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Why Can t We All Just Think Like Health-Care Providers? Part 1

In the early 1980s, the State of Indiana brought back the death penalty. I was in college, full of the passion (and none of the sense) that characterized my age. I thought I knew that the death penalty was simply wrong.

That night on the news, I learned that the governor s office had set up a hotline to hear public comments about the return of execution. I called up and told the very cordial answering machine that the practice was an outrage. Later, at dinner, I proudly reported my activism to my parents. I still remember my father saying, "What did you say was wrong with it?" It wasn t a criticism, but a valuable critique. He reminded me that you have to have a reason for your action. I try to remember that now, when I tell my little boy that it s OK not to like something, but you ve got to have reasons.

We re going through a tough time in America. Like many people, I ve become frustrated with life under the new regime. I chafe at the airport searches. I smile at the sales on plastic sheeting and duct tape. I need to make a decision about whether I want the smallpox vaccine. I feel for friends with children who are serving in or headed toward the Gulf and pray that they return safe and sound. I admire their courage, while thinking of ways to send my son to Canada should the next war come in 13 years time.

I endorse the ideas the Europeans espouse while resenting their choice of words (the best way to stop Continental boasting is to bring up WWII, mentioning either the fact that we won or that we bailed them out, depending on whom you re talking to). I understand their reluctance to back a war while being furious at them for not readily honoring their commitment as NATO partners.

But as I learned 20 years ago, it s not enough to simply have an opinion. For a position to have meaning, the opinion requires thought. Otherwise, one s view is simply part of the rabble, the mass clatter of blind voices courted by both extremist liberals and conservatives (whom, I m convinced, have a common mission aimed at discouraging independent thought).

I ve previously made the comment in this column that EMS often works on a reactionary basis. We re content with the status quo, assuming that everything we do is just fine. There s no need for the logic, the research or the critical thinking that might result in change. Under normal circumstances, this mindset is dangerous enough: Complacency makes us lose sight of our reason for being and our goals, of those things that make our efforts worthwhile. Yet when extraordinary circumstances occur, popular opinion shifts radically toward change, but without allowing time for thought or reflection.

Because there has been a single, terrible terrorist incident, the focus of our government has been narrowed to what is optimistically termed "homeland security" and a pre-emptive war in Iraq. The things that affect everyday America, like the economy, health care and the environment, are discarded in the rush to do something, anything. Witness the current focus in EMS on biological and chemical incidents. Somehow the day-to-day operations by which we make our true contribution are ignored.

I d argue that the way to avoid falling into the reactionary trap is to abandon the swings of popular opinion and rededicate ourselves to thinking like health care providers. I believe that it s the hubris of the moment and the flames of personal passions (a fire fanned by an administration unable to deal with domestic issues and looking for an outlet abroad) that has placed America in a state of perpetual fear. But as my father reminded me, it s not enough to simply complain about the reactionary posture of the government. I ll need reasons for my opinion. I think I can find them if I think like a paramedic.

Let me offer one example. I fly quite a lot for business and pleasure. Flying was already irksome before 9/11. Since then, it s gotten absolutely insane. Long, snaky security lines. Body searches, shoe searches, luggage searches. Being asked to undo my belt and flip over the front of my pants to prove there s no machete around my waist. I ve seen older people in wheelchairs being "helped" to stand so they can be patted down. My son s stuffed Pooh Bear was physically taken from his arms to be X-rayed, causing him to dissolve into tears.

I suppose you could say it s better than in the first weeks after 9/11, when my razor and fingernail clippers were confiscated. But with the recent spurious "Orange" alert, everything ramped up once again to the level of absurdity. Now we have pilots with guns in the cockpit. Assuming the pilot is the one who gets to the gun first, I m not real happy with the idea of a bullet or two bouncing around an airline cabin. These measures, no matter how well-meaning, are a product of pure reactionary thinking. Something bad happened, so we ll do everything we can think of to prevent it. As for the consequences well, let the chips fall where they may.

Now, if we think as paramedics and other emergency caregivers ought to, we may come to a different conclusion about the current system of airport security. To illustrate this point, let s think of terrorist attacks as medical incidents and societal resources as an EMS system.

In an EMS system, we try to get the most bang for the buck. We locate our response units in places where things are supposed to happen. So where do we find the incidents that require our efforts, that result in catastrophic loss of life? It s not at the airports. Since 1970, 356 persons have lost their lives in the air as a result of hijacking incidents aboard United States air carriers (247 of these died on 9/11; prior to 9/11, the last domestic hijacking occurred in 1987). Each year, nearly 32,000 Americans die in automobile crashes, and an additional 3,100 are killed while riding motorcycles. In Florida alone, there are nearly 7,000 accidental deaths, 2,300 suicides, more than 950 homicides and 1,700 deaths from AIDS each year. Even adding in the 3,200 victims "on the ground" in the World Trade Center, it s easy to see that the funds we re spending on airport security might be better spent on preventing loss of life on the road or in the community.


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