes twice a day. The article and video would have you believe this is a health care reform issue...it's not. It's an access to service issue.

The fact is this this guy (and the thousands like him) have actual disease and are either not getting or not following the medical care they need. Without access to care they are left with the only solution they know will get them service on demand...call 9-1-1 and go to the emergency department. I am not going to open debate as to the legitimacy of this guys (or anyone's) needs in this forum. Well just take it at face value that he needs care.

Enter the problem: In NYS ambulances have to transport to an emergency department. Not to a clinic, not to a doctors office...to an E.D. The most expensive and inefficient model of care for non-life threatening cases. The point is made in the story; "you call, we haul", and it is in that phrase that the change needs to be made. Could this persons needs be met at a clinic? Perhaps. Could the EMTs or paramedics use communications and medical control to appropriately triage his needs? I think so. Why not let EMS stop by once a day to help this guy take his medication and verify he did so, and conduct an assessment? Could the more than $300,000 spent on one person be better spent on meeting the needs of the chronically ill, the addicted, or the mentally ill...outside the hospital? Again, I think so.

Its not abuse of health care...Sickle Cell is a painful and debilitating disease...its about abuse of a precious resource because there are no options. That is what we have to fix. And we can fix it on a local level.

This is a story that is repeated hundreds of times a day in the city and suburbs. Although the focus of this story is an African American living in an urban setting, there are plenty of examples of misuse of EMS in the suburbs that go unseen.

Special thanks to Russ Hogue for sending this in.

I await comment and debate. I'll talk about this on the next Mitigation Journal Podcast (#118 to be released 8/5/09)