Palo Alto plans major revamp of Fire Department
Original post made
on Jun 7, 2012
Firefighters are typically associated in the popular imagination with burning buildings, wildfires and disaster response. These images, while valid, are increasingly becoming anachronistic in the Palo Alto Fire Department, where requests for medical service are now taking up more than half of all calls.
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posted Thursday, June 7, 2012, 3:05 PM
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Posted by Firefighter
a resident of another community
on Jun 8, 2012 at 2:58 pm
Wayne, I mistakenly misunderstood your prior post. I just wanted to clarify and then leave this issue to rest, as it is irrelevant to the PAFD changes this article discusses.
My post in regards to healthcare systems was in response to a previous poster who asked why other departments do not transport. While EMS is a specialty of medicine as a whole, the strategic planning is no different then other types of healthcare specialties or public services, both private and governmental. On paper its about resource allocation, supply and demand.
I also wanted to clarify that my understanding of your previous post was very elementary in the fact that I assumed you were talking about nifty difty machines, such as 12 lead monitors that tell the practitioner what the computer reads. (often times it is wrong).
In terms of knowledge based medicine, I want to agree with you and disagree. Firstly I will agree that knowledge based medicine is the thing of the future, but it isn't so "new". This all happened with the managed care phenomena (think Kaiser) and the gatekeeper to specialized care. Why are we doing X procedure when its not proven to make a difference? Why do they do X procedure in part Y of the country and not part Z? I agree wholeheartedly. Kind of reminds me, is this not what healthcare reform and nationalized healthcare hopes to cover? (in addition to many other topics). Then again, I probably don't need to teach you in this matter, as I am sure from your citations and links you know what your talking about.
Here is where I disagree, EMS and Emergency Medicine (both pre-hospital and hospital) differs in the fact that the primary goal is and always will be life saving techniques and maneuvers. This is of course on paper, as we all know actual life threatening emergencies are the minority. That being said, the concept of acute care does not change, be it a life saving emergency or the mental aspect of an emergency in the perspective of the patient, you treat the acute issue.
Evidence and knowledge based medicine is applicable to all avenues, its just not as applicable in terms of computer software, coding, and diagnostics in the acute setting. The goal is not to diagnose (although this is counter intuitive, since to treat the symptoms a well educated practitioner should have a good idea when it comes to what is going on) the goal is to treat the symptoms.
The new networks and computer systems are great when deciding treatment plans for a 68 year old female patient with UTI like symptoms, elevated white blood cells, signs and symptoms of kidney failure, and history of congestive heart failure. Wouldn't it be great if that physician treated the patient with the best evidence based medicine? Treated them just like the hospital across the street? I think so!
In the field though, evidence based medicine is taught, updated, and retrained into the minds of providers who provide quick decisions/procedures based on hands on assessment. (hence why education and clinical training are so important) I can't get a full (CBC- Complete Blood Count) in the field, but a 68 year old female with a fever, swelling in her ankles and a history of foul odored low urine output, is going to be treated in a manner that stabilizes her. I will treat her like I treat all my patients, make sure the blood goes round and round, her blood pressure for perfusion of the brain is adequate, and her breathing is not effected.
Sounds simple enough, but providing advanced life support in the field should not be discounted, it takes education, training, updating, retraining, and hands on experience to become proficient. As evidence based medicine leaks its why into peer reviewed journals, gets reviewed by services, and presented to their medical program directors, changes can be made to existing treatment plans and programs.
Nice debate, nice talking to you, and thanks for the links.