By Dr. Tom Gross
Marin Independent Journal (California)
Copyright 2007 Marin Independent Journal
All Rights Reserved
MARIN, Calif. — When I was first certified as an emergency medical technician, Hippocrates was still a medical student. EMT programs were new. Few people knew what EMTs were. On more than one occasion, I brought medical patients or accident victims to a hospital and got chewed out by the physician who told me that I was “not authorized to do that.”
Actually, he was wrong, for I was authorized and trained to take the actions that he did not realize were available.
Then again, the physician was not an emergency physician. The specialty of emergency medicine was still in its infancy. Only a few urban centers were aware that a new medical specialty was arising, emphasizing the care of emergencies. At that time, however, I did resolve to become a physician, believing I would get to write the rules and would never have someone tell me what skills I could or could not use.
My naive resolution occurred before the era of health maintenance organizations and managed care. Once again, the rule book is still out of my reach.
The American College of Emergency Physicians (ACEP) has designated this week as Emergency Medical Services week. This week is a time to remember that not all medical care takes place in a hospital.
Emergency care often starts in a patient’s house or at their work. It often starts on a sidewalk, in the crumbled remains of a small automobile or down a muddy embankment in the rain. An ACEP press release describes EMS as “responsive to all kinds of medical emergencies despite weather conditions or hazards.”
EMS is a system of dispatchers and administrators, firefighters and paramedics, physicians and nurses, whose purpose is to provide emergency care to anyone who calls.
When you have been in a motor vehicle accident, we rush to your location to get you safely out of your vehicle and to the hospital. We have established agreements among the¼ medical prehospital providers in the county so that the patient experiences a seamless transition from a crumbled car in a ditch to medical care at the hands of trauma experts.
We have conducted drills with the local hospitals to see if we can discover ways to improve the transition of care from the field providers to the hospital.
In some areas, medical response is provided by private companies. In many other areas, this service is provided by paramedics and emergency medical technicians who are also firefighters.
Regardless of whether the service is provided by a private provider or a public agency, the quality of care is monitored by state and county EMS agencies. If you call 911 in Marin and report a medical emergency, your local fire department will respond. Our calls for emergency medical service now outnumber our calls for fire suppression.
Recent advancements in medical care are reaching out of the hospitals into the prehospital care.
Medications are available to paramedics that a decade ago were restricted to cardiologists.
The goal has always been to extend the reach of high-quality medical care from the hospital into your own home when you need it. A paramedic is not just giving you a fast ride to the hospital but is providing the same care that an emergency physician would provide.
Take the time this week to say “hello” and “thank you” to the EMTs and paramedics of your local EMS systems. I’ll do the same when they bring their patients to me in the emergency department.
Dr. Tom Gross is the emergency medical services director for the Novato Fire Protection District.