December 29, 2018
Every group looks to the presidential candidate that will address the issues they care about most. But what about EMTs? What candidate would be best for us? With Election Day almost here, it is interesting to ponder what each of the candidates would do about several hot issues currently affecting EMTs. Yes, health care is often discussed by both candidates, but it is usually just a general back and forth about the state of Obamacare. But though the average voter may not know much about these more specific topics that concern EMTs, they are affecting hundreds of thousands of people every day and deserve to be addressed.
Here are four questions the candidates should answer:
- What steps will you take to reverse the opioid overdose epidemic?
- How can you alleviate the funding strain caused by the low payment for ambulance transportation for Medicaid/Medicare patients?
- Will you support the creation of a federal body for EMTs to increase productivity and efficiency?
- Will you place restrictions on the price increases of common, life-saving drugs that are basic EMT requirements, such as the EpiPen?
Opioid Overdose Epidemic
Guess what? More people die from opioid overdose each year than from motor vehicle collisions! In 2014 alone, there were 47,055 deaths from drug overdose, 2/3rds from opioids. The opioid overdose epidemic should be a big concern for anyone considering EMT training, because opioid addicts are highly likely to be repeat patients.
EMT’s responding to an opioid overdose use Naloxene a synthetic drug, similar to morphine, that blocks opiate receptors in the nervous system and can reverse the effects of opioid overdoses. But because the use of naloxone has skyrocketed together with the rate of overdoses, the price, once about a dollar per dose, has increased by 1000% or more, adding more strain to the underfunded EMS system. Repeat patients and overpriced medicines all contribute to reduced EMT salaries.
What a future president can do:
- Institute strict legislation on the administration of OxyContin (oxycodone).Why? Until the mid 1990’s, opioids were used only for patients with truly significant chronic pain, such as cancer patients. Then OxyContin came onto the market. And the creators of OxyContin downplayed the addictive qualities of the drug and marketed it aggressively to doctors. Money is the be all and end all, right? The result? An increase in sales of OxyContin from $45 million in the first year to nearly $3 billion a decade later – along with an equally severe increase in addiction, overdose and death from opioids.
There are already several models of drug restriction the federal government can follow. In Pennsylvania, for example, there is a strict limit on the number of opioids a patient can receive after an ER visit. There is also an electronic prescription drug monitoring program that allows prescribers of controlled substances to prevent patients from going from doctor to doctor to get more opioid prescriptions. By placing similar federal guidelines on the use of oxycodone as a pain reliever, the next president could be preventing hundreds of thousands of innocent patients from inadvertently becoming opioid addicts.
- Mandating long-term intervention for any patient brought in for an opioid overdose.When a patient is brought in for major trauma from a car accident, vast resources are invested to reduce the rate of death and disability from their injuries. A severely injured accident victim will probably spend weeks in the hospital and then rehab. What resources are invested into opioid overdose patients? A short period of observation and then a discharge right back into the environment that caused them to overdose to begin with! There are better ways. In Toms River, NJ, the RWJ Barnabas Health system created a program where recovery specialists are sent to Emergency Rooms whenever an opioid overdose patient is admitted. The specialists offers the patient immediate access to an inpatient recovery unit or up to eight weeks of long-term follow-up in the community. The Barnabas Health IFP program has seen its success rate of getting addicts into recovery rise from 20% of patients to 80%.
Therefore, the next president can encourage legislation requiring:
a) Recover specialists on site in every emergency room
b) A mandatory admission to an addiction recovery unit for any overdose patient
Insufficient Ambulance Reimbursement for Medicaid/Medicare Patients
There are several problems with the current mode of payment by Medicaid and Medicare for ambulance transport.
- The fact is that the insurance coverage provided by Medicare and Medicaid for ambulance transport does not cover the cost of service – and these patients account for more than three quarters of all ambulance transport patients.
- EMS agencies do not get paid for the cost of medical care delivered to patients who decline transport to the hospital. The result? EMS agencies have an incentive to transport all patients to the hospital, even if unnecessary, so at least some of their costs get reimbursed.
At the moment, this shortfall is usually addressed by subsidies from local governments. But this is not a long term solution. The next president must set up some sort of federal funding for EMS systems so they can continue to operate in an efficient manner.
Creating a Federal Body for EMS Services
When it comes to national disasters such as major terror attacks, or virus epidemics, the local EMS service model doesn’t work very well. Because there is not central body to coordinate, it is hard for EMS from different locations to work well together. In addition, if the data from all the EMS agencies was consolidated, it would allow for better national disease surveillance and national disease prevention programs. The formation of a single Federal “home” for EMS would promote equipment standardization, national emergency response coordination, and central training guidelines. It would allow EMS to improve our EMS system’s ability to respond daily and during disasters.
Will the next president make this a priority?
Yes, there are alternatives to the EpiPen. But, come on – they aren’t truly solutions.
Imagine entering your child’s school nurse office and finding a collection of generic medical supplies – syringes and vials – rather than a stock of neatly-packaged EpiPens. Which makes you feel more secure?
Auto injectors are easy to store, easy to use, and don’t require much training. Other injection methods are a lot messier – but that is what EMTs are using these days as the price of EpiPens skyrocketed. Why? Well, “because it’s cheaper”. Should that be a reason for potentially endangering patients?
The same applies to the sharp price rise in Naloxine. The next president needs to institute some federal guidelines restricting the unnecessary price rise of lifesaving drugs.