This is a bit far afield from my usual blogging about the world of EMS, but if you think big picture above and beyond considering what clinical skills an EMT or paramedic should have, maybe this is exactly about EMS.
A couple of things about COVID-19 and business and government. As most of y’all know, I’m a practicing attorney with over 16 years of experience in government law, so I think I have some qualifications to comment.
1) In regards to the availability of the various loans, contracts, and grants, especially to small businesses and individuals that all levels of government are providing, it’s no surprise to me that they’re not getting where they need to be. Government moves slowly, even when it’s trying to move fast. And when it does move fast, it often fails to consider how the program will work. (See the current Paycheck Protection Program loans and how they seem to really overlook certain businesses, especially the restaurant business.) There’s an art to doing business with or getting money from the government and it usually takes a level of sophistication to navigate it. Sometimes, it’s not merit that gets the money as much as it’s the person or company that knows how to fill in the paperwork best. Early in my career in state government, the state agency that I worked for regularly contracted for advertising services for a public relations campaign. The company that regularly got the contract had hired one of our agency’s former office managers. One of said manager’s duties prior to leaving state employment was reviewing contracts and preparing the bid and contract documents. In other words, that company knew exactly which forms to fill out and what answers were expected on the document. And how does this relate to EMS? Simple. Let’s think about some of the EMS grants out there. We know that certain EMS agencies nationwide have the expertise to apply for grant funding. These same agencies get every grant they apply for Meanwhile, there are small EMS services struggling to keep supplies on the ambulance that have neither the time nor the savvy to navigate the grant process while at the same time, the right large systems get a WMD trailer, a HazMat truck, and a tactical medicine supply that would keep the Green Berets and SEALS stocked for the next ten years. Or there’s a Federal grant program available only to certain types of recipients. For example, a grant for EMS may only be available to local government entities or to fire-based departments and will completely overlook private non-profit departments. Moral of the story? It often takes a lawyer or at least someone savvy with the ways of government to tap into the “free government money” that the media reports on. And just as surely as the media will report on two things after this pandemic goes away. First, they’ll report on some entity that did or didn’t get the money and why that’s a travesty. Next, when the pandemic stockpiles get recreated and funded, there will be a story within the next two years about “exposing government waste” and a “warehouse full of supplies that no one has ever used.”
2) Failures. The truth is that COVID-19 is causing unprecedented failures, whether in business or healthcare. And those failures need to be documented and measured so that we don’t make the same mistakes in the next pandemic or disaster. BUT… it’s also a convenient excuse for failure too. There are stories of deaths being attributed to COVID-19. At least here in the Lone Star State, death certificates allow for the listing of contributing factors. So, while COVID-19 might have killed someone, their underlying conditions may have contributed. Or maybe the underlying conditions killed the patient, but the COVID-19 contributed. COVID-19 might be the cause of death or it might contribute. This applies outside of medicine too. Lately, I’ve been reading about restaurants “closing due to COVID-19.” Yes, COVID-19 was probably the final straw. But if you had a business already in decline, maybe COVID-19 was only the contributing factor. Or you could have self-inflicted factors caused by your own business decisions. See also the restaurant that refused to allow delivery services BEFORE the pandemic and then closed one of their locations, even for to-go orders, at the first quarantine action by local government. Business, especially the restaurant business, is a Darwinian process with low profit margins. Relevance to EMS? I’d also note that EMS is known for low financial margins and is heavily reliant on government funds, as is much of healthcare. Throwing any disruption into this narrow financial margin and there’s bound to be a financial catastrophe. (See also: nursing homes) In short, it’s always easier to blame an outside event than your own failings and decisions. Case in point being a long time local restaurant deciding to close “due to COVID-19” at the same time that the owner planned to close in the next few months due to retirement and rising rents.
3) And I’ve saved the most controversial post for last. Let’s talk about quarantines, “stay home, stay safe,” or the popular phrase “flatten the curve.” I am the absolute first to say that COVID-19 isn’t the flu. It’s a literal pandemic. And we know that, right now, there’s neither a cure nor a vaccine. As such, we have to take drastic actions to slow the spread of the disease, save lives, and equally importantly, save the foundations of our healthcare system. And to get people to take drastic action, we have to create a sense of urgency. As such, we’ve told people to stay home. We’ve closed schools and offices and told people to work from home if they can. We’ve made the decision to take a massive hit to the economy to spare lives and lessen the strain on our healthcare system. That decision is a no-brainer. It’s the right decision and it remains so, especially without either a cure or vaccine for this disease. But the models predicting catastrophe have changed and reduced their estimates. Granted, some places in the United States, like the New York City corridor, have born a terrible price. (Population density is a real curse in pandemics.) At this point, if ever, we’re unlikely to know if the decrease in deaths is due to our social distancing efforts, better treatment regimens, or a flawed modeling scheme. At some point, whether now or at a still to be determined time, we will have to reopen the country and our economy. The cure for the pandemic may be the death of our economy. Clearly, we’re going to have to address this — and smarter minds than my own will have to weigh in. I am pleased that our political leadership is looking for advice from those outside of the medical field. While the medicine is crucial in this discussion, my own experience is that the medical community, probably more than any other field I’ve been exposed to, tends to believe its knowledge of healthcare trumps all other concerns and their expertise on health requires immediate deference on all other fields. Regardless, I’ve noticed that our society has changed over the four decades that I’ve been around. Whether its societal evolution, the 24 hour news cycle, or a climate where social media gives everyone, even the unqualified, the same ability to spread their opinion, we’ve changed. The biggest change I’ve noticed is that our modern society is afraid. We’ve grown to demand safety over all else and find any risk intolerable. Risk must be mitigated to an infinitesimally small factor. In other words, Karen from Nextdoor has become the avatar of our society.
Sorry for the rambling and the massive diversion from the usual EMS discussions. Or wait…. maybe this discussion of government, failures, and risk versus safety is EXACTLY what EMS needs to advance. As I’ve harped more than once, the practice of medicine (including EMS) involves much more than scientific knowledge and clinical skills. Medicine is like engineering or architecture — it applies sciences to human problems. As such, medicine has to factor in more than the hard sciences.
Thanks for listening.
