Inside siren-wailing ambulances, swerving in and out of traffic,
are EMS workers with hundreds of hours of extra training that
allows them to perform advanced procedures, including administering
drugs and inserting breathing tubes, yet they are racing to scenes
that bewilder and frustrate. They take hundreds of people to the
hospital each week for real emergencies - but also for ailments
including hiccups, toothaches, headaches, splinters and menstrual
cramps.
It's the result of a new taxi voucher program that says anyone
who wants an ambulance ride to the hospital gets one. The policy
is supposed to ensure quick crisis care for everyone who needs
it. But instead, it costs cities millions and could threaten rapid
response to life-or-death needs. Firefighters agree that the possibility
exists every day that all ambulances will be busy when someone
needs life-or-death care.
The policy is also getting harder to maintain. As city residents
grow older and poorer, they're using ambulances more - testing
the limits of fire departments across the country. People without
cars or taxi fare, or who lack health insurance, know they can
see a doctor faster by dialing the most well-known phone number
in America: 911.
For every legitimate 911 call, there seems to be an illegitimate
one. Some without insurance call to receive treatment for minor
ailments. Others phone in order to skip long lines at the ER.
Many people dial 911 because they think arriving at the emergency
room in an ambulance will get them seen faster. It does, but only
briefly - until hospital personnel realize the problem isn't an
emergency.
Last year, just a little more than 10 percent of all Fire Department
runs were to fight fires. More than 60 percent were for medical
emergencies. And of those, the firefighters union president estimates
that one of every three was for a minor malady.
Responding to an emergency call the other day, a San Antonio
paramedic discovered a man who didn't need a hospital. He needed
hardware. "When my ambulance got to him," the paramedic
says, "he explained that he called 911 because after the
plumber replaced the water heater, the faucet made an awful noise
and air came out of his pipes."
Dozens of firefighters recount more examples: Paper cuts. Crying
babies. Women in labor who need rides to the hospital. Firefighters
in Camp Washington recently responded to a report of a 1-year-old
bleeding baby. The baby had diaper rash.
EMS workers are not only stretched -- they're stressed. The San
Antonio Fire Department estimates up to one of four transports
for basic life support is noncritical. But that may be low. In
2000, emergency medical workers found that in more than half of
their calls, "patients" did not require hospital attention.
Cincinnati City leaders - hesitant to relax the "you call,
we haul" for fear they'll be sued - are left with few options.
They could be more aggressive in collecting unpaid ambulance fees,
which last year topped $4.5 million of $7.9 million billed through
mid-November. Or they could split firefighters' shifts to relieve
the stress on emergency responders.
The city bills patients' insurance carriers, if they have them,
and Medicare or Medicaid. But depending upon the patient's ailment,
the insurer doesn't always pay the entire bill. Those without
insurance are billed directly, but aren't forced to pay. Many
don't.
Over the past three decades, the mission of most fire departments
has turned from predominantly fighting fires to mostly providing
emergency medical care. It's a trend across the country as fire
prevention technology improves, lessening fire calls, and societal
factors such as poverty and a lack of access to health care worsen.
EMS has become the provider of choice for some people.
Fire chiefs everywhere debate how to balance the increasing workload
with budgetary concerns, says Jack Krakeel, Emergency Medical
Services director for the International Association of Fire Chiefs
and chief of public services in Fayetteville, Ga.
"It is one of the top issues we face today," Krakeel
says. "We are always trying to come up with new ideas, but
it can be very difficult. It's a daunting task, both from an operations
perspective and a public-policy perspective."
In Dallas, population of more than 1 million, the nearly 2,000
firefighters made almost 147,000 emergency medical runs last year.
But they transported just 60,594 of those to the hospital - or
fewer than half the calls.
"A toothache?" says Dallas Lt. Joel Lavender. "No,
you don't go."
In Phoenix, calls for minor medical help are sometimes answered
by teams of emergency medical technicians and social workers who
ride around the city in minivans. The program saves money, Phoenix
Chief Alex Brunacini says, and directs resources more appropriately.
The department made more than 104,000 emergency medical runs last
year, and transported people in roughly half.
In San Francisco, rescue personnel give taxi vouchers to patients
they think do not need immediate transportation. Houston sends
emergency medical supervisors to scenes to determine whether the
caller needs to go to the hospital.
Many cities have systems in which people who need help with non-emergencies
can dial 211 or 311. While some are proposing a public awareness
campaign about when - and when not - to call 911. Some cities
are also starting to charge fees for runs in which personnel respond
but don't transport anyone.
Lt. Al Pining recently started his 42nd year with the Cincinnati
Fire Department. He has watched as the work became less about
fighting fires and more about emergency medical service, a change
that's difficult for old-timers to embrace. He's made plenty of
runs that might be considered unnecessary and says it's easy to
become frustrated.
At the same time, though, he says it's very difficult to walk
out of a house - particularly where the patient is elderly - when
the patient has decided not to go to the hospital this time.
"You kind of cringe when you walk out of there," Pining
says. "You just hope you don't have to go back. Because if
you do, it's going to be something serious."
Sources: San Antonio Express-News, Paramedics Frustrated by Non-Emergency
911 Calls author: Ken Rodriquez Cincinnati - The Enquirer, You call, We haul, author: Jane
Prendergast
