Becca Balint: The Emergency Room on wheels

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When you work on a rescue squad, you see some unsavory aspects of the human condition. I was reminded of this when I along with several of my legislative colleagues visited the underappreciated and underpaid EMTs and paramedics at Rescue, Inc and Deerfield Valley Rescue earlier this month.

As we sat and talked over lunch, I learned something that gave me chills: the danger associated with administering Naloxone to a person who has overdosed on heroin. The heroin user pulled from the brink of death often starts swinging at the rescuer because his or her "high" has been ruined. Not a great thank you for saving a life.

This is a frequent occurrence. When Naloxone (sold under the brandname Narcan) is administered to reverse the effects of opioids, the patient often experiences restlessness, anger, agitation, nausea, and vomiting. But at least the patient is alive. The effects of the Naloxone last about 30 minutes to one hour, and sometimes multiple doses are required because today's heroin is so strong. Our rescue squads, tragically, now routinely battle to reverse heroin overdoes. But the work of these vital crews has changed dramatically in other ways, too.

My mom was an EMT and served on our local ambulance when I was a kid. I don't think she would recognize the equipment and the vehicles that our local EMTs and paramedics use today. The ambulances have evolved into emergency rooms on wheels each valued at $160,000 and carrying critical lifesaving equipment that, not surprisingly, is very costly to purchase and maintain. On our visit we saw a cardiac monitor priced at $42,000, a ventilator that runs $12,000 and an IV pump that sets them back a cool $10,000.

Our rescue teams obviously use these portable emergency rooms for life-threatening 911 calls, but they also serve several other vital roles in our healthcare system. Ambulance transport of patients is a key aspect of providing care in more remote areas. Vermont is a rural state, and many areas are served by small, critical access community hospitals that provide only limited services. In order to access specialty care, patients routinely need transportation to larger regional medical centers. EMS crews give treatment, transport, and care between these centers. Many of these patients require complex care due to their complicated constellation of medicines and conditions.

From emergency situations, to battling our heroin problem, to providing vital transport services to our ailing, aging population, our EMS teams are a critical part of our healthcare system. And yet, they have not been part of our statewide conversation about healthcare reform. These men and women have frequent, direct contact with patients in the field and would bring invaluable knowledge and experience to the table.

Our Windham County legislative team recently sent a letter to Al Gobeille, chair of the Green Mountain Care Board to ask that EMS crews be brought directly into the healthcare conversation. There are many certainly moving parts, but some basic questions must be answered: Why are Medicaid reimbursement rates for ambulance services negotiated separately from other parts of the system? Why aren't ambulance services reimbursed when they respond and stabilize a patient, thus saving a much more expensive trip to the hospital? Why is there no reimbursement provided for all the drugs administered in the field?

Medicaid patients made up about 18 percent of local EMS calls in 2012; today that number is 32 percent. But Medicaid reimbursement rates have not increased since 2008. Our critical EMS teams are not on healthy financial footing. They cannot continue to deliver their vital services unless we find a way to offer them the kind of care they provide to us.

Becca Balint writes from Brattleboro on history, politics and culture. She currently serves as a state senator from Windham County.


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