3 strikes and you're dead? Not in my ambulance
Extrapolating the consequences of a policy limiting opioid overdose treatment that goes against the foundation of EMS
Over the years, I have seen some pretty egregious examples of how even the most skilled EMS providers can lose their way with regard to providing unconditional patient care. I knew a paramedic, years ago, who measured – with a sense of pride – the number of patients he didn’t transport. He’s not a paramedic anymore.
I also understand, personally, the frustration that comes with those “frequent flyers;” especially the drunks and drug addicts.
However, I have never seen such a blatant, callous and utterly illegal disregard for the mission of EMS and disdain for human beings than the proposal by Middletown, Ohio City Councilman Dan Picard to let overdose patients die.
According to news reports, Picard has proposed a three strikes and you’re dead policy that would have 911 dispatchers refuse to send emergency resources to a patient who has already received two overdose reversals. Since Picard's comments went viral, the City Manager has clarified that this isn't a policy change, but a city council request for the city to conduct legal research on an unconscionable question.
EMS Duty to Act
Every jurisdiction that provides tax-based or contracted EMS does so with a codified Duty to Act; a duty to respond, treat and transport as necessary or possible given the circumstances. The duty is not negotiable or subject to terms other than provider safety and resource availability.
Although not true of fire districts, as we learned years ago in Tennessee, EMS districts that are subscription-based even have a duty to respond, a duty to treat and a duty to transport the sick and injured to the appropriate receiving facility.
The idea that a city council can propose refusing care to anyone or any patient type is ludicrous beyond measure. What’s even more terrifying is the thought that an elected official would even propose such a plan – even if it is just a scare tactic and never intended to be implemented.
After the drug addicts, who is next?
As a lawyer, one of my favorite games is the extrapolation game; let’s extrapolate everything out to its absurd end and see what we get.
Let’s say that this ridiculous plan of three strikes and you’re dead actually becomes law, extrapolate it out:
1. The number of overdose calls will naturally decrease as the number of addicts in the jurisdiction eventually dies out.
2. Call volume goes down.
3. The city saves money.
4. Cost savings sparks new ideas for reducing call volume.
5. Next, the city council votes to refuse to send emergency resources to shortness of breath calls where the patient is a known smoker; they knew the risks.
6. The city is saving so much money now leaders decide to refuse to send resources to chest pain calls where the patient is known to be obese.
7. This is amazing … now let’s stop sending resources to diabetic calls in restaurants.
You see? It does not take any time at all before the utter callousness of the idea reaches the highest levels of absurdity.
Emergency service reality check
This proposal seems to have sparked some serious passion and heat on social media, but let’s all take that deep breath and recognize that, in the real world, this does not exist. Again, the extrapolation game:
1. City has a duty to act.
2. City passes unconstitutional law providing for three strikes and you’re dead.
3. City stops sending resources to overdoses, thus breaching the duty to act.
4. The first overdose patient dies.
5. The lawsuit is filed.
6. The plaintiff wins easily.
7. The court orders damages.
8. The city cuts services to pay the damages.
9. Residents sue for the service cuts.
10. City declares bankruptcy.
If you are an EMS provider who truly believes in EMS, this proposal should make you very angry and you should put that anger to good use and examine how your agency addresses and will continue to address the growing and deadly problem of drug abuse and its effect on already strained EMS systems.
It does not matter whether his proposal is a sincere, albeit misguided, effort to save the city money or if it is get tough political posturing that was never intended to pass. Ultimately, the voters must decide whether the position will result in a re-election win or loss for Picard and the other members of the city council.
EMS foundation: unconditional care
Most regular people don’t know or understand EMS or how it really works; most people just think they know what they are told by people with voices louder than their own.
This issue is your opportunity to educate political and civic leaders and the citizens in the community you serve about EMS and solidify the foundation upon which EMS is built: unconditional care to all.