At the American Ambulance Association Conference in Las Vegas on Monday, Dr. Richard Carmona, 17th Surgeon General of the United States, presented an inspiring keynote address. Carmona, a successful and highly respected physician who had a hard start in life, detailed his rise from being homelessness and a truant from school and then was able to follow his dreams, with a few helpful breaks - several that came as a result of his military service.
Noting that there are a lot of Richie Carmonas in EMS that could benefit from encouragement (and opportunities) to succeed and reach their dreams, Carmona, a former paramedic and nurse who dropped out of high school to serve in the military, told the AAA audience that his military experience and all his emergency medical training thereafter made him never forget his roots. He said that he has never forgotten the privilege of serving his fellow man and that helped him succeed. “I did it because I loved what I was doing – and still do!” he told the AAA audience.
Amusing the audience by detailing his amazing advancement to Surgeon General, Carmona said that after numerous interviews with federal officials, he was called and told he was going to be nominated by the President for the top medical post in the Administration. He said that, while waiting for the President to arrive in the Oval Office, he decided to see what it felt like to sit in the President’s chair. “I sat there and thought “I could do this!’”.
Carmona figured he could jump out of the chair when he heard the President arriving through the outer office, but was not aware the Commander-in-Chief has a private office with a hidden door panel that opens on the opposite side of the room. So, without warning, the President entered and caught him sitting in his office chair. “Looks easy doesn’t it?”, asked the President. Carmona humbly said, “No Sir.”
Carmona also had the audience laughing while telling an amusing story of a conversation he had with Senator Ted Kennedy. When speaking about politics in Washington, Kennedy told Carmona that he had advice for him. The first thing he told him not to take pointed questions and challenges from Congress personally. Kennedy said, “Remember, it’s more about them (and politics) – Not you.”
Kennedy then told Carmona an often stated joke. “If you want a FRIEND in Washington – you have to bring a dog!” Carmona said that, a year after being unanimously approved for the Surgeon General’s post, Kennedy asked Carmona if he remembered the advice he had given to him a year earlier. Carmona said he told the respected Senator, “Yes Sir, but, with all due respect Senator, I have to tell you that I disagree with your advice.”
With a startled look on his face, Kennedy asked Carmona, “Why?”
Carmona said, “Well, Senator, after a year of experience here, I believe your advice was off a little bit. You need to bring two dogs with you to Washington, because during your term here one of them will turn on you!”
Carmona then detailed some serious issues the EMS managers and administrators needed to pay attention to. The first was the ability to think outside the healthcare box and deal with the rapidly approaching changes in the healthcare system. Although we are not sure of the entire impact it will have on EMS systems, Carmona said it is clear that the need for data and proof that what we are ding works to show CMS and others why EMS needs support and funding. He added that hospitals are beginning to realize that EMS is more important to them than they ever realized in the past, noting that this is a god thing that EMS services need to capitalize on in the near future. Hospitals are going to need data linkages to their EMS agencies to show the Federal government that they have closed the 360 degree loop in patient care – from the start of the patient’s incident (pre-hospital), through to their discharge from the hospital.
Carmona also said that agencies should be looking at mobile healthcare, management of morbidly obese patients and earlier trauma intervention. Noting that obesity is a major accelerator of serious medical problems such as diabetes, hypertension and strokes, Carmona said that EMS has to be ready for this grown health care population.
He also noted that EMS agencies have always been seen as the gatekeeper for patients, assessing them and getting them to the most appropriate care/facility. So, mobile healthcare should be a natural for EMS agencies that will now be tasked with checking up on discharged patient, finding and intervening in their care by having medications and care adjusted in their home, and keeping them from making unnecessary trips to hospital EDs and wasting valuable and expensive resources.
Carmona urged the AAA attendees to get involved proactively in mobile health care and improved patient/customer service - paraphrasing a quote from Winston Churchill about Americans: “I love Americans. They always do the right things – eventually!”
Carmona also addressed trauma care and Active Shooter incident EMS care. He said that the use of tourniquets has been well documented by the military and should return to being a frontline treatment by EMS crews.
He stated that all police officers should be provided Individual First Aid Kits (IFAKs) like tactical medics and military personnel carry. He, once again, noted that early trauma and hemorrhage intervention with tourniquets; chest seals; hemostatic and pressure dressings have proven to be invaluable to soldiers wounded in combat, far from aid stations or Medevac helicopters; and tactical officers wounded and pinned down in hot zones and recommended that all officers have access to these important hemorrhage control items.
Dr. Carmona concluded his remarks by addressing the controversial issue of sending EMS personnel into the Hot or Warm Zone at Active Shooter incidents. He said that no matter what the local fire-EMS-Police philosophies or policies are on sending EMS personnel into incidents with police, “someone (police or EMS) on the “front lines” needs to be trained and equipped with tourniquets; chest seals; hemostatic and pressure dressings so they can attend to critically injured tactical team members or victims ASAP after they are shot or injured so they do no bleed to death.”
He recommended that ALL agencies and emergency response personnel (Police, Fire, EMS and Dispatch) read “The Harvard Consensus, Joint Committee to Create a National Policy to Enhance Survivability From Mass Casualty Shooting Events,” an insightful report of the proceedings of a meeting of key officials in Hartford Connecticut on April 2, 2013 to discuss recommendation on EMS and care at Active Shooter incidents.
You can download a copy of this important document – developed to help improve survival from active shooter events – at: http://www.naemt.org/Libraries/Trauma%20Resources/Hartford%20Consensus%20Document%20Final%204-8-13.sflb