Beginning of the end of volunteer EMS in NJ

Sad as it is, another volunteer squad in NJ has closed its doors.

See the article here.

I could have predicted this when I was living in northern New Jersey earlier this decade. With the reduction of volunteerism comes the end of volunteer ambulance squads. Many squads in Bergen County and throughout New Jersey will face tough questions about consolidation in upcoming years. The idea of home rule that is rampant in NJ will be trumped by the reality that each little town, village, or borough doesn't need its own BLS ambulance squad running less than 1,000 calls per year. I predict that larger regional squads running a few thousand calls would be much more efficient. The counter-argument would say that a regional system might lack the down-home neighborly feel the current system provides, but I'd rather have a reliable and cost-effective ambulance service than an unreliable "home town" squad that might not get out the door when the pager tones sound.

Remind me to avoid Columbus, Ohio

When money gets tight, people put their heads up their rear ends...

I just read an article from March 22, 2009 that Columbus, Ohio is considering taking paramedics off their ambulances and reverting to an all-basic (EMT) system.

"A committee charged with finding ways for Columbus to save money has recommended that the city return to a basic emergency medical system. The last time the Columbus Division of Fire provided only basic-level care was in 1968."

These days, there is a clear trend of upgrading ambulances from basic (BLS) to advanced life support (ALS). I'm not sure there are any BLS squads left in the county where I volunteer. All of them upgraded to ALS or disappeared within the last decade.

While they are at it, I think Columbus should replace their fleet of ambulances with hearses. Being built on a car chassis, a hearse probably gets better fuel economy than an ambulance, so the savings would be two-fold!

Trauma Center in Chester County?

I recently got an e-mail from my US Representative, Jim Gerlach, discussing the need for a trauma center in Chester County. As an emergency medical services worker, I would applaud the creation and ongoing support of such a facility. Driving a patient 75 minutes by ground ambulance to a trauma center is a miserable experience. Spending the patient's "golden hour" in the back of an ambulance is not appropriate. However, having lived in far western Montgomery County and served with an ambulance squad that bordered Chester County, I know that even in the early 1990s we frequently used helicopter services to "MedEvac" patients to trauma centers. Our ground transport times to a major trauma center in Center City Philadelphia would have been about 40 minutes, hence the frequent use of helicopters.

Looking at a recent news article, the proposed cost of running a trauma center in Chester County is to be between $5 million and $8 million per year. From a purely economic standpoint, it's a no-brainer that this would be a money-losing proposition. The last trauma center in Chester County, Brandywine Hospital, closed its doors in 2002, citing financial reasons for its demise. So what has changed since 2002 that would cause a new trauma center to succeed where others have failed?

It's expected that 500 trauma patients per year would come to the proposed Chester County trauma center. At a cost of $8 million, that translates to $16,000 per trauma patient. That's a lot more than it costs to fly somebody to Center City trauma center. I acknowledge that helicopters aren't always available due to other commitments and weather. Furthermore, nationwide helicopter EMS have a spotty safety record. On a nearly-monthly basis somewhere around the country there is a report of a chopper going down.

Consider what Chestnut Hill Hospital, a small community hospital in Philadelphia near the border of Montgomery County is doing for heart patients with a specific cardiac condition: they are FLYING them to Presbyterian Medical Center in Center City. The same goes for any major trauma patient that ends up at Chestnut Hill, who possibly gets flown to a Center City trauma center. In the case of cardiac patients, the ground transport to Presbyterian Medical Center would normally be about 30 minutes. I'm actually having a hard time figuring out the finances behind this arrangement, but that discussion is for another time.

Philadelphia Woman Dies During Botched EMS Call — (EMSResponder.com)

This is scary stuff, and I'm certainly happy to not be affiliated with Philadelphia's EMS system.
Philadelphia Woman Dies During Botched EMS Call — (EMSResponder.com)

To understand how far away the BLS unit (not even a medic unit) that responded to the call had to come, consider that Google Maps shows the travel distance from their station as 14.3 miles. At normal driving speed that would be a 24-minute response. Even if they were speeding recklessly all the way to the scene, it would have been perhaps 17 minutes. Not to mention that the crew probably wasn't familiar with the Northeast section of Philadelphia if they are normally based in South Philly.

In my mind as an EMS provider, this is a case of the City of Philadelphia not cooperating with neighboring jurisdictions to provide the most appropriate medical care for its residents. My first-due response area in Montgomery County includes property up to the Philadelphia line, but not on the other side of it. My squad has never been called for mutual aid over the Philadelphia border. In my experience, it appears that Philadelphia would prefer to have someone die in the street than to pick up the phone and call a neighboring county to request mutual aid.

What squads outside of Philadelphia were theoretically closer than BLS unit "Medic 43-B?" From my calculations, Bensalem, Cheltenham, Bryn Athyn, and Second Alarmers' in Abington were closer than the responding Philadelphia unit's home station.

In defense of the Medic 43-B crew, I don't know where they were located when they were dispatched. It's possible that they were roving, or at a hospital dropping off another patient. I also give credit to the two fire crews who were first responders on the scene. Is the solution to the problem to have transport-capable medic engines?

Rollover accident on I-95

Kate and I had a good but abbreviated visit with our brothers in the DC area. While a flight cancellation and travel delays meant that I arrived at BWI about 9 hours (!) behind schedule, we made the most of the weekend.

We visited the International Spy Museum in downtown DC. I had been in DC the day that it opened in 2002, but the line was around the block. It only took 5 years for me to get back there to enjoy the experience. In addition to the normal museum tour, we bought tickets for the "Operation Spy" experience. Kate and I both enjoyed the entire museum, but were very hungry by the time we got towards the end of the tour. We gave only a cursory look at the last three portions of the exhibit in order to get through it and get to lunch.

We had dinner with my brother and sister-in-law at Lia's in Bethesda. The food was enjoyable and the service was great. We started with "Sweet Potato Gnocchi with Smoked Duck," which was delicious. For the main dish, I got the "Day Boat Scallops," which were served with an autumn "ratatouille", pumpkin seed pesto, and crispy prosciutto. Kate had the "Saffron Fettuccine with Shellfish Stew," which she said was yummy, though she was disappointed that in the description: "mussels, clams, jumbo shrimp, roasted tomato broth" the word shrimp was singular.

We finally hit the road to head back to Philly after 10pm. About 20 minutes into the trip we decided to pull off I-95 to get some fuel. We hopped off at Rt-198 in South Laurel, MD. After a quick refill we were back on the road. Unfortunately, there was a severe accident on the on-ramp to I-95 north that had just happened a few moments before. It looked like a car had lost control and rolled over onto the median between the on-ramp and the interstate. We were the third car to come down the on-ramp after the accident and were immediately stopped in our tracks by a state trooper putting down flares across the road.


View Larger Map

While I wanted to help with patient care as an EMT, we were was in Maryland and I didn't feel comfortable offering my services. There were already three ambulances on scene, and it seemed like they had everything under control. So instead I used my fancy new digital camera with image stabilization to capture some shots of the accident scene. I was impressed with the level of detail that the Canon SD850 was able to record in the low light.

In the end, they brought in two State Police medical helicopters that landed on the highway. I couldn't tell how many patients they transported. Ambulances from Montgomery, Prince George, and Howard County were on scene.

After waiting for about 45 minutes, the state police finally started having people turn around the on-ramp and drive the wrong way up the on-ramp to return to Rt-198. It felt strange to be driving with the yellow line on the right side of the single-lane ramp when it's supposed to be on the left. In the end, the accident delayed us about an hour.