By Dr. Tom Gross
Marin Independent Journal (California)
Copyright 2007 Marin Independent Journal, a MediaNews Group publication
All Rights Reserved
Editor’s note: Dr. Tom Gross is the emergency medical services director for the Novato Fire Protection District. His column appears every Monday in the Marin Independent Journal. His views do not necessarily reflect the views of JEMS.
The advancements in medical technology that raise the standard of medical care in our country are certainly noteworthy. Last year I was the beneficiary of such an advancement. The revolution in pharmacology is a good example. There are medications available now, such as the antivirals directed against HIV, that could hardly be dreamed of a generation ago.
As much as I applaud and support these advancements, I am even more impressed by the progress that results when people get together to achieve a common goal.
Large organizations encounter a phenomenon called “stovepiping,” which occurs when small groups in one division keep important information within their group, hopefully to make their division more influential. We all have heard about the failures, before 9/11, of the various federal intelligence agencies to share information pertaining to the activities of terrorist groups, and we cannot help but wonder if, had they shared some of their intelligence, could not some of those lives have been saved.
This inability of these agencies to communicate is an excellent and also tragic example of stovepiping.
Stovepiping is a natural phenomenon and increases in frequency as an organization grows. Therefore, it must be resisted. The way to overcome stovepiping is to recognize that different groups have different beliefs, and to sit down with all groups to find what they all have in common.
For me, the victory in cardiac care that has occurred in Marin over the past two years is more about overcoming human obstacles than technological ones. Under the auspices of the Marin County Emergency Medical Services Agency, members of different organizations in Marin organized a system for the assessment and treatment for acute myocardial infarctions. These meetings included representatives from the county EMS agency, fire departments, EMS dispatchers, cardiologists, emergency physicians, nurses, paramedics and each of the three Marin County hospitals.
Sitting down at one table does not mean that everyone is going to agree. For the trauma system, which emerged in 2000, and the current system for the treatment of ST elevation myocardial infarctions, there was considerable difference of opinion, to put it mildly. Despite these differences, people stayed at the table and stayed devoted to the goal, which was improved medical care in Marin.
The standard of care is a moving target. What is standard in 2000 could be ancient folk remedy by 2007. The standard of care also shifts geographically. The standard of care for heart attacks in the small Alaska mining town where I once worked is different than that in downtown San Francisco.
Although the phrase, “standard of care,” implies a technological standard, there is also a human component. A community decides what its standard of care will be, based upon available technology and the cost of that technology to the community. My mining community could not afford a trauma center or a cardiac hospital. Instead we invested in all-weather air travel to move our sick and injured to Juneau.
Ten years ago, Marin residents decided to support a higher standard of trauma care, and after much negotiation, evaluation and gnashing of teeth, a trauma system was born. Now we have a system for improved cardiac care. Is it perfect? Not yet.
It’s called democracy. Nobody ever said it was easy. It beats the alternatives. I guess Forrest Gump was right. It’s like a box of chocolates. You never know what you’re going to get.