Politics and Medical Practice

Once again, a governmental entity feels the need to stick its nose into business it is not equipped to understand.

The Emergency Services Agency of El Paso County, CO oversees the contracted ambulance provider, American Medical Response.

Recently, the bureaucrats on that board felt the need to dictate medical practice to the paramedics tasked with providing it:

 
On Sept. 5, the board, chaired by El Paso County Commissioner Sallie Clark, held a closed session and afterward asked AMR to change how it uses rapid sequence intubation for 120 days, pending study. Commonly called RSI, the procedure paralyzes so a paramedic can insert a breathing tube. 

The ESA board said it wanted AMR to perform the procedure only when they're on the phone with a doctor. Before that, AMR paramedics used RSI under standing orders.

Rule #1 of EMS Protocols: If you really need to do a procedure, you never have time to pick up the phone and say "Mother, may I?"

You know, the .gov already has a pretty obtrusive presence in dictating health care standards, by virtue of holding the reimbursement purse strings. Hospitals, and the doctors who work in them, are constantly hamstrung by insurance plans or Medicare refusing to pay for this procedure or that diagnostic test. As such, the federal government effectively dictates to a large extent what the doctor can do.

And yet, some people still seem to believe that our health care system will improve by having the government provide it.

But I'd bet a healthy sum that if say, Podunk City Council approached our ER doctors and said, "We think you should prescribe more antibiotics. The public demands it, and we look out for the needs of our citizens..." 

...said ER doctors would tell them to go piss up a rope. And if the council pressed the issue, they'd relocate to some place where rice farmers and auto mechanics don't have the power to tell a doctor how to practice.

And that is exactly what AMR should do in this case. Medical practice issues are not the purview of a bunch of volunteer bureaucrats.

There are a number of physicians who have serious reservations about the use of RSI or even simple endotracheal intubation in prehospital care.

That's fine, as long as those reservations are based upon sound principles of evidence based medicine. My feeling is that RSI is an excellent tool to have in the airway toolbox, but one that far too many EMS providers are unqualified to use. But ultimately, that issue should be left to the doctors who oversee those systems.

It looks as if the Emergency Services Agency has referred the issue to their Medical Control Committee, which is where it belongs. Hopefully, wiser heads, ones with some modicum of medical knowledge, will prevail.

Still, if you live in El Paso County, perhaps you should give your Emergency Services Agency a polite call and remind them to stick to the issues for which they're best suited, like wasting taxpayer money.