Airmail, Part 2 - @

Airmail, Part 2

Responding to Reader E-mail from 30,000 Feet


Howard Rodenberg, MD, MPH, Dip(FM) | | Monday, November 26, 2007

Editor's note:As you'll recall, Dr. Rodenberg was on his way to Salt Lake City to speak at EMS Today when he finally found time to go through his e-mail in-box. This article is part 2 of three-part series he wrote in response to feedback on his various articles. You can read part 1 here.

Rural EMS

The column on rural EMS ( Country Musings:Thoughts on Rural EMS ) received a similar outpouring of support. Many letters commented on the family aspect of rural EMS care and on the relative lack of attention and resources given to these vital healthcare providers.

Oregon s John Wish, MD, who has done some statistical work in the area of rural trauma, suggests that when comparing trauma death rates among the states, up to one-third of the differences can be explained by the lack of urbanized areas. But with every problem, there are potential solutions. Jim Effinger notes that care in his rural Pennsylvania system is enhanced by a university partnership that has brought teleconferencing to his area to facilitate long-distance learning.

One letter actually sent me into an official career conniption. Following up on my comment for someone to let me know when I could go back to Kansas, Chris Tilden, MD, of the Kansas Department of Health and Environment wrote to tell me that the position of Director of Health was indeed open. To add to the mental anguish, Lt. Evan Mayfield of the Federal Office of Rural Health Policy pointed out that many good things in rural EMS were happening in Kansas (no doubt as a result of Dr. Tilden s work).

I ve got to tell you that the thought of going home and taking over the state (Machiavellian, but you know what I mean) was immensely appealing to me. But I only had three months on the job here, and there was still a lot left to do. It wouldn t be fair to leave with the work only partly done. And it was winter. And although I have a great appreciation for wheat and flatland, I ve never really developed one for cold. But I was able to use the opening to get some local sympathy for a few weeks, and I still keep it in reserve as a leveler when things get tough ( You know, I could always leave. ) Now, if the job can be open again in a few years

Youth behavior

Elmer Holt of Seminole County, Fla., commented on my discussion of youth behavior ( Letter from Idaho ) and our obligation to teach professional and personal responsibility. He offered the thought that one of our problems when we look at youth is that we evaluate them through their behavior without considering the root cause of that behavior. Youthful rebellion and behavior and a lack of adherence to adult standards must be viewed through the eyes of an adolescent who needs (and may even be biologically required) to test his needs against that of society.

I find this a fascinating thought because it means that the testing process results in each generation inevitably establishing its own norms as it springboards off what already exists. The fact that it s simply impossible to return to the good old days is bound to induce fear in their elders. Mr. Holt cites Plato in that the father accustoms himself to become like his child and fears his sons, while the son likens himself to his father, and feels neither shame nor fear in front of his parents, so he may be free. (Just for the record, I can find no evidence that Plato ever had kids.) I m probably just as bad as anyone at not understanding current trends in language, dress and music, but I do think we can find commonalities between the generations. As adults, it s incumbent upon us to look for those links because the kids are too busy finding themselves to try to find us.

POC testing

My thoughts on point of care (POC) ( Is 'Point of Care' Testing Worthwhile, or a Waste? ) testing prompted an interesting response from Scott Lancaster. While able to see the lack of benefit in POC efforts for overdose and trauma patients, he gives the example of the case in which an elderly patient is complaining of chest pain, but has a negative ECG. He contends that a positive troponin or CK value might not influence prehospital care, but may expedite the care of the patient once in the ED. He rightly points out that we need to be patient advocates in all phases of care and not simply in the EMS setting.

I couldn t agree more, and I think my work pointed out that the real benefit in POC testing is that it might facilitate ED care. I d certainly consider POC testing to be of value when transport times are prolonged. I m much less certain about its value in urban systems with short transport times. Either you need to stall on the scene or en route to get the result (current technology requires that most POC assays take 10 15 minutes), or you have to hang around the ED after patient transport to get the result and make sure you get your testing meter back. I ll be the first to admit, however, that I m talking about the ideal world. At our Daytona Beach ED, where the winter brings down the Snowbirds and starts the roll-out of the hallway beds because there s no room at the inn, delays in getting EMS units back on the road are common. Maybe waiting for the result is not a big issue if you re standing idle, waiting for a bed. As I ve said before, timing is everything.

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