One of the best pieces of advice that an attorney gave me as I entered the legal profession was that I should read the news every day. He told me that you never know what future cases might be in the news. Being a bit of a nerd for politics and policy, I still follow that advice. This morning’s review of the news led me down a trail where I ended up reading an article from a liberal/progressive publication about rural hospitals in Texas closing.
The article had two accounts of patients dying because a rural hospital in northeast Texas had closed. One patient apparently had a heart attack and the other patient had a brain aneurysm. And the article quoted family members and local politicians as saying that these people wouldn’t have died if the little hospital had still been there.
If you’ve got any experience (or even baseline knowledge) of emergency medicine and EMS in particular, you’ll know that rural hospitals have limited capabilities. In fact, both of the cases in question likely could not have been stabilized at a local rural hospital. Both of these patients required extensive specialist interventions that would typically be found in a larger city. In fact, taking these patients to a rural hospital without specialist capabilities would have actually delayed care. The well-intentioned laws designed to prevent dumping of patients into an emergency department (EMTALA) would have required the initial hospital to find a specialist facility to accept this patient and then transfer care to said facility. Even in other cases, patients admitted to a hospital may require specialist care or intensive care treatment that is largely unavailable in rural hospitals.
A properly trained, staffed, and equipped EMS system would have been able to recognize that these patients required care well above and beyond local capabilities. Properly trained and equipped paramedics would be able to provide the same resuscitation and stabilization abilities AND transport directly to the appropriate specialist facility. As I’ve heard said more than once, there’s no magic resuscitation fairy waiting at the hospital. Resuscitation measures are the same, whether in an inpatient setting or out of hospital.
The solution to healthcare in rural America is not to engage in a quixotic quest to reopen rural hospitals with limited capabilities and delaying access to definitive, specialist care. The solution is to channel that funding toward expanded access to primary care, specialists making regular visits to rural communities, and establishing a robust EMS system that provides comprehensive and competent paramedic level care. With an aging population that’s poorer than average, a strong EMS system can absolutely make a difference in rural healthcare. And our EMS voices need to say such. We are the experts on emergency care outside the hospital. Period.
Journalists know how to write. They rarely know medicine. Or policy. In this case, their advocacy may well harm patients by delaying definitive care in favor of local care.
