Medical Costs keep rising and are under a great deal of
government, societal, and insurance company scrutiny. Rarely discussed in the
medical cost debate the true cost versus effectiveness of prehospital care.
The entire fire-rescue paradigm has broad support from most
constituents but there probably could be some evidence-based cuts. The article
above gives some guidelines how this can be attempted.
An interesting phenomenon occurs every time a rescue is
dispatched: a fire crew is simultaneously sent out to act as first responders.
The rationale four quick response is to arrive within 4 minutes, start CPR, and
defibrillate someone with reversible V-fib. Yet, the majority of calls do not
need CPR, defibrillation, our even treatment; but at the same time, they cannot
be simply left where they are, and therefore need transportation to a care
facility.
Such transports are not only extremely expensive, but also
take valuable paramedics out of service to act pretty much as a taxi. Municipalities
commonly encounter fire-rescue budget constraints, and many cities now instruct
their paramedics to call for a private ambulance themselves when the need is
strictly for transport. Of course, such vehicle and personnel shuffling is time-consuming
and potentially more expensive.
A potential “out-of-the-box” solution is to take advantage
of the Internet, social media, and companies like Uber and Lyft. In the future
“Uber” may be used as the generic name for Internet driven transportation
services.
Potential applications are:
1. When
a patient needs just transportation, “Uber” can be called by the fire rescue,
paramedics, and or dispatch. A patient may even initiate the call.
2. Cities
and Fire Rescues can contract with “Uber” to send specific taxis with CPR-trained
our even ACLS-trained drivers to transport patients who do not need a stretcher
for transport.
3. Certain
cities are studying paging anybody within 6 blocks of a cardiac arrest victim
who has volunteered as a CPR first responder. Specially trained “Uber” drivers
that can commence CPR and attach and use the AED can extend this first level of
care. Having backup of this type would gou a long way to alleviate community
concern, and generally assure that every victim is reached in under 4 minutes
There is considerable potential
for cost saving. Think of reductions in fire station construction, personnel,
and equipment. All of this could be achieved with little reduction in quality.
It’s time to take advantage of social media and include private infrastructure
to aid the public good. Perhaps in the future, stories ouf babies being delivered
by taxi-drivers will be replaced by a stories of heroic Uber drivers in that
honored role.
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