Ambulance Driver

An Automatic External Defibrillator (AED), pictured left,  is a life-saving tool that   is  becoming  common place in today’s society. They have a proven track record for delivering  definitive care for those who have suffered a cardiac arrest. They are light weight, very simple to use (they talk to you), and provide the treatment of choice in a large number of cardiac arrest states. These things save lives.

Unfortunately, the United States Postal Service can’t seem to get its bureaucracy to approve the installation of an AED that is going to be donated to its downtown Minneapolis facility.

As the Minneapolis Star Tribune reports today, it has been 7 months since a worker at the facility died as a result of a cardiac arrest. Since then, his co-workers have tried in vain to get the upper-echelon paper pushers to approve their request – even though one is being donated.

Sure, the Post Office spokesman had a myriad of excuses:

“We can’t just make a local decision,” Nowacki said. “There are processes and things like that within the Postal Service.”

That was spoken like a true Government worker, don’t you think?

The article goes on to say that the spokesman denied the urgency of the request, in part due to the 4 minute response time of the paramedics from Hennepin County Medical Center.

I’ve responded to the downtown post office numerous times. As the workers attest in the article, it is a vast space. Their assertion that it actually took 13 minutes for the medics to arrive at the side of the patient does not surprise me a bit. Having an AED at the patient’s side immediately is much preferable to having to wait for me to show up.

And the spokesman just couldn’t stop digging:

Nowacki said the Postal Service couldn’t move forward, however, until the facility first updated its CPR certification. That process was completed Dec. 1, so a formal request will go to regional headquarters in the next few days, he said.

Nowacki estimated the facility would need 15 defibrillators, and that any decision to employ them must fit in with the “overall safety program” for 14,000 local postal employees.

When you go to the airport, the malls, the skyways or hundreds of other places where you see AED’s, you are not going to see a sign which says “DO NOT USE UNLESS YOU ARE CERTIFIED IN CPR.” As stated before, these machines are fool-proof. As long as you get the lid open, you’re home free. It starts talking to you and gives very simple instructions. Any moron can use one of these things.

They also assert that they need 15 devices. Well, knock yourself out. Go ahead, if you think you must. But that does not preclude placing ONE in a central location where everyone could know where it is.  I bet you could even get a couple of employees to mount it on the wall for you free of charge – except I’m sure there are regulations about that as well.

Well, anyway, I suppose the Postal Service employees can expect to see their new AED sometime in the next couple of years. Meanwhile let’s salute a group of federal workers who are trying like hell to do the right thing.

I Blame Bush

Let’s say you went to get an oil change for your car. Upon driving in, you asked the attendant what the price would be for the service. “I don’t know,” he replies.

He hands you a telephone number to call for pricing information. You find yourself on hold for several minutes but finally discover that the oil change will cost $50.

“Wait a minute,” you tell the attendant. “That is way more than I’m prepared to pay.”

“Too late,” you’re told. “The job is already done.”

Outrageous? Sure it is. But that is what reportedly happened to to a Hopkins, MN couple during an emergency room visit at a Twin Cities’ hospital.

Stories such as these are always difficult to unravel. One always questions whether the story is true and/or complete. The public is woefully ignorant on the subject of health care delivery and providers have a history of not being terribly forthcoming in explaining things. On top of that, news reporters are notorious for inaccuracy when writing about health care.

Nevertheless, this story has the ring of truth to it, in my opinion.

First of all, why couldn’t the hospital give pricing information when requested? Answer – there is no good reason, expect for the fact that no one in health care knows (or seemingly cares) what anything costs. To simply give the customer a phone number so he can investigate the matter himself is ridiculous.

Secondly, there was no reason that the scan could not have waited until the customer’s questions were answered to their satisfaction. No emergency existed. For the hospital to rush this procedure in the manner reported and not allowing the customer to make an informed decision is just a poor business practice.

If this situation occurred as reported, then I’m afraid that the hospital in question is way out of bounds.

A reader, who claims to be a health care professional, has anonymously declared that this blog violates the Health Insurance Portability and Accountability Act, or HIPAA,  as it relates to patient confidentiality.

Insuring that a patient’s protected health information is kept private has been my greatest concern. It is my understanding that as long as the information presented here cannot be linked to a specific individual patient, then there is no HIPAA violation.

To protect a patient’s confidentiality, I have set up some rules for myself which include:

• No ages – just a general description, such as elderly.
• No addresses – not even the city.
• If the patient does not speak English, they are described as non-English speaking. No nationalities are reported.
• Specific hospital destinations are not given
• If I am on a scene that will probably make the 6 o’clock news, I will simply say, “I was there.”

It seems to me that if any personal information is to be linked to a specific patient,  it would have to be released by my employer. There is no way it can be gleaned from the stories told on Ambulance Driver.

It must be said, however, that the rules are arcane and can be interpreted in some very odd-sounding ways. Two examples come to mind.

1. At the scene of an auto accident, I can tell the police that the patient has a broken leg but I cannot tell them that I suspect the patient has been drinking. They have to figure it out themselves.
2. Cell phone cameras are great for bringing visual images from the scene to the hospital. Vehicle damage from wrecks, height of a fall, or the length of a knife that the patient was stabbed with are just some examples of information that is valuable to hospital staff. Our medical director will not allow this use due to HIPAA concerns.

I am asking several individuals and entities, whose job includes HIPAA concerns, to review this blog’s content. Unless there are good reasons to stop, I am going to carry on with my 911 Updates.