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National Emergency Medicine Report Card

Mediocre: average; ordinary. That’s New York. That’s New York health care according to the American College of Emergency Physicians, anyway.

The American College of Emergency Physicians (ACEP) has recently released the National Report Card on the State of Emergency Medicine – Evaluating the Environment of Emergency Care Systems State by State. In this 129 page document, ACEP rated each state on access to emergency care, quality and patient safety, public health and injury prevention, and medical liability. An overall grade was calculated for each state as well as for the Nation as a whole.

“The results are sobering” says ACEP. “The National health care system is in serious condition, with many states in critical condition” the report says. ACEP concluded the emergency medicine system in the United Sates [as a whole] rates a C-…just above “D”. As for individual states; no state scored either an A or an F. I sense political correction here! After all, if some state were to receive an A; there would be no room for improvement. Conversely, can you imagine the fallout should a state rate an F? After reading the report I speculate that some state(s) in fact should have rated an F, but for fear of litigation, bad press, or whatever ACEP did not assign the grade. Perhaps the ACEP version of no child left behind…everyone passes. But don’t let my cynicism fool you.
Take a look at the grading criteria:
· States that reached at least 80% of the top state score received an A
· States that reached at least 70% of the top state score received a B
· States that reached at least 50% of the top state score received an C
· States that reached at least 30% of the top state score received an D
· States that fell below 30% of the top state score received an F

Let’s get back to New York.
New York State scored an overall grade of C+. Great, we’re just above the middle…mediocre. Access to emergency care rated a B-, quality and patient safety B-; under 70% for both.

Can anyone please tell me; since when can you score 50% on anything and get a C? In New York, EMT’s have to achieve a minimum of 70% to pass a written EMT or paramedic exam.

If I were in charge of NYS health care, I’d take away the PlayStation!

Public health and injury prevention leads the pack with a whopping A+…that is, a little better than an 80%. And bringing up the rear; Medical Liability Environment: D-.

The grades only tell half the story. New York ranked 49th for number of emergency departments per 1 million people and 43rd in percentage of population with access to enhanced 9-1-1 services. Yet, New York ranked near the top in annual Medicare fee-for-service (4th), annual Medicaid cost per person younger than 65 (7th), and annual per capita expenditure on hospital care (3rd).

There is little wonder why insurance costs in NYS are out of control. Insurance costs in Western NY are expected to jump between 12% and 16% in 2006
(for more information see the post: Spring Loaded in the Stupid Position

The report cites overcrowding, medical liability concerns, poor access to care, and get this; inability to respond to public health emergencies or terrorist attacks as major shortfalls. The report attributed its findings to increased demands placed on the emergency medical system, and on budget cuts, which have lead to a steady decline in critical-care beds. The report noted that “the number of emergency departments has decreased by 14 percent since 1993. . .and hospitals are operating far fewer inpatient beds than they did a decade ago.” The report also found that there is a general association between the wealth of a state and emergency care, and a correlation between population density and a state’s overall grade.

FEMA, health care, disastrous events…is anyone adding this up?
Read the report:


Get Rid of that Customer!

Here is my New Years resolution for 2006. This woke me up from a sound sleep the other night so, I have to just put this one out there and wait to hear what you think.

Get rid of the term “customer”. All-in-all the term customer is not a bad way to describe the people we serve as it embodies thoughts and accompanying behaviors that are most often positives in public service. Webster’s defines customer as a patron, clientele, or consumer. Rather than simply defining the term, let’s examine what a customer is…what actions do they take? What choices do they make?
The fact is that a customer or consumer makes a decision as to what services or goods they wish to consume along with the time of use and consumption. A majority of emergency service “consumers” don’t make those choices. They call when the need arises. In daily life, the consumer may also choose with whom they do business. Again, the majority of the folks calling 9-1-1 have no choice about who is going to show up to take care of them or put out their fire. So, in our “this is a business” mentality, the term customer is the first to go.
Let’s replace customer with citizen. A citizen deserves our care and attention. “Citizen” implies earned respect and comes with certain expectations. We’re not working behind the counter at Burger King and the citizens we serve are not customers! They are citizens of our communities.

The term “productivity” is another useless business term I won’t be using (or tolerating from others) in 2006. I just can’t stand it, the term as applied to emergency service lacks meaningful definition…even by the limp and leaderless that uses it!
I have had enough with supposed leaders spouting off about emergency services being a Business! Yes, I know the administration and management of any public service organization must be conducted in a business-like and professional manner. I also understand that the use of public funds such as tax dollars, require a level of justification and prudence. Agencies such as commercial ambulances certainly have to be managed as the business they are. But I’m not talking about commercial or for-profit services here. I’m strictly addressing tax-based organizations. The point that’s getting under my skin is that some leaders in public service agencies are starting to use the “this is a business” mentality and associated terminology and taking it way too seriously.
It seems that we have traded brothers for employees, leaders for managers, and a culture of family in service for a culture of corporate corruption and disposable people. Can you imagine the day when firefighters come to work as if it were “just a job”? Public emergency service is a calling, not just a job! Can we expect that our would-be leaders that are now managers in the “this is a business” mentality will continue to adopt other traits of the big business world? Perhaps we’ll be seen as more productive if they were to adopt a KODAK or ENRON mentality? Think of it…the disloyalty, dishonesty, and the corporate CEO corruption! Is this where emergency service leadership is heading?
Let’s get rid of the customer and go back to serving the citizen. Let’s understand that how a firefighter or EMT represents themselves in the public eye and what they are capable of doing is productive.